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      Clinical Implications of Antineutrophil Cytoplasmic Antibody Test in Lupus Nephritis


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          To elucidate the prevalence and clinical implications of antineutrophil cytoplasmic antibody (ANCA) in lupus nephritis (LN), we examined ANCA by indirect immunofluorescence and by ELISA against antilactoferrin (anti-LF) and antimyeloperoxidase (anti-MPO) antibody. To discriminate perinuclear ANCA (pANCA) with antinuclear antibody (ANA), all the ANCA-positive sera were tested again after incubating patients’ sera with single-stranded (SS) and double-stranded (ds) DNA. These results were compared with clinicopathologic manifestations and clinical courses of LN. ANCA was positive in 19 (37.3%) of 51 LN patients. Among these LN patients, 3 had cytoplasmic ANCA (cANCA) and 16 had pANCA. ANCA was not found in 8 SLE patients without nephritis and 30 normal controls. The presence of ANCA, particularly pANCA, was associated with the presence of nephritis (18/51 cases vs. 0/8 cases, p < 0.05), especially with diffuse proliferative lupus nephritis, WHO class IV (17/18 cases vs. 21/31 cases, p < 0.05) as well as the presence of anti-dsDNA antibody (17/19 cases vs. 18/30 cases, p < 0.05). Patients with ANCA frequently had deterioration of renal function (3/16 vs. 0/26 cases). Anti-LF antibody was positive in 13 patients. Among those, 12 patients had nephritis. Five patients with anti-LF antibody did not have ANCA, but 7 had pANCA, and 1 had cANCA. Patients with anti-LF antibody had lower initial creatinine levels than those without it [serum creatinine (mg/dl): 0.78 (0.6–1.0) vs. 1.43 (0.5–5.0), p < 0.05]. Anti-MPO antibody was positive in only 1 patient, suggesting that MPO is a rare antigen for ANCA in LN.

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          The value of indirect immunofluorescence and solid phase techniques for ANCA detection

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            Anti-neutrophil cytoplasmic antibodies in childhood systemic lupus erythematosus.

            The prevalence and antigen specificity of anti-neutrophil cytoplasmic antibodies (ANCA) in sera from 23 children with active systemic lupus erythematosus (SLE) were studied utilizing indirect immunofluorescence and IgG and IgM ELISA using crude neutrophil extract and purified proteinase 3, myeloperoxidase, lactoferrin, cathepsin G and elastase. ANCA were present in 69% of SLE children and consisted of IgM and IgG antibodies of variable specificities, but did not correlate with organ involvement or disease activity. It remains unclear whether they have pathogenic significance or are epiphenomena in the category of polyclonal B-cell activation. However, their presence is entirely compatible with SLE even though they have hitherto been commonly associated with other systemic vasculitides.

              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              February 2000
              13 January 2000
              : 20
              : 1
              : 57-63
              Divisions of aNephrology, bRheumatology and cPathology, College of Medicine, Seoul National University, and dClinical Research Center, Seoul National University Hospital, Seoul, South Korea
              13557 Am J Nephrol 2000;20:57–63
              © 2000 S. Karger AG, Basel

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              Page count
              Figures: 2, Tables: 4, References: 23, Pages: 7
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/13557
              Self URI (text/html): https://www.karger.com/Article/FullText/13557
              Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
              Clinical Study

              Cardiovascular Medicine,Nephrology
              Lupus nephritis,Antineutrophil cytoplasmic antibody,Antilactoferrin antibody


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