RT Journal Article
SR Electronic
T1 Persistent or New Onset Microscopic Hematuria in Patients with Small Vessel Vasculitis in Remission: Findings on Renal Biopsy
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1413
OP 1417
DO 10.3899/jrheum.111608
VO 39
IS 7
A1 DUVURU GEETHA
A1 PHILIP SEO
A1 CARLA ELLIS
A1 MICHAEL KUPERMAN
A1 STUART M. LEVINE
YR 2012
UL http://www.jrheum.org/content/39/7/1413.abstract
AB Objective. Hematuria is considered a sign of active renal disease in patients with small-vessel vasculitis. In patients who are in apparent clinical remission, presence of persistent or new-onset microscopic hematuria may reflect active vasculitis, damage, or other glomerular pathology. Methods. We identified 74 patients from the Johns Hopkins Renal Pathology database between 1995 and 2009 with the diagnosis of pauciimmune glomerulonephritis (GN). Among them we identified 9 who were in clinical remission and underwent a renal biopsy for evaluation of persistent or new-onset hematuria. Results. Nine patients with small-vessel vasculitis, 8 antineutrophil cytoplasmic antibody (ANCA)-positive and 1 ANCA-negative, underwent a renal biopsy at variable time periods after remission of vasculitis (6 to 164 months) for persistent microscopic hematuria (n = 6) or new-onset microscopic hematuria (n = 3). All patients were in apparent clinical remission at the time of renal biopsy. Of the 3 patients presenting with new-onset hematuria, 2 had crescentic IgA nephropathy and 1 had healed crescentic pauciimmune GN. Of the 6 patients with persistent hematuria, 2 had arteriosclerosis, 2 had focal segmental glomerulosclerosis, and 2 had global and segmental glomerulosclerosis and healed crescentic GN, and none had active vasculitis. Conclusion. Microscopic hematuria in patients with renal vasculitis otherwise in remission could represent chronic glomerular injury from prior episode of vasculitis or may represent new glomerular pathology. Renal biopsy should be considered in these patients to guide therapy.