Document Detail


Pathways to renal biopsy and diagnosis among patients with ANCA small-vessel vasculitis.
MedLine Citation:
PMID:  23343774     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Antineutrophil cytoplasmic antibody small-vessel vasculitis (ANCA-SVV) is an autoimmune systemic process increasingly recogniSed since the advent of antibody testing for the disease. Prompt diagnosis and institution of immunosuppressive therapy has been shown to improve patient outcome. The goal of this study was to better understand how patients navigate the health care system from symptom presentation to biopsy diagnosis, and to study the effects of prompt versus delayed diagnosis.
METHODS: Disease symptoms and number of physicians seen prior to renal biopsy were assessed for 127 ANCA-SVV patients. Direct, delayed, and quest pathways to diagnosis and treatment of vasculitis were defined for both patients and providers. Kruskal-Wallis and Fisher exact tests were used to evaluate continual measures and compare categorical variables across pathways.
RESULTS: Among patients who sought direct care, physician delay in referral to a nephrologist was common (49/127, 71%, p=0.0023). Patients who delayed seeking care also experienced a delayed diagnosis 57% of the time (p=0.0023). Patients presenting with prodromal flu or upper respiratory involvement were more likely to have a delay/quest patient pathway (56% and 55%, respectively) than a direct patient pathway (44%, p=0.033 and 45%, p=0.019, respectively). There was a trend for patients with more severe loss of renal function to have a more direct referral to a nephrologist.
CONCLUSIONS: Delay in diagnosis of ANCA SVV may be due to lack of or non-specific symptoms, especially in patients who present with non-renal manifestations of disease. Better algorithms are needed to identify extra-renal manifestations, expedite diagnosis and improve patient outcomes.
Authors:
C J Poulton; P H Nachman; Y Hu; J G McGregor; J C Jennette; R J Falk; S L Hogan
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-23
Journal Detail:
Title:  Clinical and experimental rheumatology     Volume:  31     ISSN:  0392-856X     ISO Abbreviation:  Clin. Exp. Rheumatol.     Publication Date:    2013 Jan-Feb
Date Detail:
Created Date:  2013-05-13     Completed Date:  2013-08-16     Revised Date:  2013-10-22    
Medline Journal Info:
Nlm Unique ID:  8308521     Medline TA:  Clin Exp Rheumatol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  S32-7     Citation Subset:  IM    
Affiliation:
University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. caroline-poulton@unc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Algorithms
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / complications,  pathology*,  therapy
Biopsy
Critical Pathways*
Delayed Diagnosis
Disease Progression
Early Diagnosis
Female
Health Care Surveys
Health Knowledge, Attitudes, Practice
Health Services Accessibility*
Humans
Kidney / pathology*
Kidney Diseases / etiology,  pathology*,  therapy
Male
Middle Aged
Patient Acceptance of Health Care*
Predictive Value of Tests
Prognosis
Questionnaires
Referral and Consultation
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
P01 DK058335/DK/NIDDK NIH HHS; P01-DK58335/DK/NIDDK NIH HHS
Comments/Corrections

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