Welcome to this episode of que digo conversations in Nephrology this episode titled challenges in the early diagnosis of aav is provided by KD go and supported by Amgen, here's your host dr. Vladimir tesser. We will today discuss the challenges in early diagnosis of ankle associated. With colitis, as early diagnosis may have a decisive impact on the outcome of our patients. Hello and welcome to KD go conversations in apology. I am dr.
Vladimir tests ahead of nephrology a general University Hospital in park and joining me to discuss the challenges in the early diagnosis on Council, stated vasculitis is dr. Dubrow geetha, geetha, is an effort Reggie's and professor at the Department of Medicine Johns, Hopkins University School of Medicine. Baltimore Maryland, USA, her research interests include different aspects of diagnosis, and treatment and Care Associated.
Vasculitis, including renal transplantation in patients with anchor Associated vasculitis Gita. Welcome to the program. Thank you. Thank you, Tricia for the kind introduction. It is a great honor for me to participate in this discussion about diagnostic delays and vasculitis, thank you. So, let's begin our discussion with the first question. I'll delays in diagnosis, common in a AV. And what are the factors that may contribute to these delays?
This is a very important question and an area where we really need to focus on dr. Tesar, we need to increase our efforts. It's on educating primary care, physicians and patients delays in diagnosis are common and is an important contributor to patient comorbidities as well as Healthcare expenditures. The median time to diagnosis is about seven months with a wide range.
From a few weeks to over a year. Now, delays in diagnosis can be due to multiple causes disease related, patient-related and healthcare system related factors, play a role. First of all. Aav is a rare disease with an incidence of 10 to 20 cases per million. So gaining expertise is not easy. Secondly, aav patients may have symptoms that are shared by other common diseases and therefore, it is difficult, especially for the physician of first Contact.
In addition, misdiagnosis is common as a number of other diseases can mimic vasculitis Within Affections allergies and other autoimmune diseases being common. One of the classic examples Is a GPA patient who presents with recurrent sinus symptoms and some of these patients actually can go through multiple rounds of antibiotics. Before a diagnosis of aav is considered, furthermore AV is also heterogeneous disease and patients may be seen by many
specialist Physicians before. Diagnosis is considered, I believe improving access to specialist is important. So if this is one of the factors that is contributing to delay in diagnosis, finally, depending on the organ involvement, a every can be silent classic examples include those with renal, limited aav and interstitial lung disease, but we have some good news. There is wider, availability of
anchor testing. So mu cases of aav have been diagnosed in the last two decades, heh, Educating patients and Physicians on the multi-system nature of aav and related symptoms. Is key for early detection.
Since kidneys are often involved, an aav affecting 80 to 90 percent of the patients, screening for renal vasculitis, with urine analysis, and serum, creatinine should be done in all patients with suspected a heavy delays in diagnosis can have negative Health consequences especially when some major organs like kidneys and world. Many thanks for the somebody of Des Moines causes of delays in diagnosis of anchor associated with colitis. And now, I have the second
question. How can we increase the awareness in the disease and early diagnosis? Sure, early recognition and treatment of vasculitis is critical to prevent complications. We need to recognize that patients come with different levels of Education, educational efforts, should be spearheaded by vasculitis. Experts patient should be empowered through disease, education and racing vasculitis. Cavernous, in the general public caregivers should also be educated as well. Even something simple.
I give you an information leaflet on diagnosis and treatment of vasculitis. At the end of the clinic, visit can play a huge role in raising disease, awareness and improving patient engagement, the role of patient advocacy groups to increase disease, awareness has been well recognized in many. Communities. We should also remember that listening to patients is quite important as patients of often able to tell about disease relapse before the physician
suspects, that elapsed. Finally, it is important to educate patients with renal vasculitis on the use of urine, dipstick, which can detect, hematuria and proteinuria, which are early signs of renal, vasculitis on the same page, education of trainees Physicians and Allied health professionals is equally important. To raise awareness of vasculitis, we should educate them on thinking about systemic
diseases. When someone initially presents with sinusitis and then with pneumonia or hearing issues, rather than treating them as different illnesses. Similarly, when someone presents with recurrent, bouts of pneumonia, we should take a step back and think of non infectious etiologies information should filter from the vascular and experts to Primary Care. Additions and specialist through workshops webinars seminars and Grand rounds online learning why our website dedicated to diagnosing.
