Factors associated with pauci-immune glomerulonephritis in patients undergoing kidney biopsy with positive anti-neutrophil cytoplasmic antibody results

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BACKGROUND: Pauci-immune glomerulonephritis (GN) is a typical renal manifestation of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, patients positive for ANCA can present with kidney pathologies other than pauci-immune GN. This study aimed to investigate and compare the characteristics of ANCA-positive patients diagnosed with pauci-immune GN to those with non-pauci-immune kidney diseases, based on kidney biopsy findings. METHODS: We retrospectively analyzed the electronic medical records of ANCA-positive patients who underwent kidney biopsy from January 2010 to October 2023 at a single tertiary center in Seoul, Republic of Korea. Logistic regression analysis was performed to identify variables associated with the diagnosis of pauci-immune GN in this cohort. RESULTS: Of 268 ANCA-positive patients, 195 (72.8%) were diagnosed with pauci-immune GN, while 73 (27.2%) had other kidney diseases. The most common pathologies in the non-pauci-immune GN group were IgA nephropathy (20.5%) and lupus nephritis (16.4%). Compared to the non-pauci-immune GN group, patients with pauci-immune GN exhibited higher platelet counts and C-reactive protein (CRP) levels, along with lower estimated glomerular filtration rate (eGFR). Urine abnormalities, categorized by the presence or absence of hematuria and/or proteinuria, differed significantly between the groups. Multivariate analysis identified hematuria and pulmonary involvement as significant predictors of pauci-immune GN. CONCLUSIONS: Approximately 70% of our ANCA-positive patients who underwent kidney biopsy were diagnosed with pauci-immune GN. Predictive factors for pauci-immune GN included platelet count, CRP levels, eGFR, hematuria, and pulmonary involvement. Identifying these clinical and laboratory markers may be valuable for improving the diagnostic approach towards AAV-related kidney manifestations.

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