ANCA-associated Vasculitis Prognosis

Primary GNmedium

A 70-year-old woman is diagnosed with ANCA-associated glomerulonephritis. Among the following clinical factors, which is most strongly associated with progression to kidney failure?

  1. A.Serum creatinine (eGFR) at presentationCorrect
  2. B.Presence of alveolar (pulmonary) hemorrhage
  3. C.Patient age at the time of disease onset
  4. D.Absolute ANCA antibody titer at diagnosis

Explanation

Among the listed clinical variables, baseline kidney function (serum creatinine/eGFR) is strongly associated with long-term renal outcome in ANCA-associated GN. Histologic variables - especially the percentage of normal glomeruli and the degree of interstitial fibrosis/tubular atrophy - add important prognostic information and are incorporated into validated renal-risk models. Alveolar hemorrhage is important for acute severity and mortality but is not the dominant predictor of renal survival; age and absolute ANCA titer are less useful for individual renal prognosis.

Why each option

A.
Correct. Presenting creatinine/eGFR (reflecting baseline renal damage) is the dominant predictor of renal survival.
B.
Incorrect. Pulmonary hemorrhage predicts early mortality but is not the leading predictor of renal outcome.
C.
Incorrect. Age influences overall prognosis but weakly predicts renal recovery compared with baseline function.
D.
Incorrect. Absolute ANCA titer correlates poorly with renal prognosis and should not guide it.

Reference: KDIGO 2024 ANCA-Associated Vasculitis Guideline, Kidney Int 2024.

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