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When Heart Failure Masks Kidney Disease: A Case of Missed ANCA Vasculitis

RPEP-130472025Phyu, Ei Ei; Yit, Chesda; San, Su Su
Case ReportVery Low evidence
The takeaway

Progressive kidney decline in an elderly patient was misattributed to heart failure for 8 months before ANCA-associated vasculitis was finally diagnosed.

8 months

Duration of misdiagnosis before ANCA-associated glomerulonephritis was identified

What the researchers found

ANCA-associated glomerulonephritis was misdiagnosed as cardiorenal syndrome for 8 months, leading to irreversible kidney damage.

Why it matters

In elderly patients with multiple conditions, autoimmune kidney disease can hide behind more common diagnoses, and delays in recognition can be devastating.

The numbers in context

75-year-old female. 8 months of progressive renal decline. MPO-ANCA positive. Renal biopsy: pauci-immune focal proliferative glomerulonephritis. Progressed to dialysis despite cyclophosphamide.

How the study worked

Single case report with serological testing and renal biopsy confirmation.

Who was studied

One elderly woman with misdiagnosed ANCA vasculitis

What this study cannot tell us

Single case report; treatment was initiated late which confounds assessment of therapy effectiveness.

How to read the evidence

Single case report — valuable for clinical awareness but cannot establish frequency or generalizability.

When this study was published

Published in 2025, highlighting an ongoing diagnostic challenge in geriatric medicine.

The bigger picture

This case highlights the importance of considering autoimmune causes of kidney decline in older adults, even when cardiovascular explanations seem sufficient.

Questions still open

  • Should ANCA testing be routine in elderly patients with unexplained progressive kidney decline?
  • Could earlier diagnosis have prevented dialysis dependence?

Common questions

What is ANCA-associated vasculitis?
An autoimmune condition where antibodies attack small blood vessels, often damaging the kidneys. It requires early aggressive treatment to preserve kidney function.
Why was this diagnosis missed?
The patient had heart failure and diabetes, which provided alternative explanations for her declining kidney function, delaying the autoimmune workup.

Read the original research

Beyond Heart Failure: A Case of Missed Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Glomerulonephritis.

Cureus, 17(7), e87973

View on PubMed ↗Publisher’s paper ↗

Citation

Phyu, Ei Ei; Yit, Chesda; San, Su Su. (2025). Beyond Heart Failure: A Case of Missed Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Glomerulonephritis.. Cureus, 17(7), e87973. https://doi.org/10.7759/cureus.87973