Clinicopathological Features of ANCA-Associated Glomerulonephritis with Preserved Renal Function and Mild Proteinuria

 

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https://storage.unitedwebnetwork.com/files/1099/4d83e76d050d8423a2ea2fd4229590d3.pdf
Clinicopathological Features of ANCA-Associated Glomerulonephritis with Preserved Renal Function and Mild Proteinuria

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Kumiko
Muta
Kumiko Muta k-io@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan * Nagasaki University School of Medicine Advanced Medical Education Center Nagasaki Japan
Tomohisa Tsuyuki tomohisa1002@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Mayu Iwata i-mayu@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Naoki Akeho n-ake-edu@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan - Nagasaki University School of Medicine Advanced Medical Education Center Nagasaki Japan
Emiko Otsuka e-otsuka@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Kenta Torigoe ktorigoe@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Ayuko Yamashita ayamashita@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Mineaki Kitamura minekitamura@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
Tomoya Nishino tnishino@nagasaki-u.ac.jp Nagasaki University Hospital Department of Nephology Nagasaki Japan -
 
 
 
 
 
 

Renal biopsy is the gold standard for diagnosing anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis in patients presenting with renal dysfunction, obvious hematuria or proteinuria. However, it remains largely unknown whether pathological features can be detected in renal biopsy specimens from patients presenting with preserved renal function and mild proteinuria.

Adult patients diagnosed with ANCA-associated glomerulonephritis based on renal biopsy findings between 2019 and 2025 were analyzed, and patients who had preserved renal function (>60 ml/min/1.73m2) and mild proteinuria (<1 g/gCr) were included. Patient characteristics, pathological findings and treatment responses were analyzed.

Among 47 patients diagnosed with ANCA-associated glomerulonephritis, 11 were eligible (4 women; median age, 73 years; median eGFR, 71.1 ml/min/1.73m2; median proteinuria, 0.35 g/gCr). Fever was the most common symptom (54.5%), followed by cough (36.4%), extremity pain (27.3%) and other symptoms. All patients presented with at least one symptom and microscopic hematuria. Median serum C-reactive protein was 6.9 mg/dL. Pathologically, tuft necrosis and necrotizing arteritis were observed in 72.7% and 27.3% of patients, respectively. Cellular crescents were present in 90.9% of cases, fibrocellular crescents in18.2%, and fibrous crescents were absent. Overall, acute lesions were detected in all cases. Among the 10 patients with available follow-up, immunosuppressive therapy was initiated in 9 patients. One month after treatment, renal function was preserved, with a median eGFR of 71.1 mL/min/1.73m², and proteinuria decreased to a median of 0.17 g/gCr. Microhematuria resolved in 4 patients.

Renal biopsy should be actively considered, as characteristic histopathological features can often be identified even in patients with ANCA-associated glomerulonephritis who have preserved renal function and mild proteinuria.

Kewords