Challenges of defining renal response in ANCA-associated vasculitis: call to action?

Published version
Repository DOI

Type
Article
Change log
Authors
Odler, Balazs 
Scott, Jennifer 
Geetha, Duvuru 
Abstract

Avoiding end-stage kidney disease in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a high therapeutic priority. Although renal response is a crucial measure to capture clinically relevant changes, clinal trials have used various definitions and no well-studied key surrogate markers to predict renal outcome in AAV exist. Differences in clinical features and histopathologic and therapeutic approaches will influence the course of kidney function. Its assessment through traditional surrogates (i.e. serum creatinine, glomerular filtration rate, proteinuria, hematuria and disease activity scores) has limitations. Refinement of these markers and the incorporation of novel approaches such as the assessment of histopathological changes using cutting-edge molecular and machine learning mechanisms or new biomarkers could significantly improve prognostication. The timing is favourable since large datasets of trials conducted in AAV are available and provide a valuable resource to establish renal surrogate markers and, likely, aim to investigate optimized and tailored treatment approaches according to a renal response score. In this review we discuss important points missed in the assessment of kidney function in patients with AAV and point towards the importance of defining renal response and clinically important short- and long-term predictors of renal outcome.

Description
Keywords
ANCA vasculitis, ESKD, kidney function, outcome, renal response
Journal Title
Clin Kidney J
Conference Name
Journal ISSN
2048-8505
2048-8513
Volume Title
16
Publisher
Oxford University Press (OUP)
Sponsorship
Wellcome Trust (203930/B/16/Z)