PT  - JOURNAL ARTICLE
AU  - Cui Li
AU  - Min-Lin Zhou
AU  - Dan-Dan Liang
AU  - Jing-Jing Wang
AU  - Jing Yang
AU  - Cai-Hong Zeng
AU  - Zhi-Hong Liu
AU  - Hai-Tao Zhang
TI  - Treatment and clinicopathological characteristics of lupus nephritis with anti-neutrophil cytoplasmic antibody positivity: a case–control study
AID  - 10.1136/bmjopen-2016-015668
DP  - 2017 Jul 01
TA  - BMJ Open
PG  - e015668
VI  - 7
IP  - 7
4099  - http://bmjopen.bmj.com/content/7/7/e015668.short
4100  - http://bmjopen.bmj.com/content/7/7/e015668.full
SO  - BMJ Open2017 Jul 01; 7
AB  - Objective To assess the clinical features, pathological presentations, treatments and outcomes of lupus nephritis (LN) with anti-neutrophil cytoplasmic antibody (ANCA) positivity.Design A case–control study.Methods Patients (n=49) were retrospectively included from Jinling Hospital in China if presenting with biopsy-proven ANCA-positive LN between 1985 and 2008. Clinicopathological characteristics and outcomes were analysed and compared with those of a control group (n=1279). We further compared treatment responses and outcomes of ANCA-positive LN patients based on the treatment issued.Results The study included 40 women and 9 men (median age 33 years at biopsy): 38 with myeloperoxidase (MPO)-ANCA, 7 with proteinase 3 (PR3)-ANCA and 4 with double positivity. ANCA-positive LN patients exhibited higher haematuria, serum creatinine levels and systemic lupus erythematosus disease activity index scores. On pathological evaluation, class IV LN was predominant, accounting for 61.22% of cases. Light microscopy revealed significantly higher activity index and chronicity index scores, including cellular crescents, interstitial inflammation, tubular atrophy and interstitial fibrosis. ANCA-positive LN patients receiving mycophenolate mofetil as induction therapy had a higher remission rate and better renal outcomes than those receiving cyclophosphamide. During follow-up, end-stage renal disease developed in seven (14.29%) ANCA-positive LN patients, all of them were MPO-ANCA positive.Conclusions The characteristics of ANCA-positive LN were massive haematuria and advanced renal insufficiency. We observed a higher remission rate and better prognoses when using mycophenolate mofetil than when using cyclophosphamide as induction therapy.