Persistent or new onset microscopic hematuria in patients with small vessel vasculitis in remission: findings on renal biopsy.
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.


CONCLUSIONS
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.
Division of Nephrology, Johns Hopkins Bayview Medical Center, 301 Mason Lord Drive, Room 2509, Baltimore, MD 21224, USA. gduvura@jhmi.edu
Duvuru
D
Geetha
Philip
P
Seo
Carla
C
Ellis
Michael
M
Kuperman
Stuart M
SM
Levine
D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000473:pathology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000473:pathology*; D005922:Glomerulonephritis, IGA / Q000473:pathology; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology; D006417:Hematuria / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000098:blood supply* / Q000473:pathology*; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
D019268:Antibodies, Antineutrophil Cytoplasmic