And managing vasculitis, may be helpful for Physicians, we should especially educate them on the various ways, vasculitis can present and the best approach to diagnosing. The various vasculitis, as far as the treatment options. Educating on recognizing disease and treatment related complications and managing this complicated Locations is Paramount to improving outcomes, the minutes. Thanks for sharing the dance. This very important ideas.
How to improve early diagnosis of anchor associated with colitis, or those just tuning in. You are listening to Katy. Go conversations in apology. I will today, topic is challenges in early diagnosis of a baby. I am dr. Hardy Nickerson. And I'm speaking with dr. Guru Gita and my Third question is a bit different topic. Can we rely on our composite ability or is it necessary to have a histological information? Sure. So anchor can be actually - in 10 to 30% of cases, depending on
where. And when the studies were conducted, for example, the incidence of nk- diseases higher in European cohorts, we have to remember the use of antigen-specific immunoassays important. And when diagnosis is in doubt, histologic confirmation is needed to guide in a suppressive therapy. And can I get two patients are also more likely to have renal limited disease or disease? Limited to upper respiratory
tract. So would you recommend Reno biopsy in on patients with uncouple ctvt and suspected EAD and renal involvement? Yeah, so kidney biopsy, you know, it's one of the organs where you have a high diagnostic value with a greater than 90 percent yield.
But more importantly, the kidney biopsy gives prognostic information so we should consider kidney biopsy, especially if there are no contraindications in all patients, a diagnostic kidney biopsy is often indicated in patients or Hank and - to exclude vascular deck mimics like other system, achromatic diseases infections and malignancies. But what we do need to remember, however, is that a kidney biopsy? You should not delay treatment initiation, in your opinion.
Is there any role of repeat biopsy and ongoing associated with colitis? This is an excellent question and a really unexplored area. So we currently use resolution of he material as one of the markers for renal remission, but close to 50% of the patients, have persistent immaterial at 6 months post, induction therapy in Single Center, study of protocol biopsies, there was evidence of disease activity.
After clinical remission was achieved in some of the biopsies, we all know that treatment-related side effects, especially infections are common during induction therapy. Therefore, repeat biopsies should be considered in patients with persistent hematuria and those with poor response to therapy to guide immunosuppression especially with the changing landscape in the tree. Point of a every - thanks and probably the most important is my last question. How should we collaborate with
our colleagues icon? Special tests in order to diagnose as early as possible? The patients with anchor associated with colitis gain an excellent question. So, diagnosing and managing aav requires a team of experts who are familiar with vasculitis. The different treatment options and complications related to That's great isn't treatments given the multi-system involvement in vasculitis, shared decision-making and collaboration among Specialists
is a central pillar. Both a diagnosis and follow up. The model in most vasculitis centers is to have a collaborative team with nephrologists rheumatologist pulmonologist and ENT specialist who have special interest and training to take care of as colitis. Patients collaboration Especially important. When presentation is a typical, for example, when a patient with the recurrent sinusitis is evaluated by rheumatologist, but
the anchor test is negative. However, if the patient is hematuria and nephrologist can do a kidney biopsy to confirm a diagnosis of vasculitis. Similarly, collaboration is important to diagnose refractory disease, vasculitis, mimics and disease, relapse many scientists before we close Gita, or any final messages or takeaways. Like to leave with our listeners. I think the three main messages I would like the audience to take away or a number one
education. Both from a patient perspective and a healthcare professional perspective. And then number two is Axis to vasculitis experts because that's a common cause of delay in diagnosis. And number three is collaboration among Specialists, because that is really key both in managing disease, as well as the applications related to disease and treatment. I completely agree. And I hope that you all enjoyed our discussion today. I want to thank my guest, dr.
Dubrow Gita for joining me, Geeta, many, thanks for accepting my invitation to our program dr. Katherine has been a great honor to participate. I hope that today's discussion has not only reflected power current situation on the delays to diagnosis of a every but also has highlighted some of the Steps. We can take to diagnose vasculitis, early. Thank you. I am doctor about amethyst or to access this and other episodes in our series.
Visit Katie go on Spotify or que digo dot org slash podcast. Thanks for listening.