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Diagnostic accuracy of ANCA serology in ANCA-associated vasculitis with renal involvement

Adrienne Cohen1, Nethmi Weerasinghe1, Karla Lemmert2

  • 1Department of Nephrology and Renal Transplant, John Hunter Hospital, Newcastle, New South Wales, Australia.

Internal Medicine Journal
|June 14, 2024
PubMed

Insights

Serum antineutrophil cytoplasmic antibody (ANCA) titres are highly predictive of pauci-immune glomerulonephritis (GN) in patients with ANCA-associated vasculitis (AAV). Quantifying ANCA titres can aid early treatment decisions for severe kidney disease.

Area of Science:

  • Nephrology
  • Immunology
  • Vasculitis

Background:

  • Pauci-immune glomerulonephritis (GN) in ANCA-associated vasculitis (AAV) has high mortality and progression rates.
  • Kidney biopsy is standard for diagnosing renal involvement in AAV.
  • The predictive value of serum ANCA quantification for renal involvement is unclear.

Purpose of the Study:

  • To assess the diagnostic accuracy of serum ANCA titres for AAV with renal involvement.
  • To determine the utility of ANCA quantification in AAV diagnosis.

Main Methods:

  • Retrospective analysis of native kidney biopsies and ANCA serology from 2016-2021.
  • ANCA titres measured by indirect immunofluorescence; specific antibodies by chemiluminescent immunoassay.
  • Included adult patients with both kidney biopsy and ANCA serology.

Main Results:

  • 8.1% of 507 patients had pauci-immune GN.
  • Positive ANCA at any titre showed 97.6% sensitivity and 71.2% specificity for pauci-immune GN.
  • An ANCA titre cutoff of 1:160 offered optimal sensitivity (75.6%) and specificity (94.0%).

Conclusions:

  • Serum ANCA titres are highly predictive of pauci-immune GN.
  • ANCA quantitation aids early treatment decisions in AAV with organ- or life-threatening disease.
  • While not replacing biopsy, ANCA titres are valuable diagnostic adjuncts.
Abstract

Keywords:
ANCAdiagnostic accuracyglomerulonephritisvasculitis

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