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Clin J Am Soc Nephrol. 2018 Feb 7;13(2):251-257. doi: 10.2215/CJN.04160417. Epub 2018 Jan 25.
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 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.
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; =0.02); persistent proteinuria was not associated with renal relapse (subdistribution hazard ratio, 1.44; 95% confidence interval, 0.47 to 4.42; =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; <0.01). The median time to renal relapse was 22 months.
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.
对于抗中性粒细胞胞浆抗体（ANCA）相关性血管炎患者，在临床缓解期仍存在持续性血尿或蛋白尿的意义尚不清楚。
设计、地点、参与者和测量方法：使用参加两项随机、安慰剂对照临床试验的患者进行了一项分析，这些患者患有由 ANCA 相关性血管炎引起的活动性肾小球肾炎，ANCA 阳性，并在第 6 个月达到缓解。每次就诊时都进行尿试纸和显微镜检查。检查至少持续 6 个月的持续性血尿或蛋白尿和血尿的累计持续时间。根据肉芽肿性多血管炎的伯明翰血管炎活动评分，将新出现或加重的红细胞管型和/或肾功能恶化定义为肾脏复发。
本研究共纳入 149 例患者：42%的患者存在持续性血尿，43%的患者在 6 个月后仍存在持续性蛋白尿。即使在调整了潜在混杂因素后，持续性血尿与复发风险显著相关（亚分布危险比，3.99；95%置信区间，1.20 至 13.25；=0.02）；持续性蛋白尿与肾脏复发无关（亚分布危险比，1.44；95%置信区间，0.47 至 4.42；=0.53）。此外，血尿的累计持续时间越长，与肾脏复发的风险越高显著相关（调整后的亚分布危险比，每月增加 1.08；95%置信区间，1.03 至 1.12；<0.01）。肾脏复发的中位时间为 22 个月。
在接受诱导治疗后达到缓解的 ANCA 相关性血管炎和肾脏受累患者中，持续性血尿而非蛋白尿的存在是未来肾脏复发的显著预测因素。
