ANCA-associated Glomerulonephritis
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Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a group of systemic diseases that involves small blood vessels of multiple organ systems. ANCA-associated vasculitis is classified into three subtypes: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and microscopic polyangiitis. The kidney involvement known as ANCA-associated glomerulonephritis which represents severe manifestation of ANCA-associated vasculitis is more commonly observed with eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. The underlying mechanisms involve the attack of antibodies on the neutrophils which in turn activates immunologic and complement systems resulting in injuries of small blood vessels. To make a diagnosis, serologic tests for antibodies are particularly helpful because of the convenience and the high diagnostic yield. Nevertheless, the kidney biopsy remains a gold standard for diagnosis and is necessary prior to treatment with immunosuppression. For the past decades, cyclophosphamide has been the cornerstone for induction therapy in combination with plasma exchange in severe cases. Recently, rituximab has shown comparable efficacy with cyclophosphamide with less toxicities. Avacopan has demonstrated non-inferior efficacy to glucocorticoid with less metabolic side effects. Novel insights into the pathogenesis is crucial in finding new therapeutic targets that will help improve outcomes and prognosis of patients with ANCA-associated vasculitis.
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References
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11.
Kitching AR, Anders H-J, Basu N, Brouwer E, Gordon J, Jayne DR, et al. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020;6(1):71.
Jennette JC, Nachman PH. ANCA Glomerulonephritis and Vasculitis. Clin J Am Soc Nephrol. 2017;12(10):1680-91.
Sumethkul V, Changsirikulchai S, Radinahamed P, Chalermsanyakorn P. Antineutrophil cytoplasmic antibody (ANCA) and rapidly progressive crescentic glomerulonephritis in Thai population. Asian Pac J Allergy Immunol. 1999;17(4):281-7.
Knight A, Sandin S, Askling J. Risks and relative risks of Wegener’s granulomatosis among close relatives of patients with the disease. Arthritis Rheum. 2008;58(1):302-7.
Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DRW, et al. Genetically Distinct Subsets within ANCA Associated Vasculitis. N Engl J Med. 2012;367(3):214-23.
Weng C-H, Liu Z-C. Drug-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. Chin Med J (Engl). 2019;132(23):2848-55.
Geetha D, Jefferson JA. ANCA-Associated Vasculitis: Core Curriculum 2020. Am J Kidney Dis. 2020;75(1):124-37.
Bossuyt X, Cohen Tervaert J-W, Arimura Y, Blockmans D, Flores-Suárez LF, Guillevin L, et al. Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Nat Rev Rheumatol. 2017;13(11):683-92.
KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021;100(4s):S1-s276.
Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, et al. Histopathologic Classification of ANCA-Associated Glomerulonephritis. J Am Soc Nephrol. 2010;21(10):1628-36.
Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med. 1983;98(1):76-85.
de Groot K, Harper L, Jayne DR, Flores Suarez LF, Gregorini G, Gross WL, et al. Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med. 2009;150(10):670-80.
Stone JH, Merkel PA, Spiera R, Seo P, Langford CA, Hoffman GS, et al. Rituximab versus Cyclophosphamide for ANCA-Associated Vasculitis. N Engl J Med. 2010;363(3):221-32.
Jones RB, Cohen Tervaert JW, Hauser T, Luqmani R, Morgan MD, Peh CA, et al. Rituximab versus Cyclophosphamide in ANCA-Associated Renal Vasculitis. N Engl J Med. 2010;363(3):211-20.
Jayne DRW, Gaskin G, Rasmussen N, Abramowicz D, Ferrario F, Guillevin L, et al. Randomized Trial of Plasma Exchange or High-Dosage Methylprednisolone as Adjunctive Therapy for Severe Renal Vasculitis. J Am Soc Nephrol. 2007;18(7):2180-8.
Walsh M, Merkel PA, Peh C-A, Szpirt WM, Puéchal X, Fujimoto S, et al. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. N Engl J Med. 2020;382(7):622-31.
Jayne DRW, Merkel PA, Schall TJ, Bekker P. Avacopan for the Treatment of ANCA-Associated Vasculitis. N Engl J Med. 2021;384(7):599-609.
Jayne D, Rasmussen N, Andrassy K, Bacon P, Tervaert JWC, Dadoniené J, et al. A Randomized Trial of Maintenance Therapy for Vasculitis Associated with Antineutrophil Cytoplasmic Autoantibodies. N Engl J Med. 2003;349(1):36-44.
Karras A, Pagnoux C, Haubitz M, Groot K, Puechal X, Tervaert JWC, et al. Randomised controlled trial of prolonged treatment in the remission phase of ANCA-associated vasculitis. Ann Rheum Dis. 2017;76(10):1662-8.
Guillevin L, Pagnoux C, Karras A, Khouatra C, Aumaître O, Cohen P, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med. 2014;371(19):1771-80.
Charles P, Terrier B, Perrodeau É, Cohen P, Faguer S, Huart A, et al. Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2). Ann Rheum Dis. 2018;77(8):1143-9.
Charles P, Perrodeau É, Samson M, Bonnotte B, Néel A, Agard C, et al. Long-Term Rituximab Use to Maintain Remission of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Randomized Trial. Ann Intern Med. 2020;173(3):179-87.
Pagnoux C, Mahr A, Hamidou MA, Boffa J-J, Ruivard M, Ducroix J-P, et al. Azathioprine or Methotrexate Maintenance for ANCA-Associated Vasculitis. N Engl J Med. 2008;359(26):2790-803.
Smith RM, Jones RB, Specks U, Bond S, Nodale M, Aljayyousi R, et al. Rituximab as therapy to induce remission after relapse in ANCA-associated vasculitis. Ann Rheum Dis. 2020;79(9):124