Research progress on immunoglobulin A nephropathy with positive anti-neutrophil cytoplasmic antibody_West China Medical Journal

Authors：

HE Chunying , MA Liang ,  GOU Shenju

Department of Nephrology and Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

GOU Shenju, Email: goushenju@scu.edu.cn

Keywords：

Anti-neutrophil cytoplasmic antibody; immunoglobulin A nephropathy; crescentic glomerulonephritis

DOI：

10.7507/1002-0179.202412076

Video：

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In recent years, with the improvement and popularization of anti-neutrophil cytoplasmic antibody (ANCA) detection technology, more and more patients with immunoglobulin A nephropathy (IgAN) have been tested positive for serum ANCA. The clinical value of ANCA is still unclear, and there is a lack of consensus on diagnosis and treatment strategies. This article reviews the clinical and pathological characteristics, diagnosis, and treatment features of IgAN patients with serum ANCA positivity through literature reading and analysis, aiming to provide a reference for standardized diagnosis and individualized management of this type of patient.

1.	中国医药卫生文化协会肾病与血液净化专业委员会. 原发性 IgA 肾病管理和治疗中国专家共识. 中华肾病研究电子杂志, 2024, 13(1): 1-8.
2.	田新平, 赵丽珂, 姜振宇, 等. 抗中性粒细胞胞质抗体相关血管炎诊疗规范. 中华内科杂志, 2022, 61(10): 1128-1135.
3.	Montalvo CMM, Gutierrez LC, Perez C, et al. Anca-positive vasculitis with full-house nephropathy, an unusual association: a case report and review of literature. J Bras Nefrol, 2022, 44(2): 285-290.
4.	Cui Z, Zhao MH, Segelmark M, et al. Natural autoantibodies to myeloperoxidase, proteinase 3, and the glomerular basement membrane are present in normal individuals. Kidney Int, 2010, 78(6): 590-597.
5.	O’Donoghue DJ, Nusbaum P, Noel LH, et al. Antineutrophil cytoplasmic antibodies in IgA nephropathy and Henoch-Schönlein purpura. Nephrol Dial Transplant, 1992, 7(6): 534-538.
6.	Haas M, Jafri J, Bartosh SM, et al. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis, 2000, 36(4): 709-718.
7.	Bantis C, Stangou M, Schlaugat C, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis, 2010, 55(2): 259-268.
8.	Yang YZ, Shi SF, Chen YQ, et al. Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case-control study. Clin Kidney J, 2015, 8(5): 482-488.
9.	Xie L, He J, Liu X, et al. Clinical value of systemic symptoms in IgA nephropathy with ANCA positivity. Clin Rheumatol, 2018, 37(7): 1953-1961.
10.	Li W, Chen R, Chen W, et al. Clinicopathological features and outcomes of iga nephropathy with serum antineutrophil cytoplasmic autoantibody positivity. Am J Nephrol, 2023, 54(9/10): 416-424.
11.	Pattrapornpisut P, Avila-Casado C, Reich HN. IgA nephropathy: core curriculum 2021. Am J Kidney Dis, 2021, 78(3): 429-441.
12.	Stone JH, Talor M, Stebbing J, et al. Test characteristics of immunofluorescence and ELISA tests in 856 consecutive patients with possible ANCA-associated conditions. Arthritis Care Res, 2000, 13(6): 424-434.
13.	Bossuyt X, Cohen Tervaert JW, et al. Position paper: revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Nat Rev Rheumatol, 2017, 13(11): 683-692.
