Objective This study aimed to evaluate the density of tubulointerstitial macrophages with renal outcomes in patients with myeloperoxidase (MPO)-ANCA associated glomerulonephritis (MPO-ANCA GN). Methods This study analyzed patients with MPO-ANCA GN who had renal biopsies at Jinling Hospital. It looked at the density of CD68+ macrophages in the tubulointerstitium and examined correlations with serum creatinine levels, urinary protein levels, treatment regimen, and renal histologic class. The study used KM curves to show the impact of these factors on renal prognosis and conducted multivariate analyses with Cox proportional hazards regression models. Results A total of 172 patients with MPO-ANCA GN (median age: 50 y, 43.6% male) were included. Stratification of the cohort into tertiles was based on tubulointerstitial macrophage density. Significant differences in serum creatinine levels, induction treatment regimen, the rates of ESKD, and renal histologic class were observed between the three groups. Correlation analysis showed that induction treatment regimen and renal histologic class were correlated with tubulointerstitial macrophage density. Kaplan–Meier curves illustrated patients with a lower presence of CD68+ macrophages in the tubulointerstitium experienced significantly better renal survival compared with those with a higher presence. The higher levels of CD68+ macrophage infiltration were significantly associated with adverse renal outcomes. This association persisted after adjusting for potential confounders including baseline serum creatinine, histopathological class, and induction therapy modalities. Conclusions The results of our study provide insight into the prognostic significance of macrophage infiltration in the tubulointerstitium in MPO-ANCA GN.

中文翻译：

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MPO-ANCA 相关肾小球肾炎中肾小管间质巨噬细胞密度的预后意义：对肾脏结局的影响


目的 本研究旨在评估髓过氧化物酶 （MPO）-ANCA 相关肾小球肾炎 （MPO-ANCA GN） 患者肾小管间质巨噬细胞密度与肾脏结局的关系。方法 本研究分析了在金陵医院行肾活检的 MPO-ANCA GN 患者。它观察了肾小管间质中 CD68+ 巨噬细胞的密度，并检查了与血清肌酐水平、尿蛋白水平、治疗方案和肾脏组织学分级的相关性。该研究使用 KM 曲线来显示这些因素对肾脏预后的影响，并使用 Cox 比例风险回归模型进行了多变量分析。结果 共纳入 172 例 MPO-ANCA GN 患者 （中位年龄： 50 岁，43.6% 为男性）。将队列分层为三分位数是基于肾小管间质巨噬细胞密度。3 组患者血清肌酐水平、诱导治疗方案、ESKD 发生率和肾组织学分级差异有统计学意义。相关性分析显示，诱导治疗方案和肾脏组织学分级与肾小管间质巨噬细胞密度相关。Kaplan-Meier 曲线显示，与肾小管间质中 CD68 + 巨噬细胞存在较少的患者相比，肾存活率明显更高。较高水平的 CD68 + 巨噬细胞浸润与不良肾脏结局显著相关。在调整了包括基线血清肌酐、组织病理学分级和诱导治疗方式在内的潜在混杂因素后，这种关联仍然存在。结论 我们的研究结果为 MPO-ANCA GN 中巨噬细胞浸润肾小管间质的预后意义提供了见解。