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J Am Soc Nephrol. 2015 Mar;26(3):537-42. doi: 10.1681/ASN.2013111233. Epub 2014 Oct 16.

ANCA as a predictor of relapse: useful in patients with renal involvement but not in patients with nonrenal disease.

Author information

1
Clinical and Experimental Immunology and Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands;
2
Cardiovascular Research Institute Maastricht and.
3
Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; and.
4
Clinical and Experimental Immunology and.
5
Clinical and Experimental Immunology and Noordoever Academy, Sint Franciscus Gasthuis, Rotterdam, The Netherlands jw.cohentervaert@maastrichtuniversity.nl.

Abstract

The value of measuring ANCA during follow-up to predict a relapse is controversial. On the basis of recently obtained pathophysiologic insights, we postulated that measuring ANCA is useful in patients with renal involvement but is less valuable in patients with nonrenal disease. One hundred sixty-six consecutive patients with ANCA-associated vasculitis, positive for either proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA, were included in our study, followed at regular intervals, and tested for PR3-ANCA and MPO-ANCA. In this cohort, 104 patients had renal involvement (72 with PR3-ANCA, 32 with MPO-ANCA) and 62 patients had nonrenal disease (36 with PR3-ANCA, 26 with MPO-ANCA). During an average (±SD) follow-up of 49±33 months and 18±14 ANCA measurements, 89 ANCA rises and 74 relapses were recorded. ANCA rises correlated with relapses in patients who presented with renal involvement (hazard ratio [HR], 11.09; 95% confidence interval [95% CI], 5.01 to 24.55), but in comparison, associated only weakly with relapses in patients who presented with nonrenal disease (HR, 2.79; 95% CI, 1.30 to 5.98). In conclusion, longitudinal ANCA measurements may be useful in patients with renal involvement but is less valuable in patients with nonrenal disease.

KEYWORDS:

ANCA; GN; vasculitis

PMID:
25324502
PMCID:
PMC4341475
DOI:
10.1681/ASN.2013111233
[Indexed for MEDLINE]
Free PMC Article

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