PREDICTING long-term kidney outcomes in patients with ANCA-associated vasculitis (AAV) may be improved by integrating additional clinical markers into existing risk models, according to new research.
The ANCA Kidney Risk Score (AKRiS), introduced in 2023 to replace the earlier ANCA Renal Risk Score, provides a structured approach to estimating prognosis in patients with AAV and kidney involvement. Researchers retrospectively analyzed 115 patients who underwent kidney biopsy between 2005 and 2020, aiming to determine whether recently identified predictors could further refine prognostic accuracy.
Over a median follow-up of 6.4 years, 34% of patients progressed to kidney failure and 11 percent died. Among the factors evaluated, AKRiS, the need for dialysis within four weeks of diagnosis, the presence of C3 deposits, renal arteritis on biopsy, reduced estimated glomerular filtration rate (eGFR) after induction therapy, and elevated urine protein-creatinine ratio (UPCR) after induction emerged as risk indicators.
Multivariable analysis demonstrated that dialysis within four weeks, lower eGFR after induction, and higher UPCR after induction remained significant predictors of long-term kidney outcome, even after adjusting for AKRiS. Patients requiring dialysis within four weeks showed a more than sixfold higher risk of kidney failure compared with others. Each incremental decline in eGFR after induction also increased risk, while higher post-induction proteinuria was associated with poorer prognosis.
The predictive accuracy of AKRiS alone, reflected by an area under the receiver operating characteristic curve (AUROC) of 0.77, improved when combined with these additional markers. Incorporating dialysis within four weeks raised AUROC to 0.82, while including eGFR and UPCR after induction yielded AUROCs of 0.80 and 0.79, respectively.
These findings suggest that short-term clinical measures following diagnosis and induction therapy provide important context for long-term prognosis in AAV. The authors propose that dialysis status, post-induction eGFR, and proteinuria be considered as interim endpoints for kidney failure in future clinical studies, offering physicians practical indicators to guide patient monitoring and management.
Reference: Maalouli C et al. Predicting prognosis in ANCA-associated vasculitis with kidney involvement. Clin Kidney J. 2025;18(9):sfaf268.
