The Utility of Urinalysis in Determining the Risk of Renal Relapse in ANCA-Associated Vasculitis.
Clin J Am Soc Nephrol
; 13(2): 251-257, 2018 02 07.
Article
em En
| MEDLINE
| ID: mdl-29371340
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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Proteinúria
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Urinálise
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Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos
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Glomerulonefrite
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Hematúria
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article