Abstract
Background
Prognostic tools for kidney outcomes in ANCA‐associated vasculitis (AAV) were developed mainly in European and North American populations, and their performance in Hispanic populations remains less well characterized. ANCA in Latin America (ANCLA) was previously developed and internally validated in a Colombian cohort to predict end‐stage kidney disease (ESKD).
Objective
To compare the prognostic performance of ANCLA with the Berden classification, Renal Risk Score (RRS), Mayo Clinic Chronicity Score (MCCS), and the ANCA Kidney Risk Score (AKRiS) for ESKD prediction in ANCA‐associated glomerulonephritis.
Methods
This secondary comparative analysis used the previously described ANCLA derivation cohort of 164 adults with biopsy‐proven pauci‐immune necrotizing and/or crescentic glomerulonephritis treated from 2011 to 2024 at a tertiary referral center in Colombia. The five prognostic systems were evaluated in the same population using Kaplan–Meier analyses, Harrell’s C‐index, and 1‐ and 2‐year ROC analyses. Pairwise AUC differences between ANCLA and each comparator were formally assessed.
Results
During a median follow‐up of 12.9 months, 63 patients (38.4%) progressed to ESKD. ANCLA showed the most favorable overall discrimination (C‐index 0.801; AUC 0.890 at 1 year and 0.896 at 2 years), followed by AKRiS (C‐index 0.760) and RRS (0.749); MCCS (0.673) and Berden (0.640) showed lower discrimination. ANCLA had significantly higher AUCs than MCCS and Berden at both horizons, whereas differences versus AKRiS and RRS were smaller. ESKD occurred in 7.3% of the ANCLA low‐risk group and 82.5% of the very‐high‐risk group.
Conclusion
In this high‐risk, predominantly Hispanic Latin American cohort, ANCLA showed the most favorable short‐term discrimination, while AKRiS and RRS also performed well. Independent external validation remains necessary.