PROGNOSTIC OF THE PERSISTENCE OF HEMATURIA AND PROTEINURIA AFTER INDUCTION IN VASCULITIS ASSOCIATED WITH ANCA IN THE NEPHROLOGY SERVICE, HOSPITAL DE CLÍNICAS UNIVERSITARIO, BOLIVIA.

Introduction:

The prevention of end-stage chronic kidney disease (ESKD) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) constitutes a therapeutic priority after remission induction treatment, with periodic monitoring of biomarkers urinary renal response and progression to ESKD; Although hematuria and proteinuria are accessible and economical compared to urinary CD163, the latter is undergoing research to establish its definitive clinical use; which reflect renal involvement at the time of diagnosis, renal decline after its reappearance after a period of remission, however its prognostic value is still uncertain after its persistence, with no concise prognostic interpretation regarding renal outcomes.

Methods:

Retrospective observational cohort study, in 22 patients, with a recent diagnosis of active AAV-ANCA with renal involvement with induction of remission completed, during 2020 to 2023, the patients received glucocorticoids with intravenous cyclophosphamide for the induction of remission, analyzed demographic data, serotype prevalence, histopathological reports, hemodialysis at the time of diagnosis, dependence on it after induction, the association of the persistence of hematuria and proteinuria with the risk of renal relapse, progression to ESKD and survival at level renal. The SPSS version 20 program was used, with a confidence level of 95%.

Results:

Respecto a la prevalencia, el (54,5%) de los pacientes correspondió al serotipo proteinasa (PR3) – ANCA, seguido del (45,5%) del serotipo mieloperoxidasa (MPO) – ANCA, con una mediana de edad de 53, 5 años. Se encontró que el (40,9%) requirió hemodiálisis al momento del diagnóstico, de los cuales el (45,5%) permaneció dependiente de diálisis; respecto a la persistencia de hematuria y recaída, el (31,8%) de los pacientes presentó este desenlace (p=0,027; HR: 7) con un riesgo 7 veces mayor de presentar recaída renal; respecto a la persistencia de proteinuria, el (54,4%) de los pacientes progresó a TRE (p=0,04; HR. 1,14). La sobrevida renal en el grupo MPO-ANCA fue del (90%), en comparación con el grupo PR3-ANCA (40%), luego de 38 meses de seguimiento. 

Conclusions:

Persistence of hematuria is significantly associated with long-term renal relapse, including recurrence after a period of remission with short-term renal relapse, while persistent proteinuria indicates a higher risk of ESKD progression.  These findings underscore the need to regularly evaluate these biomarkers, in conjunction with serological ANCA levels, the application of the Birmingham Vasculitis Activity Score (BVAS), and the performance of protocolized renal re-biopsy in selected cases, for a preventive medicine. precision in the management of ANCA-associated vasculitis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.