Persistent or New Onset Microscopic Hematuria in Patients with Small Vessel Vasculitis in Remission: Findings on Renal Biopsy

Abstract

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.

Microscopic Haematuria in ANCA-Associated Vasculitis with Glomerulonephritis During Treatment and Remission

“…In this retrospective study of 96 patients with pauci-imune glomerulonephritis it was questioned whether microscopic haematuria in patients with renal vasculitis in clinical remission could represent chronic glomerular injury from prior episodes of disease-activity or may represent new glomerular pathology [1]. We found that in general, haematuria disappears between three and six months after diagnosis and start of induction therapy and that the disappearance coincides in time with stabilisation of renal function.…”

“…The small-vessel vasculitides consist of a heterogeneous group of uncommon systemic multi-organ disorders that are prone to cycles of remission and relapse [1]. These vasculitides include Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and eosinophilic Granulomatosis with Poly-Angiitis (eGPA) [1].…”

“…These vasculitides include Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and eosinophilic Granulomatosis with Poly-Angiitis (eGPA) [1]. These diseases are strongly associated with the presence of antineutrophil cytoplasmic autoantibodies (ANCA): more than 90% of patients have ANCA against proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA) [1][2][3][4].…”

“…These vasculitides include Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA), and eosinophilic Granulomatosis with Poly-Angiitis (eGPA) [1]. These diseases are strongly associated with the presence of antineutrophil cytoplasmic autoantibodies (ANCA): more than 90% of patients have ANCA against proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA) [1][2][3][4]. Renal involvement is the most common severe manifestation in patients with ANCA-associated vasculitis (AAV), manifesting as glomerulonephritis with microscopic haematuria, red blood cell casts, proteinuria and a variable level of renal failure [1][2][3].…”

“…Remission of renal vasculitis is defined as decrease or resolution of clinical disease manifestations and subsequent stabilisation in serum creatinine; thoughts about the resolution of haematuria and/or proteinuria are less clear [1]. It is suggested that the persistence of haematuria in AAV patients (in apparent remission) reflects a kind of smouldering disease-activity or should be considered as a renal flare that might benefit from increasing immunosuppressive therapy [1].…”