Dpss. Lal et al., EFFECT OF DIAGNOSTIC DELAY ON DISEASE SEVERITY AND OUTCOME IN GLOMERULONEPHRITIS CAUSED BY ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES, Journal of Clinical Pathology, 49(11), 1996, pp. 942-944
Aims-To measure the time between onset of symptoms and intention to tr
eat in patients with anti-neutrophil cytoplasmic antibody (ANCA) assoc
iated glomerulonephritis; and to investigate the effect of any delay i
n diagnosis on disease severity at presentation and outcome. Methods-A
U. ANCA positive patients with biopsy proven glomerulonephritis presen
ting in the North West Region over a consecutive period of 57 months w
ere identified from the North West Glomerular Disease Registry. Sixty
nine patients were identified and notes from 61 were reviewed. Results
-The 61 patients had a median diagnostic delay of 92 days. In only 12
patients had an ANCA test been performed prior to the nephrology refer
ral. Thirty three patients had renal failure requiring dialysis within
one week of admission and had a shorter delay (median 72 days) than t
hose not requiring dialysis (median 132 days), None of the 28 patients
with independent renal, function at presentation required dialysis su
bsequently. Eighteen (55%) of those who required dialysis recovered in
dependent renal function at three months and 13 (39%) had long term re
covery. Both for patients who did and did not undergo dialysis, a long
er delay was correlated with an increased percentage of sclerotic glom
eruli at presentation. Patients with end stage renal failure had a med
ian delay of 92 days, compared with one of 42 days in those who were d
ialysis independent at final follow up. Conclusions-Prolonged delay in
diagnosis of ANCA associated glomerulonephritis is associated with an
increased risk of end stage renal failure.