Findings from a recent study support performing a follow-up kidney biopsy in patients with ANCA-associated vasculitis, according to investigators.
Faten Aqeel, MD, of Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues studied 29 patients with ANCA glomerulonephritis who underwent a repeat for-cause kidney biopsy. The patients had a mean age of 73 years. The mean time from the first to second kidney biopsy was 42 months. The mean follow-up duration was 11 years.
The most common indication for a repeat kidney biopsy was elevated serum creatinine (16 patients), followed by proteinuria (14 patients), and new or persistent hematuria (10 patients).
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On repeat biopsy, 11 (38%) of the 29 patients had active ANCA glomerulonephritis, Dr Aqeel’s team reported in Kidney International Reports. The remaining patients had an alternate pathology.
Among the 11 patients with active ANCA glomerulonephritis, the indications for repeat biopsy were elevated serum creatinine (82%), proteinuria (36%), new hematuria (54%), and persistent hematuria (27%), according to the investigators.
Following a repeat biopsy, 13 patients (45%) had a change in their immunosuppression regimen: 11 with active disease requiring induction immunosuppression and 2 with inactive disease who were transitioned from induction to maintenance treatment, according to the investigators.
Progression to end-stage kidney disease (ESKD) occurred in 12 patients (41%), of whom 5 had active disease on repeat biopsy. Of the 11 patients with active ANCA glomerulonephritis, ESKD developed in 5 (45%).
Previous research has shown that clinicians’ impression of disease activity in ANCA-associated vasculitis is incorrect in 25% of cases, “supporting the utility of a follow-up kidney biopsy to guide management,” Dr Aqeel and colleagues wrote.
Although their study was limited by a small sample size, the authors wrote that their data “support histologic confirmation of disease activity rather than relying on current conventional markers to improve prognostication and guide treatment decisions.”
Reference
Aqeel F, Xu L, Geetha D. Repeat kidney biopsies in ANCA-associated vasculitis: clinical and histologic progression. Kidney Int Rep. Published online July 28, 2023. doi:10.1016/j.ekir.2023.07.021
