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. 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

Michael J Kemna  1 , Jan Damoiseaux  2 , Jos Austen  2 , Bjorn Winkens  3 , Jim Peters  4 , Pieter van Paassen  4 , Jan Willem Cohen Tervaert  5
Affiliations

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

Michael J Kemna et al. J Am Soc Nephrol. 2015 Mar.

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.

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Figures

Figure 1.
Figure 1.
Flowchart of the included patients. As shown, patients who become ANCA negative during follow-up do not experience a major relapse if an ANCA rise has not occurred.
Figure 2.
Figure 2.
The predictive value of an ANCA rise as determined by the antigen-specific solid-phase ANCA method in the entire cohort and subgroups of patients with AAV. A differentiation is made in renal involvement, sampling interval (<4 versus ≥4 per year), ANCA pattern (persistently positive or nonpersistently positive), and ANCA serotype (MPO-ANCA versus PR3-ANCA). HRs are shown with 95% CIs. The area up to a HR of 1 marks the border of significance.
See this image and copyright information in PMC

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