How to manage 5.6 U/ml levels of c-ANCA?

Question

Hello doctor,

My c-ANCA levels are 5.6 U/ml (borderline positive). I have hypertension and proteinuria (3g), high serum creatinine (2.4), and UTI. My other autoimmune tests and serum electrophoresis results are negative. What should I do and what is the general prognosis?

Answer 1

Hi,

Welcome to icliniq.com.

Based on your query, my opinion is as follows:

C-ANCA (antineutrophil cytoplasmic antibodies) positivity indicates Wegener's Granulomatosis. In this condition, there is involvement of the upper and lower respiratory tract and kidneys. The most common diagnosis, while kidneys are affected, is Lupus. But I suppose your ANA and anti-Ds DNA are negative. I would like to see all your reports, and I also recommend you get an x-ray of paranasal sinuses to see for any polyps that are associated with Wegener's Granulomatosis. A chest x-ray may show a cavitary lesion. You need a kidney biopsy, first of all, followed by which you will be started on immunosuppressive therapy. Steroids and other immunosuppressive agents like Cyclophosphamide, Azathioprine are used. Prognosis and life expectancy can be commented on after the report of kidney biopsy, as most of the time fatality occurs due to renal failure. I hope it helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I have gone through your reports (attachments removed to protect patient identity). Following are the answers for your query. Yes, autoimmune disease can progress very rapidly. However, the progression can be delayed with appropriate treatment. A biopsy is relatively safe. Every procedure has its own risk but it is important in your case for your diagnosis. Yes, ANCA (antineutrophil cytoplasmic antibodies) can be false positive, but chances are less in your case. Get the investigations that I have advised and you need to start immunosuppressive treatment as soon as possible.

Thank you.