EFFECT OF DIAGNOSTIC DELAY ON DISEASE SEVERITY AND OUTCOME IN GLOMERULONEPHRITIS CAUSED BY ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES

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.