The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis.

Published

Journal Article

BACKGROUND AND OBJECTIVES: The significance of persistent hematuria or proteinuria in patients with ANCA-associated vasculitis who are otherwise in clinical remission is unclear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A post hoc analysis was conducted using participants enrolled in two randomized, placebo-controlled clinical trials who had active GN due to ANCA-associated vasculitis, had positive ANCA, and achieved remission by month 6. Dipstick and microscopic urinalyses were performed at each visit. Persistent hematuria or proteinuria for at least 6 months and the cumulative duration of hematuria were examined. Renal relapse was defined as new or worsening red blood cell casts and/or worsening kidney function according to the Birmingham Vasculitis Activity Score for Granulomatosis with Polyangiitis. RESULTS: There were 149 patients included in this study: 42% had persistent hematuria, and 43% had persistent proteinuria beyond 6 months. Persistent hematuria was associated with a significantly higher risk of relapse, even after adjusting for potential confounders (subdistribution hazard ratio, 3.99; 95% confidence interval, 1.20 to 13.25; P=0.02); persistent proteinuria was not associated with renal relapse (subdistribution hazard ratio, 1.44; 95% confidence interval, 0.47 to 4.42; P=0.53). Furthermore, greater cumulative duration of hematuria was significantly associated with a higher risk of renal relapse (adjusted subdistribution hazard ratio, 1.08 per each month; 95% confidence interval, 1.03 to 1.12; P<0.01). The median time to renal relapse was 22 months. CONCLUSIONS: In patients with ANCA-associated vasculitis and kidney involvement who achieve remission after induction therapy, the presence of persistent hematuria, but not proteinuria, is a significant predictor of future renal relapse.

Full Text

Duke Authors

Cited Authors

  • Rhee, RL; Davis, JC; Ding, L; Fervenza, FC; Hoffman, GS; Kallenberg, CGM; Langford, CA; McCune, WJ; Monach, PA; Seo, P; Spiera, R; St Clair, EW; Specks, U; Stone, JH; Merkel, PA

Published Date

  • February 7, 2018

Published In

Volume / Issue

  • 13 / 2

Start / End Page

  • 251 - 257

PubMed ID

  • 29371340

Pubmed Central ID

  • 29371340

Electronic International Standard Serial Number (EISSN)

  • 1555-905X

Digital Object Identifier (DOI)

  • 10.2215/CJN.04160417

Language

  • eng

Conference Location

  • United States