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Screening for renal involvement in ANCA-associated vasculitis: room for improvement?
E Houben1, J W van der Heijden, B van Dam
1Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands.
Background:
Renal involvement in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) requires prompt and aggressive immunosuppressive therapy. The aim of this study was to evaluate screening practice for renal involvement in AAV and its potential effect on renal outcomes.
Methods:
Between 2005 and 2015, ANCA-positive AAV patients in a teaching hospital in the Netherlands were retrospectively included. Complete screening for renal involvement was defined as: assessment of erythrocyturia, proteinuria and serum creatinine within two weeks of the diagnosis of AAV. Characteristics at presentation and at 12 months were compared between patients with and without complete screening.
Results:
A total of 109 AAV patients (63% male) were identified with a mean age of 62 ±; 14 years. Complete screening for renal involvement was performed in 90 of the 109 patients (83%). Patients with incomplete screening had a lower serum creatinine (86 ±; 53 vs. 190 ±; 185 μmol/l, p < 0.001) and were more often diagnosed outside the renal department (100% vs. 78%, p = 0.02). Three patients with incomplete screening had a rise in serum creatinine of ≥ 30% at 12 months. Incomplete screening was not associated with the development of end-stage renal disease. Urine analysis of patients with renal biopsy-proven AAV (n = 31) showed erythrocyturia in 58% after one sample and in 94% after three samples.
Conclusion:
Screening for renal involvement in AAV was suboptimal, primarily in patients who presented outside the renal department. A higher sensitivity for erythrocyturia is achieved if urine analysis is repeated. Incomplete screening may lead to renal impairment if renal involvement is not treated appropriately.
Insights
Prompt screening for kidney issues in ANCA-associated vasculitis (AAV) is crucial. Incomplete screening, especially outside renal departments, may risk kidney impairment, though not directly linked to end-stage renal disease in this study.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can affect the kidneys, necessitating prompt immunosuppressive therapy.
- Evaluating screening practices for renal involvement in AAV is essential to understand its impact on patient outcomes.
Purpose of the Study:
- To assess the screening practices for renal involvement in patients diagnosed with AAV.
- To determine the effect of complete renal screening on renal outcomes in AAV patients.
Main Methods:
- Retrospective analysis of ANCA-positive AAV patients from 2005-2015.
- Complete renal screening defined as erythrocyturia, proteinuria, and serum creatinine assessment within two weeks of AAV diagnosis.
- Comparison of patient characteristics and outcomes between those with complete and incomplete screening.
Main Results:
- Complete renal screening was performed in 83% of 109 AAV patients.
- Incomplete screening was associated with lower serum creatinine and diagnosis outside the renal department.
- Repeated urine analysis increased erythrocyturia detection sensitivity (58% to 94%).
Conclusions:
- Renal screening in AAV was suboptimal, particularly for patients diagnosed outside renal departments.
- Incomplete screening may contribute to renal impairment if AAV-related kidney involvement is not promptly addressed.
- Repeated urine analysis enhances the detection of renal involvement in AAV.
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