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Welcome to this episode of que 
digo conversations in Nephrology

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this episode titled challenges 
in the early diagnosis of aav is

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provided by KD go and supported 
by Amgen, here's your host dr. 

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Vladimir tesser. 
We will today discuss the 

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challenges in early diagnosis of
ankle associated. 

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With colitis, as early diagnosis
may have a decisive impact on 

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the outcome of our patients. 
Hello and welcome to KD go 

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conversations in apology. 
I am dr. 

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Vladimir tests ahead of 
nephrology a general University 

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Hospital in park and joining me 
to discuss the challenges in the

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early diagnosis on Council, 
stated vasculitis is dr. 

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Dubrow geetha, geetha, is an 
effort Reggie's and professor at

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the Department of Medicine 
Johns, Hopkins University School

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of Medicine. 
Baltimore Maryland, USA, her 

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research interests include 
different aspects of diagnosis, 

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and treatment and Care 
Associated. 

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Vasculitis, including renal 
transplantation in patients with

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anchor Associated vasculitis 
Gita. 

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Welcome to the program. 
Thank you. 

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Thank you, Tricia for the kind 
introduction. 

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It is a great honor for me to 
participate in this discussion 

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about diagnostic delays and 
vasculitis, thank you. 

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So, let's begin our discussion 
with the first question. 

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I'll delays in diagnosis, common
in a AV. 

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And what are the factors that 
may contribute to these delays? 

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This is a very important 
question and an area where we 

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really need to focus on dr. 
Tesar, we need to increase our 

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efforts. 
It's on educating primary care, 

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physicians and patients delays 
in diagnosis are common and is 

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an important contributor to 
patient comorbidities as well as

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Healthcare expenditures. 
The median time to diagnosis is 

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about seven months with a wide 
range. 

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From a few weeks to over a year.
Now, delays in diagnosis can be 

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due to multiple causes disease 
related, patient-related and 

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healthcare system related 
factors, play a role. 

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First of all. 
Aav is a rare disease with an 

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incidence of 10 to 20 cases per 
million. 

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So gaining expertise is not 
easy. 

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Secondly, aav patients may have 
symptoms that are shared by 

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other common diseases and 
therefore, it is difficult, 

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especially for the physician of 
first Contact. 

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In addition, misdiagnosis is 
common as a number of other 

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diseases can mimic vasculitis 
Within Affections allergies and 

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other autoimmune diseases being 
common. 

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One of the classic examples Is a
GPA patient who presents with 

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recurrent sinus symptoms and 
some of these patients actually 

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can go through multiple rounds 
of antibiotics. 

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Before a diagnosis of aav is 
considered, furthermore AV is 

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also heterogeneous disease and 
patients may be seen by many 

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specialist Physicians before. 
Diagnosis is considered, I 

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believe improving access to 
specialist is important. 

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So if this is one of the factors
that is contributing to delay in

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diagnosis, finally, depending on
the organ involvement, a every 

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can be silent classic examples 
include those with renal, 

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limited aav and interstitial 
lung disease, but we have some 

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good news. 
There is wider, availability of 

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anchor testing. 
So mu cases of aav have been 

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diagnosed in the last two 
decades, heh, Educating patients

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and Physicians on the 
multi-system nature of aav and 

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related symptoms. 
Is key for early detection. 

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Since kidneys are often 
involved, an aav affecting 80 to

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90 percent of the patients, 
screening for renal vasculitis, 

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with urine analysis, and serum, 
creatinine should be done in all

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patients with suspected a heavy 
delays in diagnosis can have 

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negative Health consequences 
especially when some major 

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organs like kidneys and world. 
Many thanks for the somebody of 

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Des Moines causes of delays in 
diagnosis of anchor associated 

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with colitis. 
And now, I have the second 

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question. 
How can we increase the 

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awareness in the disease and 
early diagnosis? 

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Sure, early recognition and 
treatment of vasculitis is 

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critical to prevent 
complications. 

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We need to recognize that 
patients come with different 

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levels of Education, educational
efforts, should be spearheaded 

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by vasculitis. 
Experts patient should be 

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empowered through disease, 
education and racing vasculitis.

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Cavernous, in the general public
caregivers should also be 

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educated as well. 
Even something simple. 

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I give you an information 
leaflet on diagnosis and 

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treatment of vasculitis. 
At the end of the clinic, visit 

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can play a huge role in raising 
disease, awareness and improving

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patient engagement, the role of 
patient advocacy groups to 

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increase disease, awareness has 
been well recognized in many. 

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Communities. 
We should also remember that 

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listening to patients is quite 
important as patients of often 

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able to tell about disease 
relapse before the physician 

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suspects, that elapsed. 
Finally, it is important to 

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educate patients with renal 
vasculitis on the use of urine, 

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dipstick, which can detect, 
hematuria and proteinuria, which

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are early signs of renal, 
vasculitis on the same page, 

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education of trainees Physicians
and Allied health professionals 

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is equally important. 
To raise awareness of 

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vasculitis, we should educate 
them on thinking about systemic 

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diseases. 
When someone initially presents 

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with sinusitis and then with 
pneumonia or hearing issues, 

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rather than treating them as 
different illnesses. 

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Similarly, when someone presents
with recurrent, bouts of 

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pneumonia, we should take a step
back and think of non infectious

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etiologies information should 
filter from the vascular and 

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experts to Primary Care. 
Additions and specialist through

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workshops webinars seminars and 
Grand rounds online learning why

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our website dedicated to 
diagnosing. 

