#3101 The pathway to diagnosis and institution of therapy in patients with pauci-immune glomerulonephritis

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Abstract Background and Aims Delays in diagnosis and treating pauci-immune glomerulonephritis (PIGN) and vasculitis have been associated with adverse outcomes. This study retrospectively evaluated the pathway following the onset of symptoms associated with PIGN, estimate the time interval until diagnosis and the delay, if any, until institution of appropriate treatment. Method Included patients should be older than 16 years, with biopsy-proven PIGN, followed for a minimum of 12 months after diagnosis or end-stage kidney disease or death, and received the standard of care. Demographics, disease characteristics and all the steps from onset of symptoms to the time patients came to medical attention and diagnosis was established were recorded, including the type of initiating symptom, medical visits and specialties, the related management (associated or not with the disease) and workup. The dates of first urine analysis and the first antineutrophil cytoplasmic antibodies (ANCA) test were also recorded. Results 148 patients with a mean age of 61.8 (±13.9) years were included, of whom 85 (57.4%) were males and 147 (99.3%) were Caucasians. Overall, 141 (95.8%) were positive for ANCA and 88 (62.4%) of them had P/MPO-ANCA. The reason for seeking medical attention was general symptoms in 56.8% of cases and disease specific symptoms in the rest. Internists were the most common specialty (51.5%) involved at the 1st medical assessment while the related management was non-associated with the disease in 29.65% of cases (“delayed” diagnosis group), and associated in 71.25% (“non-delayed” diagnosis). The median number of medical visits prior to nephrology referral was 3 (±2.1) in the “delayed group” vs. 1 (±1.5) in the non-delayed (P < 0.0001) and the time to nephrology referral was 105.5 (±141.6) days and 20.1 (±48.05) respectively. Urine analysis was performed in 46.15% of patients during the 1st medical assessment in the “delayed” group vs. 94.4% in the “non-delayed” (P < 0.0001), while microscopic hematuria was present in 94.4% in the “delayed” and 98.7% in the “non-delayed” group (P = 0.248). The time to the 1st ANCA test was significantly longer in the “delayed diagnosis” group vs. the “non-delayed” 125.3 (±174.8) vs. 22.8 (±59.3) days from the 1st medical assessment. Conclusion It seems that urine analysis and ANCA testing performance play a critical role for the prompt referral and diagnosis of PIGN during the initial phase of evaluation.

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