14.	Damoiseaux J, Csernok E, Rasmussen N, et al. Detection of antineutrophil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays. Ann Rheum Dis, 2017, 76(4): 647-653.
15.	Zhang W, Zheng Z, Jia R, et al. Evaluation of 12 different assays for detecting ANCA in Chinese patients with GPA and MPA: a multicenter study in China. Clin Rheumatol, 2019, 38(12): 3477-3483.
16.	Roth AJ, Ooi JD, Hess JJ, et al. Epitope specificity determines pathogenicity and detectability in ANCA-associated vasculitis. J Clin Invest, 2013, 123(4): 1773-1783.
17.	Land J, Rutgers A, Kallenberg CG. Anti-neutrophil cytoplasmic autoantibody pathogenicity revisited: pathogenic versus non-pathogenic anti-neutrophil cytoplasmic autoantibody. Nephrol Dial Transplant, 2014, 29(4): 739-745.
18.	Huang X, Wang Y, Xie L, et al. IgA nephropathy with anti-neutrophil cytoplasmic antibody seropositivity. Clin Nephrol, 2015, 84(3): 156-164.
19.	Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int, 2021, 100(4S): S1-S276.
20.	Ștefan G, Terinte-Balcan G, Stancu S, et al. IgA nephropathy with serum ANCA positivity: case series and literature review. Rheumatol Int, 2021, 41(7): 1347-1355.
21.	Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol, 2004, 24(3): 256-268.
22.	Walsh M, Collister D, Zeng L, et al. The effects of plasma exchange in patients with ANCA-associated vasculitis: an updated systematic review and meta-analysis. BMJ, 2022, 376: e064604.
23.	Kidney Disease: Improving Global Outcomes (KDIGO) ANCA Vasculitis Work Group. KDIGO 2024 clinical practice guideline for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Kidney Int, 2024, 105(3S): S71-S116.
24.	Durmaz D, Anbarcioglu B, Bulut M, et al. The critical role of therapeutic plasma exchange in the treatment of MPO-ANCA associated crescentic IgA nephropathy. Iran J Kidney Dis, 2022, 1(1): 63-65.
25.	Kim JY, Choi H, Kim MK, et al. Clinical significance of ANCA positivity in patients with IgA vasculitis: a retrospective monocentric study. Rheumatol Int, 2019, 39(11): 1927-1936.
26.	Agraz I, Castañeda Z, Sanz-Martínez MT, et al. The presence of ANCA in IgA crescentic nephropathy does not lead to worse prognosis with intensive rescue treatment. J Clin Med, 2022, 11(23): 7122.
27.	Tan SL, Potezny T, Li JY. The successful use of rituximab in crescentic IgA nephropathy with concurrent ANCA positivity. Nephrology (Carlton), 2022, 27(2): 216-217.
28.	Zeidan BS Jr, Hernandez A, Desai P. Overlap of granulomatosis with polyangiitis and IgA nephropathy. Cureus, 2021, 13(10): e18672.
29.	Waldherr R, Rambausek M, Duncker WD, et al. Frequency of mesangial IgA deposits in a non-selected autopsy series. Nephrol Dial Transplant, 1989, 4(11): 943-946.
30.	Yokoyama H, Takaeda M, Wada T, et al. Glomerular ICAM-1 expression related to circulating TNF-alpha in human glomerulonephritis. Nephron, 1997, 76(4): 425-433.
31.	Yokoyama H, Wada T, Furuichi K, et al. Urinary levels of chemokines (MCAF/MCP-1, IL-8) reflect distinct disease activities and phases of human IgA nephropathy. J Leukoc Biol, 1998, 63(4): 493-499.
32.	Wada T, Yokoyama H, Tomosugi N, et al. Detection of urinary interleukin-8 in glomerular diseases. Kidney Int, 1994, 46(2): 455-460.