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And managing vasculitis, may be 
helpful for Physicians, we 

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should especially educate them 
on the various ways, vasculitis 

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can present and the best 
approach to diagnosing. 

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The various vasculitis, as far 
as the treatment options. 

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Educating on recognizing disease
and treatment related 

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complications and managing this 
complicated Locations is 

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Paramount to improving outcomes,
the minutes. 

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Thanks for sharing the dance. 
This very important ideas. 

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How to improve early diagnosis 
of anchor associated with 

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colitis, or those just tuning 
in. 

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You are listening to Katy. 
Go conversations in apology. 

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I will today, topic is 
challenges in early diagnosis of

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a baby. 
I am dr. 

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Hardy Nickerson. 
And I'm speaking with dr. 

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Guru Gita and my Third question 
is a bit different topic. 

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Can we rely on our composite 
ability or is it necessary to 

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have a histological information?
Sure. 

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So anchor can be actually - in 
10 to 30% of cases, depending on

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where. 
And when the studies were 

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conducted, for example, the 
incidence of nk- diseases higher

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in European cohorts, we have to 
remember the use of 

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antigen-specific immunoassays 
important. 

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And when diagnosis is in doubt, 
histologic confirmation is 

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needed to guide in a suppressive
therapy. 

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And can I get two patients are 
also more likely to have renal 

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limited disease or disease? 
Limited to upper respiratory 

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tract. 
So would you recommend Reno 

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biopsy in on patients with 
uncouple ctvt and suspected EAD 

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and renal involvement? 
Yeah, so kidney biopsy, you 

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know, it's one of the organs 
where you have a high diagnostic

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value with a greater than 90 
percent yield. 

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But more importantly, the kidney
biopsy gives prognostic 

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information so we should 
consider kidney biopsy, 

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especially if there are no 
contraindications in all 

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patients, a diagnostic kidney 
biopsy is often indicated in 

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patients or Hank and - to 
exclude vascular deck mimics 

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like other system, achromatic 
diseases infections and 

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malignancies. 
But what we do need to remember,

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however, is that a kidney 
biopsy? 

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You should not delay treatment 
initiation, in your opinion. 

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Is there any role of repeat 
biopsy and ongoing associated 

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with colitis? 
This is an excellent question 

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and a really unexplored area. 
So we currently use resolution 

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of he material as one of the 
markers for renal remission, but

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close to 50% of the patients, 
have persistent immaterial at 6 

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months post, induction therapy 
in Single Center, study of 

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protocol biopsies, there was 
evidence of disease activity. 

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After clinical remission was 
achieved in some of the 

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biopsies, we all know that 
treatment-related side effects, 

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especially infections are common
during induction therapy. 

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Therefore, repeat biopsies 
should be considered in patients

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with persistent hematuria and 
those with poor response to 

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therapy to guide 
immunosuppression especially 

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with the changing landscape in 
the tree. 

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Point of a every - thanks and 
probably the most important is 

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my last question. 
How should we collaborate with 

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our colleagues icon? 
Special tests in order to 

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diagnose as early as possible? 
The patients with anchor 

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associated with colitis gain an 
excellent question. 

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So, diagnosing and managing aav 
requires a team of experts who 

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are familiar with vasculitis. 
The different treatment options 

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and complications related to 
That's great isn't treatments 

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given the multi-system 
involvement in vasculitis, 

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shared decision-making and 
collaboration among Specialists 

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is a central pillar. 
Both a diagnosis and follow up. 

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The model in most vasculitis 
centers is to have a 

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collaborative team with 
nephrologists rheumatologist 

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pulmonologist and ENT specialist
who have special interest and 

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training to take care of as 
colitis. 

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Patients collaboration 
Especially important. 

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When presentation is a typical, 
for example, when a patient with

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the recurrent sinusitis is 
evaluated by rheumatologist, but

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the anchor test is negative. 
However, if the patient is 

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hematuria and nephrologist can 
do a kidney biopsy to confirm a 

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diagnosis of vasculitis. 
Similarly, collaboration is 

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important to diagnose refractory
disease, vasculitis, mimics and 

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disease, relapse many scientists
before we close Gita, or any 

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final messages or takeaways. 
Like to leave with our 

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listeners. 
I think the three main messages 

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I would like the audience to 
take away or a number one 

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education. 
Both from a patient perspective 

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and a healthcare professional 
perspective. 

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And then number two is Axis to 
vasculitis experts because 

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that's a common cause of delay 
in diagnosis. 

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And number three is 
collaboration among Specialists,

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because that is really key both 
in managing disease, as well as 

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the applications related to 
disease and treatment. 

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I completely agree. 
And I hope that you all enjoyed 

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our discussion today. 
I want to thank my guest, dr. 

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Dubrow Gita for joining me, 
Geeta, many, thanks for 

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accepting my invitation to our 
program dr. 

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Katherine has been a great honor
to participate. 

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I hope that today's discussion 
has not only reflected power 

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current situation on the delays 
to diagnosis of a every but also

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has highlighted some of the 
Steps. 

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We can take to diagnose 
vasculitis, early. 

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Thank you. 
I am doctor about amethyst or to

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access this and other episodes 
in our series. 

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Visit Katie go on Spotify or que
digo dot org slash podcast. 

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Thanks for listening.