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Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.

Publication ,  Journal Article
Geetha, D; Sethi, S; De Vriese, AS; Specks, U; Kallenberg, CGM; Lim, N; Spiera, R; St Clair, EW; Merkel, PA; Seo, P; Monach, PA; Lepori, N ...
Published in: Am J Nephrol
2017

BACKGROUND: Immunopathologic features predict renal function at baseline and follow-up in antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN). The interstitial infiltrate consists predominantly of T lymphocytes, but their pathophysiologic significance is unclear, especially in light of the success of B-cell-directed therapy. METHODS: Renal biopsies from 33 patients treated with cyclophosphamide (CYC; n = 17) or rituximab (RTX; n = 16) in the RTX in ANCA-associated vasculitis (RAVE) trial were classified according to the new ANCA GN classification. T- and B-cell infiltration in the interstitium was assessed by immunostaining for CD3 and CD20. Correlations of clinical and histologic parameters with renal function at set time points were examined. RESULTS: The mean (SD) baseline estimated glomerular filtration rate was 36 (20) mL/min/1.73 m2. ANCA GN class distribution was 46% focal, 33% mixed, 12% sclerotic and 9% crescentic. The interstitial infiltrate consisted of >50% CD3 positive cells in 69% of biopsies, but >50% CD20 positive cells only in 8% of biopsies. In a multiple linear regression model, only baseline glomerular filtration rate (GFR) correlated with GFR at 6, 12, and 18 months. Interstitial B- and T-cell infiltrates had no significant impact on long-term prognosis, independent of the treatment limb. A differential effect was noted only at 6 months, where a dense CD3 positive infiltrate predicted lower GFR in the RTX group and a CD20 positive infiltrate predicted higher GFR in the CYC group. CONCLUSIONS: In ANCA-associated GN, the interstitial infiltrate contains mainly T lymphocytes. However, it is neither reflecting baseline renal function nor predictive of response to treatment, regardless of the immunosuppression regimen employed.

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Published In

Am J Nephrol

DOI

EISSN

1421-9670

Publication Date

2017

Volume

46

Issue

3

Start / End Page

231 / 238

Location

Switzerland

Related Subject Headings

  • Urology & Nephrology
  • T-Lymphocytes
  • Rituximab
  • Prognosis
  • Middle Aged
  • Male
  • Kidney
  • Immunosuppressive Agents
  • Humans
  • Glomerulonephritis
 

Citation

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Chicago
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Geetha, D., Sethi, S., De Vriese, A. S., Specks, U., Kallenberg, C. G. M., Lim, N., … RAVE-ITN Research Group, . (2017). Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Nephrol, 46(3), 231–238. https://doi.org/10.1159/000480443
Geetha, Duvuru, Sanjeev Sethi, An S. De Vriese, Ulrich Specks, Cees G. M. Kallenberg, Noha Lim, Robert Spiera, et al. “Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.Am J Nephrol 46, no. 3 (2017): 231–38. https://doi.org/10.1159/000480443.
Geetha D, Sethi S, De Vriese AS, Specks U, Kallenberg CGM, Lim N, et al. Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Nephrol. 2017;46(3):231–8.
Geetha, Duvuru, et al. “Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.Am J Nephrol, vol. 46, no. 3, 2017, pp. 231–38. Pubmed, doi:10.1159/000480443.
Geetha D, Sethi S, De Vriese AS, Specks U, Kallenberg CGM, Lim N, Spiera R, St Clair EW, Merkel PA, Seo P, Monach PA, Lepori N, Fessler BJ, Langford CA, Hoffman GS, Sharma R, Stone JH, Fervenza FC, RAVE-ITN Research Group. Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis. Am J Nephrol. 2017;46(3):231–238.
Journal cover image

Published In

Am J Nephrol

DOI

EISSN

1421-9670

Publication Date

2017

Volume

46

Issue

3

Start / End Page

231 / 238

Location

Switzerland

Related Subject Headings

  • Urology & Nephrology
  • T-Lymphocytes
  • Rituximab
  • Prognosis
  • Middle Aged
  • Male
  • Kidney
  • Immunosuppressive Agents
  • Humans
  • Glomerulonephritis