Hematuria duration does not predict kidney function at 1 year in ANCA-associated glomerulonephritis.
Hematuria duration does not predict kidney function at 1 year in ANCA-associated glomerulonephritis.
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DOI：
10.1016/j.semarthrit.2014.03.008
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发表时间：
2014-10
影响因子：
5
通讯作者：
Geetha D
中科院分区：
文献类型：
--
作者：
Chen TK;Murakami C;Manno RL;Geetha D
在ANCA相关性肾炎(ANCA-GN)中，血尿被认为是活动性肾脏疾病的标志，诱导免疫抑制通常持续到血尿消失。我们的目标是确定血尿持续时间较长是否与1年时估计的肾小球滤过率(EGFR)较低有关。我们对55例经活检证实的ANCA-GN患者进行了回顾性研究。建立线性回归模型以确定1年后EGFR的预测因素。主要暴露于血尿持续时间，定义为肾活检后90天与≥。协变量包括年龄、性别、ANCA类型、基线EGFR和基线蛋白尿。确诊时的平均年龄为58岁(男性53%，高加索人80%，PR3-ANCA 38%，MPO-ANCA 45%)。基线时，所有患者都有血尿，95%有蛋白尿，平均血清肌酐为3.1[标准差(SD)=2.3]mg/dL。总体而言，93%的患者接受了类固醇与环磷酰胺或利妥昔单抗的联合治疗。平均血尿持续时间为92天(SD=77)，其中34例(62%)患者在90天内血尿消失。年龄较大和基线较低的表皮生长因子受体与1年时较低的表皮生长因子受体相关(p=0.03p<；0.001)。血尿消失(<；90天与≥90天)不能预测1年后的EGFR(p=0.93)。在ANCA-GN中，血尿持续时间不能预测1年内的EGFR。我们的研究结果支持，在其他被认为处于临床缓解期的个体中，持续的血尿不应推迟从诱导免疫抑制到维持免疫抑制的转变。
Hematuria is considered a marker of active renal disease in ANCA-associated glomerulonephritis (ANCA-GN) with induction immunosuppression often continued until hematuria has resolved. We aim to determine whether longer hematuria duration is associated with lower estimated glomerular filtration rate (eGFR) at 1 year. We conducted a retrospective study of 55 patients with biopsy-proven ANCA-GN. Linear regression models were constructed to determine predictors of eGFR at 1 year. The primary exposure was hematuria (>5 rbc/hpf) duration, defined as <90 days vs. ≥90 days following renal biopsy. Covariates included age, gender, ANCA type, baseline eGFR, and baseline proteinuria. Mean age at diagnosis was 58 years (53% male, 80% Caucasian, 38% PR3-ANCA, and 45% MPO-ANCA). At baseline, all patients had hematuria, 95% had proteinuria, and mean serum creatinine was 3.1 [standard deviation (SD) = 2.3] mg/dL. Overall, 93% were treated with steroids in combination with either cyclophosphamide or rituximab. Mean hematuria duration was 92 (SD = 77) days with 34 (62%) patients having hematuria resolution within 90 days. Older age and lower baseline eGFR were associated with lower eGFR at 1 year (p = 0.03 and p < 0.001, respectively). Hematuria resolution (<90 days vs. ≥90 days) was not predictive of eGFR at 1 year (p = 0.93). In ANCA-GN, hematuria duration does not predict eGFR at 1 year. Our findings provide support that among individuals who are otherwise considered to be in clinical remission, the persistence of hematuria should not delay transition from induction to maintenance immunosuppression.
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