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Abstract: SU-OR33

Prognostic Value of Persistent Proteinuria and Hematuria After Induction Therapy in ANCA-Associated Vasculitides

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Benichou, Nicolas, HEGP, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France
  • Guillevin, Loïc, Hopital Cochin, Paris, Île-de-France, France
  • Charles, Pierre, Institut Mutualiste Montsouris, Paris, Île-de-France, France
  • Terrier, Benjamin, Hopital Cochin, Paris, Île-de-France, France
  • Mouthon, Luc, Hopital Cochin, Paris, Île-de-France, France
  • Hiemstra, Thomas F., Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom
  • Jones, Rachel B., Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom
  • Jayne, David R.W., Addenbrooke's Hospital, Cambridge, Cambridgeshire, United Kingdom
  • Karras, Alexandre, HEGP, Hopital Europeen Georges Pompidou, Paris, Île-de-France, France
Background

In ANCA-associated vasculitides (AAV), hematuria and proteinuria are biomarkers reflecting renal involvement at diagnosis. Yet, the prognostic value of their persistence after immunosuppressive induction therapy, which may reflect renal damage or persistent disease, remains uncertain.

Methods

This is a post hoc study including participants of 5 European randomized clinical trials on AAV (MAINRITSAN, MAINRITSAN2, RITUXVAS, MYCYC, IMPROVE).
We examined the association of PCR (urine protein-creatinine ratio) and hematuria on spot urine samples collected at the end of induction therapy with the occurrence of i) a combined endpoint of death and/or end stage renal disease (ESRD), and ii) relapse during follow-up.

Results

Among 571 patients (59% men, median age 60 years), 60% had PR3-ANCA, 35% had MPO-ANCA, 77% had renal involvement. After induction therapy, 157/526 (29.8%) had persistent hematuria, 165/481 (34.3%) had PCR ≥ 0.05 g/mmol. After a median follow up of 28 months (IQR : 18-42), and adjustment for sex, age, ANCA serotype, initial eGFR, persistent hematuria, a PCR ≥ 0.05 g/mmol after induction was associated with risk of death and/or ESRD (adjusted Hazard Ratio (HR) = 4.08, 95% confidence interval (CI95) 1.48-11.25, p = 0.006). Persistent hematuria was associated with renal relapse (adjusted subdistribution HR = 2.18, CI95 1.14-4.18, p = 0.019) but not with any relapse (adjusted sHR = 1.10, CI95 0.78-1.56, p = 0.59) nor with death and/or ESRD (adjusted HR = 1.88, CI95 = 0.83-4.29, p = 0.132).

Conclusion

In this large cohort of AAV patients, persistent proteinuria after induction therapy was an independent predictor of death and/or ESRD, whereas persistent hematuria after induction therapy was an independent predictor of renal relapse. These parameters must be taken into account to assess long-term renal prognosis of AAV patients.