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Specifically, ANCA have been found
(at frequencies ranging from 70% to 90%) in patients with active
Wegener granulomatosis, microscopic polyarteritis nodosa, and idiopathic
crescentic glomerulonephritis (with manifestations ranging from
kidney-limited disease to extrarenal systemic disease, including
pulmonary-renal syndromes). Glomerular lesions in patients with ANCA-associated systemic vasculitis or renal-limited disease are virtually identical. Normal controls are negative for ANCA and <10% of patients with other renal diseases are positive. ANCA may be directly involved in the pathogenesis of the vascular injury that causes the clinical manifestations in ANCA-associated disease.
Antineutrophil
cytoplasmic autoantibodies exhibiting pANCA or cANCA patterns are
detected using indirect immunofluorescent antibody (IFA) techniques with
a substrate of ethanol-fixed human neutrophils. Positive patient sera
with perinuclear or nuclear patterns are repeated using a formalin-fixed
substrate in order to differentiate the presence of true pANCA
antibodies from possible interference with antinuclear antibodies (ANA). |