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Nephrol Dial Transplant. 2019 Feb 1;34(2):301-308. doi: 10.1093/ndt/gfy106.

Proteinase-3 and myeloperoxidase serotype in relation to demographic factors and geographic distribution in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis.

Author information

1
Department of Nephrology and Medical and Health Sciences, Linköping University, Linköping, Sweden.
2
Renal Research Group, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
3
Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.
4
Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
5
Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
6
University of North Carolina School of Medicine, Chapel Hill, NC, USA.
7
Division of Nephrology and Hypertension, Department of Medicine UNC Kidney Center, Chapel Hill, NC, USA.
8
Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
9
Department of Medicine, University of Cambridge, Cambridge, UK.
10
Department of Rheumatology and Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
11
Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy.
12
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
13
Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb, Croatia.
14
Department of Nephrology, Saint Olavs University Hospital, Trondheim, Norway.
15
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

Background:

In anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, antigen specificity varies between myeloperoxidase (MPO) and proteinase 3 (PR3). This has been reported to vary in relation to age, gender, geography and extrarenal manifestations. However, studies are difficult to compare as criteria for inclusion vary. The aim of this study was to investigate the relationship between ANCA serotype, latitude, ultraviolet (UV) radiation levels, age, gender and renal function at diagnosis in a large study with uniform inclusion criteria.

Methods:

Patients with biopsy-proven ANCA-associated glomerulonephritis were identified from regional or nationwide registries in 14 centres in Norway, Sweden, the UK, the Czech Republic, Croatia, Italy and the USA during the period 2000-13. UV radiation levels for 2000-13 in Europe were obtained from the Swedish Meteorological and Hydrological Institute.

Results:

A total of 1408 patients (45.2% PR3-ANCA) were included in the study. In univariable analysis, PR3-ANCA was significantly associated with male gender {odds ratio [OR] 2.12 [95% confidence interval (CI) 1.71-2.62]}, younger age [OR per year 0.97 (95% CI 0.96-0.98)] and higher glomerular filtration rate [OR per mL/min 1.01 (95% CI 1.01-1.02); P < 0.001] at diagnosis but not with latitude or UV radiation. In multivariable logistic regression analysis, latitude and UV radiation also became significant, with higher odds for PR3-ANCA positivity at northern latitudes/lower UV radiation levels. However, the latitudinal difference in MPO:PR3 ratio is smaller than differences previously reported concerning microscopic polyangiitis and granulomatosis with polyangiitis.

Conclusions:

The ratio between PR3-ANCA and MPO-ANCA varies in glomerulonephritis with respect to age, gender, renal function and geographic latitude/UV radiation levels.

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