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

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Rhee RL1, Davis JC2, Ding L2, Fervenza FC2, Hoffman GS2, Kallenberg CGM2, Langford CA2, McCune WJ2, Monach PA2, Seo P2, Spiera R2, St Clair EW2, Specks U2, Stone JH2, Merkel PA2. Clin J Am Soc Nephrol. 2018 Feb 7;13(2):251-257. doi: 10.2215/CJN.04160417. Epub 2018 Jan 25.

Abstract

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1 Due to the number of contributing authors, the affiliations are provided in the Supplemental Material. rennie.rhee@uphs.upenn.edu.

2 Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.

Abstract

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.