title: ANCA-positive vasculitis: Clinical implications of ANCA types and titers.
abstract: BACKGROUND
  Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is an autoimmune disease that can affect multiple organs, the kidney being one of the most affected. Apart from the diagnostics value of ANCA, they have also been advocated as biomarkers of the disease activity. Recently, the genetic changes found in polyangiitis associated with serine-protease proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA raised the possibility of immune-pathogenic and therapeutic differences.
  
  
  OBJECTIVE
  To identify differences in the number of relapses, inflammatory markers, outcomes and renal histology related to the types of ANCA. To analyze the implications of ANCA titers in prognosis.
  
  
  METHODS
  A retrospective observational study in a Portuguese tertiary hospital.
  
  
  RESULTS
  There were no differences in the progression of renal function, histological pattern and initial treatment with regard to ANCA subtypes. As for the evaluated parameters, there were no significant differences according to the types of ANCA, except for mean CRP values within the normal range, which was 6.3±1.3 mg/L for MPO-ANCA and 12.4±10.14 mg/L for PR3-ANCA (p=0.04). We found that 66.7% of the MPO-ANCA-positive showed no relapses versus 40% in the case of PR3-ANCA-positive. There was no correlation between the ANCA titers at presentation, during remission, and in the last evaluation, and the number of relapses.
  
  
  CONCLUSIONS
  PR3-ANCA patients have a mean CRP value within the normal range significantly higher than that of MPO-ANCA patients (p=0.04), which seems to reveal greater inflammatory activity in the first.
authors.affiliation: MD - Resident in Internal Medicine at Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Vital Manuel Da Silva
authors.initials: VM
authors.lastname: Domingues
authors.affiliation: MD - Resident in Internal Medicine at Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Bernardete
authors.initials: B
authors.lastname: Machado
authors.affiliation: MD - Hospital Assistant of Nephrology at Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Josefina
authors.initials: J
authors.lastname: Santos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood* / Q000150:complications / Q000473:pathology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015415:Biomarkers; D001706:Biopsy; D002097:C-Reactive Protein / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D007674:Kidney Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D053146:Myeloblastin / Q000097:blood; D009195:Peroxidase / Q000097:blood; D011379:Prognosis; D011507:Proteinuria; D012008:Recurrence; D012016:Reference Values; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D002097:C-Reactive Protein; D009195:Peroxidase; D053146:Myeloblastin