Prevalence of ANCAs in Patients on Maintenance Haemodialysis

Summary

ANCA analysis as evaluated by concomitant determination of ANCA-IF, PR3AB and MPO-AB in a larger cohort of dialysis patients disclosed that the prevalence of Wegener’s granulomatosis and microscopic polyarteritis in Germany is 4 fold higher than hitherto believed. Low ANCA-IF titers without measurable PR3-AB or MPO-AB are not pathological-they resemble an increased autoimmune tendency of the dialysis patients.

According to the european dialysis and transplantation association (EDTA)registry the incidence of Wegener’s granulomatosis (WG) and microscopic polyarteritis (MP) on haemodialysis (HD) in Germany is 0.5% and the prevalence is in the same range (1), In contrast to Germany the incidence in France and Great Britain is above 2%. This is mainly based on histologically proven diseases, which can identify only 1/3 of all affected cases, corresponding to our own experience. With the advent of ANCA serology, WG and MP can be diagnosed more easily. C-ANCA with proteinase 3-antibodies (PR3-AB) is typical of WG, and p-ANCA with myeloperoxidaseantibodies (MPO-AB) is typical of MP in our country. Since a considerable number of patients are on chronic HD without knowledge of their underlying renal disease we studied the prevalence of ANCAs in a larger cohort of HD patients.