TY - JOUR
T1 - The utility of urinalysis in determining the risk of renal relapse in ANCA-associated vasculitis
AU - Rhee, Rennie L.
AU - Davis, John C.
AU - Ding, Linna
AU - Fervenza, Fernando C.
AU - Hoffman, Gary S.
AU - Kallenberg, Cees G.M.
AU - Langford, Carol A.
AU - McCune, W. Joseph
AU - Monach, Paul A.
AU - Seo, Philip
AU - Spiera, Robert
AU - St. Clair, E. William
AU - Specks, Ulrich
AU - Stone, John H.
AU - Merkel, Peter A.
N1 - Funding Information:
AR052820 (to P.S.) and K24 AR049185 (to J.H.S.) from the NIAMS. At Boston University, the RAVE Trial was supported by an Arthritis Foundation Investigator award (to P.A. Monach), CTSA grant UL1 RR025771 (to P.A. Merkel) and NIH grant M01 RR00533 (to P.A. Merkel) from the NCRR, and grant K24 AR02224 from the NIAMS (to P.A. Merkel).
Funding Information:
R.L.R. receives support from the Rheumatology Research Foundation and the Vasculitis Foundation. The Wegener’s Granulomatosis Etanercept Trial was supported by National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) grant N01-AR-92240; National Center for Research Resources, General Clinical Research Center grants M01-RRO-00533 (to Boston University), M01-RRO-0042 (to the University of Michigan), M01-RR-30 (to Duke University), and M01-RRO-2719 (to Johns Hopkins University School of Medicine); and Food and Drug Administration, Office of Orphan Products grant FD-R-001652. The work of E.W.S.C., J.H.S., and P.A. Merkel was supported by NIH, NIAMS grants K24-AR-02126-04, K24-AR-049185-01, and K24-AR-2224-01A1. The Rituximab in ANCA-Associated Vasculitis (RAVE) Trial was performed as a project of the Immune Tolerance Network (NIH contract N01-AI-15416; protocol number ITN021AI), an international clinical research consortium headquartered at the University of California, San Francisco. The RAVE Trial was supported by the National Institute of Allergy and Infectious Diseases, the Juvenile Diabetes Research Foundation, Genentech, and Biogen Idec. At the Mayo Clinic, the RAVE Trial was supportedbyClinicalandTranslationalScienceAward(CTSA)grant UL1 RR024150-01 from the National Center for Research Resources (NCRR). At Johns Hopkins University, the RAVE Trial was supported by CTSA grant UL1 RR025005 from the NCRR and grants K23
Funding Information:
We thank Joshua Baker for his input on data analysis. R.L.R. receives support from the Rheumatology Research Foundation and the Vasculitis Foundation. The Wegener’s Granulomatosis Etanercept Trial was supported by National Institutes of Health (NIH), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) grant N01-AR-92240; National Center for Research Resources, General Clinical Research Center grants M01-RRO-00533 (to Boston University), M01-RRO-0042 (to the University of Michigan), M01-RR-30 (to Duke University), and M01-RRO-2719 (to Johns Hopkins University School of Medicine); and Food and Drug Administration, Office of Orphan Products grant FD-R-001652. The work of E.W.S.C., J.H.S., and P.A. Merkel was supported by NIH, NIAMS grants K24-AR-02126-04, K24-AR-049185-01, and K24-AR-2224-01A1. The Rituximab in ANCA-Associated Vasculitis (RAVE) Trial was performed as a project of the Immune Tolerance Network (NIH contract N01-AI-15416; protocol number ITN021AI), an international clinical research consortium headquartered at the University of California, San Francisco. The RAVE Trial was supported by the National Institute of Allergy and Infectious Diseases, the Juvenile Diabetes Research Foundation, Genentech, and Biogen Idec. At the Mayo Clinic, the RAVE Trial was supportedby Clinical and Translational ScienceAward (CTSA) grant UL1 RR024150-01 from the National Center for Research Resources (NCRR). At Johns Hopkins University, the RAVE Trial was supported by CTSA grant UL1 RR025005 from the NCRR and grants K23AR052820 (to P.S.) and K24 AR049185 (to J.H.S.) from the NIAMS. At Boston University, the RAVE Trial was supported by an Arthritis Foundation Investigator award (to P.A. Monach), CTSA grant UL1 RR025771 (to P.A. Merkel) and NIH grant M01 RR00533 (to P.A. Merkel) from the NCRR, and grant K24 AR02224 from the NIAMS (to P.A. Merkel).
Publisher Copyright:
© 2018 by the American Society of Nephrology.
PY - 2018/2/7
Y1 - 2018/2/7
N2 - 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.
AB - 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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U2 - 10.2215/CJN.04160417
DO - 10.2215/CJN.04160417
M3 - Article
C2 - 29371340
AN - SCOPUS:85041710014
SN - 1555-9041
VL - 13
SP - 251
EP - 257
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 2
ER -