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Article Dans Une Revue Rheumatology Année : 2021

Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases

Renato Sinico
  • Fonction : Auteur
Vitor Teixeira
  • Fonction : Auteur
David Jayne
  • Fonction : Auteur
Jacques Gaultier
  • Fonction : Auteur
Dimitri Titeca-Beauport
Antoine Bardy
  • Fonction : Auteur
Daniel Blockmans
  • Fonction : Auteur
Yoann Crabol
  • Fonction : Auteur
Pascal Godmer
  • Fonction : Auteur
Cédric Rafat
  • Fonction : Auteur
Xavier Puéchal

Résumé

Abstract Objective Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by asthma, hypereosinophilia and ANCA positivity in 40% of patients. Renal involvement is rare and poorly described, leading to this renal biopsy-proven based study in a large EGPA cohort. Methods We conducted a retrospective multicentre study including patients fulfilling the 1990 ACR criteria and/or the 2012 revised Chapel Hill Consensus Conference criteria for EGPA and/or the modified criteria of the MIRRA trial, with biopsy-proven nephropathy. Results Sixty-three patients [27 women, median age 60 years (18–83)] were included. Renal disease was present at vasculitis diagnosis in 54 patients (86%). ANCA were positive in 53 cases (84%) with anti-MPO specificity in 44 (83%). All patients had late-onset asthma. Peripheral neuropathy was present in 29 cases (46%), alveolar haemorrhage in 10 (16%). The most common renal presentation was acute renal failure (75%). Renal biopsy revealed pauci-immune necrotizing GN in 49 cases (78%). Membranous nephropathy (10%) and membranoproliferative GN (3%) were mostly observed in ANCA-negative patients. Pure acute interstitial nephritis was found in six cases (10%); important interstitial inflammation was observed in 28 (44%). All patients received steroids with adjunctive immunosuppression in 54 cases (86%). After a median follow-up of 51 months (1–296), 58 patients (92%) were alive, nine (14%) were on chronic dialysis and two (3%) had undergone kidney transplantation. Conclusion Necrotizing pauci-immune GN is the most common renal presentation in ANCA-positive EGPA. ANCA-negative patients had frequent atypical renal presentation with other glomerulopathies such as membranous nephropathy. An important eosinophilic interstitial infiltration was observed in almost 50% of cases.
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Dates et versions

hal-03652626 , version 1 (26-04-2022)

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Citer

Cécile-Audrey Durel, Renato Sinico, Vitor Teixeira, David Jayne, Xavier Belenfant, et al.. Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases. Rheumatology, 2021, 60 (1), pp.359-365. ⟨10.1093/rheumatology/keaa416⟩. ⟨hal-03652626⟩
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