Urinary NGAL and trehalase predict end-stage kidney disease in ANCA-associated vasculitis: a prospective cohort study

Accurate prediction of renal outcomes in ANCA-associated vasculitis (AAV) is critical. This study evaluated the predictive value of urinary biomarkers for end-stage kidney disease (ESKD) progression.

A prospective cohort of 88 AAV patients with renal involvement was followed for a median of 27 months. Urinary β-catenin, IL-18, trehalase, and NGAL were measured. Cox regression and ROC analyses assessed associations and predictive performance.

65 patients (73.9%) progressed to ESKD. Urinary trehalase and NGAL were significantly elevated in the ESKD group and were independent predictors of ESKD in multivariable analysis (both p < 0.05), with AUCs of 0.857 and 0.852, respectively. Their combination improved predictive accuracy (AUC = 0.869). β-catenin showed moderate predictive value (AUC = 0.705). Although urinary IL-18 showed statistical significance when analyzed as a continuous variable in an initial model, this association was not consistent across alternative modeling strategies and therefore was not considered a stable independent predictor. Stratified and landmark analyses confirmed the robustness of trehalase and NGAL's prognostic value.

Urinary trehalase and NGAL are strong, noninvasive predictors of ESKD in AAV, and their combination enhances risk stratification, supporting potential clinical utility for personalized treatment decisions.