Persistent hematuria in patients with antineutrophil cytoplasmic antibody-associated vasculitis during clinical remission: chronic glomerular lesion or low-grade active renal vasculitis?

被引:20
作者
Lv, Li [1 ,2 ,3 ,4 ,5 ]
Chang, Dong-Yuan [1 ,2 ,3 ,4 ]
Li, Zhi-Ying [1 ,2 ,3 ,4 ]
Chen, Min [1 ,2 ,3 ,4 ]
Hu, Zhao [5 ]
Zhao, Ming-Hui [1 ,2 ,3 ,4 ]
机构
[1] Peking Univ, Hosp 1, Dept Med, Renal Div, Beijing 100034, Peoples R China
[2] Peking Univ, Inst Nephrol, Beijing 100034, Peoples R China
[3] Minist Hlth China, Key Lab Renal Dis, Beijing 100034, Peoples R China
[4] Peking Univ, Minist Educ, Key Lab Chron Kidney Dis Prevent & Treatment, Beijing 100034, Peoples R China
[5] Shandong Univ, Qilu Hosp, Jinan 250012, Shandong, Peoples R China
来源
BMC NEPHROLOGY | 2017年 / 18卷
关键词
ANCA; Vasculitis; Hematuria; ANCA-ASSOCIATED GLOMERULONEPHRITIS; SMALL-VESSEL VASCULITIS; SINGLE CHINESE CENTER; WEGENERS-GRANULOMATOSIS; TREATMENT RESISTANCE; SYSTEMIC VASCULITIS; RANDOMIZED-TRIAL; ACTIVITY SCORE; PREDICTORS; RELAPSE;
D O I
10.1186/s12882-017-0763-7
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Whether persistent hematuria in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) during clinical remission reflects active disease or chronic glomerular injury is uncertain. This study aimed to investigate the significance of persistent hematuria during clinical remission in a large cohort of AAV patients. Methods: A cohort of 219 AAV patients in complete clinical remission after induction therapy at our center was retrospectively studied, and their clinical and laboratory data as well as long-term outcomes were analyzed. Results: A total of 80 out of 219 patients had persistent hematuria during clinical remission of AAV. Compared with patients without hematuria during remission, the slope of eGFR decline in patients with persistent hematuria was significantly higher during the long-term follow-up [ 3.6 (IQR 1.2, 7.2) vs. 1.5 (IQR 0.2, 4.0) mL/min/1.73 m(2)/year, P < 0.001]. Among the 80 patients with persistent hematuria during remission, there was little difference between those with fast and slow decline of eGFR, as divided by either median or interquartile range of the slope of eGFR decline. We also compared patients without hematuria who had a slope of eGFR decline that was lower than the median level of the slope of eGFR decline with those with persistent hematuria, and found that patients with hematuria had significantly lower levels of CRP and ESR at baseline and higher levels of ANCA at remission. Conclusions: Among the AAV patients who achieved clinical remission after immunosuppressive therapy, those with persistent hematuria are not rare and may reflect either chronic renal damage or low-grade active renal disease.
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页数:9
相关论文
共 26 条
  • [11] Persistent or New Onset Microscopic Hematuria in Patients with Small Vessel Vasculitis in Remission: Findings on Renal Biopsy
    Geetha, Duvuru
    Seo, Philip
    Ellis, Carla
    Kuperman, Michael
    Levine, Stuart M.
    [J]. JOURNAL OF RHEUMATOLOGY, 2012, 39 (07) : 1413 - 1417
  • [12] A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener's granulomatosis
    Guillevin, L
    Cordier, JF
    Lhote, F
    Cohen, P
    Jarrousse, B
    Royer, I
    Lesavre, P
    Jacquot, C
    Bindi, P
    Bielefeld, P
    Desson, JF
    Détrée, F
    Dubois, A
    Hachulla, E
    Hoen, B
    Jacomy, D
    Seigneuric, C
    Lauque, D
    Stern, M
    Longy-Boursier, M
    [J]. ARTHRITIS AND RHEUMATISM, 1997, 40 (12): : 2187 - 2198
  • [13] Renal histology in ANCA-associated vasculitis:: Differences between diagnostic and serologic subgroups
    Hauer, HA
    Bajema, IM
    van Houwelingen, HC
    Ferrario, F
    Noël, LH
    Waldherr, R
    Jayne, DRW
    Rasmussen, N
    Bruijn, JA
    Hagen, EC
    [J]. KIDNEY INTERNATIONAL, 2002, 61 (01) : 80 - 89
  • [14] EULAR recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis: focus on anti-neutrophil cytoplasm antibody-associated vasculitis
    Hellmich, Bernhard
    Flossmann, Oliver
    Gross, Wolfgang L.
    Bacon, Paul
    Cohen-Tervaert, Jan Willem
    Guillevin, Loic
    Jayne, David
    Mahr, Alfred
    Merkel, Peter A.
    Raspe, Heiner
    Scott, David G. I.
    Witter, James
    Yazici, Hasan
    Luqmani, Raashid A.
    [J]. ANNALS OF THE RHEUMATIC DISEASES, 2007, 66 (05) : 605 - 617
  • [15] WEGENER GRANULOMATOSIS - AN ANALYSIS OF 158 PATIENTS
    HOFFMAN, GS
    KERR, GS
    LEAVITT, RY
    HALLAHAN, CW
    LEBOVICS, RS
    TRAVIS, WD
    ROTTEM, M
    FAUCI, AS
    [J]. ANNALS OF INTERNAL MEDICINE, 1992, 116 (06) : 488 - 498
  • [16] Predictors of relapse and treatment resistance in antineutrophil cytoplasmic anti body-associated small-vessel vasculitis
    Hogan, SL
    Falk, RJ
    Chin, H
    Cai, JW
    Jennette, CE
    Jennette, JC
    Nachman, PH
    [J]. ANNALS OF INTERNAL MEDICINE, 2005, 143 (09) : 621 - 631
  • [17] 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides
    Jennette, J. C.
    Falk, R. J.
    Bacon, P. A.
    Basu, N.
    Cid, M. C.
    Ferrario, F.
    Flores-Suarez, L. F.
    Gross, W. L.
    Guillevin, L.
    Hagen, E. C.
    Hoffman, G. S.
    Jayne, D. R.
    Kallenberg, C. G. M.
    Lamprecht, P.
    Langford, C. A.
    Luqmani, R. A.
    Mahr, A. D.
    Matteson, E. L.
    Merkel, P. A.
    Ozen, S.
    Pusey, C. D.
    Rasmussen, N.
    Rees, A. J.
    Scott, D. G. I.
    Specks, U.
    Stone, J. H.
    Takahashi, K.
    Watts, R. A.
    [J]. ARTHRITIS AND RHEUMATISM, 2013, 65 (01): : 1 - 11
  • [18] Predictors of Treatment Resistance and Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis A Study of 439 Cases in a Single Chinese Center
    Li, Zhi-Ying
    Chang, Dong-Yuan
    Zhao, Ming-Hui
    Chen, Min
    [J]. ARTHRITIS & RHEUMATOLOGY, 2014, 66 (07) : 1920 - 1926
  • [19] Predictors for Outcomes in Patients with Severe ANCA-associated Glomerulonephritis who were Dialysis-dependent at Presentation: A Study of 89 Cases in a Single Chinese Center
    Li, Zhi-Ying
    Gou, Shen-Ju
    Chen, Min
    Zhao, Ming-Hui
    [J]. SEMINARS IN ARTHRITIS AND RHEUMATISM, 2013, 42 (05) : 515 - 521
  • [20] LUQMANI RA, 1994, Q J MED, V87, P671