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ANCA vasculitis (AAV) still have poor renal and overall survival. The role of prognostic factors is yet to be defined. Herein, we explored serum and pathological biomarkers as predictors of kidney and patient survival.
Retrospective analysis of AAV glomerulonephritis diagnosed between 2006-2023 was performed. Most significant markers as ANCA titer, C3 and CRP at admission (d), remission, relapse, and last follow-up (f) were associated to GFR, dialysis need, ESKD and mortality. Berden classes (BC), Brix renal risk score (BRS), IFTA and crescentic glomeruli percentages, C3-IF and interstitial hemorrhage (IH) were also associated with outcomes.
A total of 62 patients 69±10 years old, 56,5% male and 82,3% MPO were included; in 46 biopsies 17.4% were sclerotic, 28.3% mixed, 39.1% crescentic, 15.2% focal; 2.2% with low, 28.3% medium and 58.7% high ESKD risk.
dANCA didn’t relate to dialysis requirement and titers didn’t relate to GFR at any time point. fC3 predicted ESKD (p=0.028) and shorter time to dialysis (p=0.006), not confirmed by multivariate analysis (MA). Likewise, dCRP related to dialysis need (p=0.035) only in univariate analysis.
ANCA titers didn’t predict survival. dANCA did not relate to death. Lower dC3 (p=0.023) and higher fCRP (p=0.012) were markers of mortality. MA with age and gender lost dC3 significance for death. fCRP seems to remain significant (p=0,06, model p=0,05).
C3, CRP and dANCA didn’t relate to any histological variable. Higher fANCA predicted higher BRS (p=0.037), persisting on MA (p<0.001, model p<0.001). IH was an independent predictor of ESKD in a MA with gender, age, GFR and dialysis need at admission (HR 0.332, CI 0.114-0.968, p=0.043; model p=0.002). BC didn’t predict ESKD. IFTA, BC and BRS didn’t predict mortality.
In our cohort, serum biomarkers value remains uncertain. Higher ANCA at last follow-up related to ESKD and histologic chronicity. Nonetheless, didn’t predict kidney survival. Last-CRP relation to death might translate infectious bias, although not analyzed. Initial C3 might be prognostic, in line with C3 deposition in other studies, but C3 deposition didn’t predict ESKD. IH might be relevant in future broader studies. Further and larger studies might bring stronger data and we still need better predictive markers.