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

Publication ,  Journal Article
Rhee, RL; Davis, JC; Ding, L; Fervenza, FC; Hoffman, GS; Kallenberg, CGM; Langford, CA; McCune, WJ; Monach, PA; Seo, P; Spiera, R; Specks, U ...
Published in: Clin J Am Soc Nephrol
February 7, 2018

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.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

February 7, 2018

Volume

13

Issue

2

Start / End Page

251 / 257

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinalysis
  • Treatment Outcome
  • Time Factors
  • Rituximab
  • Risk Factors
  • Risk Assessment
  • Remission Induction
  • Recurrence
  • Reagent Strips
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Rhee, R. L., Davis, J. C., Ding, L., Fervenza, F. C., Hoffman, G. S., Kallenberg, C. G. M., … Merkel, P. A. (2018). The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis. Clin J Am Soc Nephrol, 13(2), 251–257. https://doi.org/10.2215/CJN.04160417
Rhee, Rennie L., John C. Davis, Linna Ding, Fernando C. Fervenza, Gary S. Hoffman, Cees G. M. Kallenberg, Carol A. Langford, et al. “The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis.Clin J Am Soc Nephrol 13, no. 2 (February 7, 2018): 251–57. https://doi.org/10.2215/CJN.04160417.
Rhee RL, Davis JC, Ding L, Fervenza FC, Hoffman GS, Kallenberg CGM, et al. The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis. Clin J Am Soc Nephrol. 2018 Feb 7;13(2):251–7.
Rhee, Rennie L., et al. “The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis.Clin J Am Soc Nephrol, vol. 13, no. 2, Feb. 2018, pp. 251–57. Pubmed, doi:10.2215/CJN.04160417.
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. The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis. Clin J Am Soc Nephrol. 2018 Feb 7;13(2):251–257.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

February 7, 2018

Volume

13

Issue

2

Start / End Page

251 / 257

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinalysis
  • Treatment Outcome
  • Time Factors
  • Rituximab
  • Risk Factors
  • Risk Assessment
  • Remission Induction
  • Recurrence
  • Reagent Strips