1. 中国医药卫生文化协会肾病与血液净化专业委员会. 原发性 IgA 肾病管理和治疗中国专家共识. 中华肾病研究电子杂志, 2024, 13(1): 1-8.
2. 田新平, 赵丽珂, 姜振宇, 等. 抗中性粒细胞胞质抗体相关血管炎诊疗规范. 中华内科杂志, 2022, 61(10): 1128-1135.
3. Montalvo CMM, Gutierrez LC, Perez C, et al. Anca-positive vasculitis with full-house nephropathy, an unusual association: a case report and review of literature. J Bras Nefrol, 2022, 44(2): 285-290.
4. Cui Z, Zhao MH, Segelmark M, et al. Natural autoantibodies to myeloperoxidase, proteinase 3, and the glomerular basement membrane are present in normal individuals. Kidney Int, 2010, 78(6): 590-597.
5. O’Donoghue DJ, Nusbaum P, Noel LH, et al. Antineutrophil cytoplasmic antibodies in IgA nephropathy and Henoch-Schönlein purpura. Nephrol Dial Transplant, 1992, 7(6): 534-538.
6. Haas M, Jafri J, Bartosh SM, et al. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis, 2000, 36(4): 709-718.
7. Bantis C, Stangou M, Schlaugat C, et al. Is presence of ANCA in crescentic IgA nephropathy a coincidence or novel clinical entity? A case series. Am J Kidney Dis, 2010, 55(2): 259-268.
8. Yang YZ, Shi SF, Chen YQ, et al. Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case-control study. Clin Kidney J, 2015, 8(5): 482-488.
9. Xie L, He J, Liu X, et al. Clinical value of systemic symptoms in IgA nephropathy with ANCA positivity. Clin Rheumatol, 2018, 37(7): 1953-1961.
10. Li W, Chen R, Chen W, et al. Clinicopathological features and outcomes of iga nephropathy with serum antineutrophil cytoplasmic autoantibody positivity. Am J Nephrol, 2023, 54(9/10): 416-424.
11. Pattrapornpisut P, Avila-Casado C, Reich HN. IgA nephropathy: core curriculum 2021. Am J Kidney Dis, 2021, 78(3): 429-441.
12. Stone JH, Talor M, Stebbing J, et al. Test characteristics of immunofluorescence and ELISA tests in 856 consecutive patients with possible ANCA-associated conditions. Arthritis Care Res, 2000, 13(6): 424-434.
13. Bossuyt X, Cohen Tervaert JW, et al. Position paper: revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Nat Rev Rheumatol, 2017, 13(11): 683-692.
14. Damoiseaux J, Csernok E, Rasmussen N, et al. Detection of antineutrophil cytoplasmic antibodies (ANCAs): a multicentre European Vasculitis Study Group (EUVAS) evaluation of the value of indirect immunofluorescence (IIF) versus antigen-specific immunoassays. Ann Rheum Dis, 2017, 76(4): 647-653.
15. Zhang W, Zheng Z, Jia R, et al. Evaluation of 12 different assays for detecting ANCA in Chinese patients with GPA and MPA: a multicenter study in China. Clin Rheumatol, 2019, 38(12): 3477-3483.
16. Roth AJ, Ooi JD, Hess JJ, et al. Epitope specificity determines pathogenicity and detectability in ANCA-associated vasculitis. J Clin Invest, 2013, 123(4): 1773-1783.
17. Land J, Rutgers A, Kallenberg CG. Anti-neutrophil cytoplasmic autoantibody pathogenicity revisited: pathogenic versus non-pathogenic anti-neutrophil cytoplasmic autoantibody. Nephrol Dial Transplant, 2014, 29(4): 739-745.
18. Huang X, Wang Y, Xie L, et al. IgA nephropathy with anti-neutrophil cytoplasmic antibody seropositivity. Clin Nephrol, 2015, 84(3): 156-164.
19. Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases. Kidney Int, 2021, 100(4S): S1-S276.
20. Ștefan G, Terinte-Balcan G, Stancu S, et al. IgA nephropathy with serum ANCA positivity: case series and literature review. Rheumatol Int, 2021, 41(7): 1347-1355.
21. Tumlin JA, Hennigar RA. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol, 2004, 24(3): 256-268.
22. Walsh M, Collister D, Zeng L, et al. The effects of plasma exchange in patients with ANCA-associated vasculitis: an updated systematic review and meta-analysis. BMJ, 2022, 376: e064604.
23. Kidney Disease: Improving Global Outcomes (KDIGO) ANCA Vasculitis Work Group. KDIGO 2024 clinical practice guideline for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Kidney Int, 2024, 105(3S): S71-S116.
24. Durmaz D, Anbarcioglu B, Bulut M, et al. The critical role of therapeutic plasma exchange in the treatment of MPO-ANCA associated crescentic IgA nephropathy. Iran J Kidney Dis, 2022, 1(1): 63-65.
25. Kim JY, Choi H, Kim MK, et al. Clinical significance of ANCA positivity in patients with IgA vasculitis: a retrospective monocentric study. Rheumatol Int, 2019, 39(11): 1927-1936.
26. Agraz I, Castañeda Z, Sanz-Martínez MT, et al. The presence of ANCA in IgA crescentic nephropathy does not lead to worse prognosis with intensive rescue treatment. J Clin Med, 2022, 11(23): 7122.
27. Tan SL, Potezny T, Li JY. The successful use of rituximab in crescentic IgA nephropathy with concurrent ANCA positivity. Nephrology (Carlton), 2022, 27(2): 216-217.
28. Zeidan BS Jr, Hernandez A, Desai P. Overlap of granulomatosis with polyangiitis and IgA nephropathy. Cureus, 2021, 13(10): e18672.
29. Waldherr R, Rambausek M, Duncker WD, et al. Frequency of mesangial IgA deposits in a non-selected autopsy series. Nephrol Dial Transplant, 1989, 4(11): 943-946.
30. Yokoyama H, Takaeda M, Wada T, et al. Glomerular ICAM-1 expression related to circulating TNF-alpha in human glomerulonephritis. Nephron, 1997, 76(4): 425-433.
31. Yokoyama H, Wada T, Furuichi K, et al. Urinary levels of chemokines (MCAF/MCP-1, IL-8) reflect distinct disease activities and phases of human IgA nephropathy. J Leukoc Biol, 1998, 63(4): 493-499.
32. Wada T, Yokoyama H, Tomosugi N, et al. Detection of urinary interleukin-8 in glomerular diseases. Kidney Int, 1994, 46(2): 455-460.

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