title: Increase of Antimyeloperoxidase Antineutrophil Cytoplasmic Antibody (ANCA) in Patients with Renal ANCA-associated Vasculitis: Association with Risk to Relapse.
abstract: OBJECTIVE
  The diagnostic values of antiproteinase 3 and antimyeloperoxidase tests using antineutrophil cytoplasmic antibodies (ANCA) are well established. Our study determined whether an increase in ANCA level was a predictor of disease flareup.
  
  
  METHODS
  Our study included 126 patients with ANCA-associated renal vasculitis treated at 9 nephrology centers in Japan. The relationship between increased ANCA levels and relapse was assessed using time-dependent multivariate Cox regression models adjusted for clinically relevant factors. The outcome of interest was the time from remission to first relapse.
  
  
  RESULTS
  During the observation period [median 41 mos, interquartile range (IQR) 23-66 mos], 118 patients (95.8%) achieved remission at least once. After achieving remission, 34 patients relapsed (21.7%). Time-dependent multivariate Cox regression models revealed that lung involvement (adjusted HR 2.29, 95% CI 1.13-4.65, p = 0.022) and increased ANCA levels (adjusted HR 17.4, 95% CI 8.42-36.0, p < 0.001) were significantly associated with relapse. The median time from ANCA level increase to relapse was 0.6 months (IQR 0-2.1 mos).
  
  
  CONCLUSIONS
  In our study, an increase in ANCA level during remission was associated with a risk of disease relapse. A rise in ANCA level may be useful for guiding treatment decisions in appropriate subsets of patients with ANCA-associated vasculitis.
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamaguchi
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Sawako
authors.initials: S
authors.lastname: Kato
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Katsuno
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kato
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kosugi
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Waichi
authors.initials: W
authors.lastname: Sato
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Naotake
authors.initials: N
authors.lastname: Tsuboi
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Yasuda
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ito
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
authors.affiliation: From the Department of Nephrology, Nagoya University Graduate School of Medicine; Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya; Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.M. Yamaguchi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; M. Ando, MD, PhD, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital; S. Kato, MD, PhD; T. Katsuno, MD, PhD; N. Kato, MD, PhD; T. Kosugi, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine; W. Sato, MD, PhD, Department of Internal Medicine, Fujita Health University School of Medicine; N. Tsuboi, MD, PhD; Y. Yasuda, MD, PhD; M. Mizuno, MD, PhD; Y. Ito, MD, PhD; S. Matsuo, MD, PhD; S. Maruyama, MD, PhD, Department of Nephrology, Nagoya University Graduate School of Medicine. marus@med.nagoya-u.ac.jp.
authors.forename: Shoichi
authors.initials: S
authors.lastname: Maruyama
mesh_terms: D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood* / Q000628:therapy*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010956:Plasmapheresis / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D007166:Immunosuppressive Agents
keywords: ANCA LEVEL; ANCA-ASSOCIATED VASCULITIS; ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; GRANULOMATOSIS WITH POLYANGIITIS; MICROSCOPIC POLYANGIITIS; RELAPSE