class: RWH_bg_title # .black[When (and how) to do a 'vasculitis screen'] <!-- ### GIM teaching --> .RWH_footnote_title[ .RWH_footer_bold[ Rob Hunter | @renalrob ] ] .RWH_footnote_right_title[ .RWH_footer_bold[ GIM teaching | 2nd August 2024 ] ] ??? Slides created with [xaringan](https://github.com/yihui/xaringan). --- # Overview - some cases - clinical features of vasculitis - what is a 'vasculitis screen' - what is a 'renal screen' - ANCA testing .RWH_footnote_right[.RWH_footer_style[slides at: www.kidneyfish.net/talks/]] --- class: inverse, center, middle # .white[Case 1] --- `23M unwell for 4 months:` [ details redacted for online slide ] [ was a case of IgAV ] ---  .RWH_footnote_right[.RWH_footer_style[Chapel Hill Consensus]] --- class: inverse, center, middle # .white[Case 2] --- `85F unwell for 9 months:` [ details redacted for online slide ] [ was a case of AAV with ENT, nerve, skin and kidney disase ] --- # Questions - what is the differential diagnosis? - what tests would you do? -- <br> - if she is ANCA +ve, what is the probability that this is vasculitis? - if she is ANCA -ve, what is the probability that this is vasculitis? ---  .RWH_footnote_right[.RWH_footer_style[[Bossuyt *et al.* (2017)](https://pubmed.ncbi.nlm.nih.gov/28905856/)]] ??? ANCA seropositivity in 1 in 300 [blood donors](https://doi.org/10.1111/exd.12445) (c.f. 1 in 6 for ANA). Pre-test probability if sinus and GN = 0.3. ---  .RWH_footnote_right[.RWH_footer_style[[Bossuyt *et al.* (2017)](https://pubmed.ncbi.nlm.nih.gov/28905856/)]] ---  .RWH_footnote_right[.RWH_footer_style[[Bossuyt *et al.* (2017)](https://pubmed.ncbi.nlm.nih.gov/28905856/)]] --- class: inverse, center, middle #.white[ANCA vasculitis] ---  ---  ---  .RWH_footnote_right[.RWH_footer_style[[Hunter *et al.* (2020)](https://pubmed.ncbi.nlm.nih.gov/32291255/)]] --- # Indications for ANCA testing  .RWH_footnote_left[.RWH_footer_style[[Hunter *et al.* (2020)](https://pubmed.ncbi.nlm.nih.gov/32291255/)]] --- # ANCA false positives  --- class: inverse, center, middle # .white[Investigations in suspected vasculitis] ---  .RWH_footnote_right[.RWH_footer_style[[Thadani *et al.* (1996)](https://pubmed.ncbi.nlm.nih.gov/8618585/)]] ---  --- # 'Renal screen' `Consider:` - look closely at routine tests / previous trends - PR3, MPO, GBM - C3, C4 - ANA, ENA, dsDNA - paraprotein screen, immunoglobulins - HepB, HepC, HIV - CK - blood film, haemolysis screen --- # 'Renal screen' `Trak options:` - vasculitis screen = ANA, PR3, MPO, C3, C4 - connective tissue screen = ANA, DNA, ENA, C3, C4, CCP - autoimmune profile = ANA, DNAIF, GPC, AMA, SMA, TPO - glomerulonephritis = vasculitis screen + GBM + ENA screen (ENA = Ro, La, SmDP, U1RNP, Scl70S, Jo1) --- # Take-home messages - there is no catch-all 'renal screen' - test for vasculitis if there is a reasonably high pre-test probability - send PR3, MPO (+/- GBM) and phone immunology labs - ANCA not 100% sensitive or specific - indications include: suspected GN, ENT disease, alveolar haemorrhage, pulmonary nodules, scleritis, neuropathy, rash with systemic features - if suspecting vasculitis (or intrinsic renal disease) then ask renal .RWH_footnote_right[.RWH_footer_style[slides at: www.kidneyfish.net/talks/]]