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Dudreuilh C, Fakhouri F, Vigneau C, Augusto JF, Machet MC, Rabot N, Chapal M, Charpy V, Barbet C, Büchler M, Halimi JM, Gatault P: The Presence of Renal IgG Deposits in Necrotizing Crescentic Glomerulonephritis Associated with ANCA Is Not Related to Worse Renal Clinical Outcomes. Kidney Dis DOI 10.1159/000503969
Typically, IgG deposition is scanty or absent (“pauci-immune”) in antineutrophil cytoplasmic antibody (ANCA) vasculitis but variation in the extent of glomerular deposition of IgG is now recognized as occurring rather frequently in this condition. However, the prognostic significance of this variation is largely unknown.
Dudreuilh and co-workers examined this issue in a retrospective, observational study of 158 patients with ANCA vasculitis. Eighteen of the 158 patients (11%) had more than scanty IgG deposition, without lupus nephritis, IgA nephropathy or anti-glomerular basement membrane (GBM) disease. The subjects with such IgG deposition did not differ clinically from those without such deposition at the time of presentation and biopsy, except for age and a somewhat higher level of anti-myeloperoxidase (MPO) antibody. Pathologically those with IgG deposition had more interstitial fibrosis and tubule atrophy. The treatments and outcomes were similar in those with and without IgG deposition, except for higher rates of plasmapheresis in those with IgG deposition.
This study, although limited by small numbers and retrospective design, suggests that the degree of IgG deposition seen in ANCA vasculitis is of little clinical significance as it does not identify a subgroup with differing outcomes. Therapy need not be tailored on the basis of the appearance of glomerular IgG deposits in ANCA vasculitis.
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