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. 2017 Dec 6;18(1):354.
doi: 10.1186/s12882-017-0763-7.

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

Li Lv  1   2 , Dong-Yuan Chang  1 , Zhi-Ying Li  1 , Min Chen  3 , Zhao Hu  2 , Ming-Hui Zhao  1
Affiliations

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

Li Lv et al. BMC Nephrol. .

Abstract

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 m2/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.

Keywords: ANCA; Hematuria; Vasculitis.

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Conflict of interest statement

Ethics approval and consent to participate

The study was in adherence with the Declaration of Helsinki and was approved by the ethics committee of Peking University First Hospital (approval number 2016–010). All these patients gave written informed consent before data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The slope of eGFR decline in AAV patients with persistent hematuria and without hematuria
Fig. 2
Fig. 2
Renal survival in AAV patients with persistent hematuria and without hematuria
See this image and copyright information in PMC

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