Evidence map›Paper›PMID 37395920›Full record

ArticleJournal of nephrology2023

Urinary isomorphic red blood cells for the prediction of disease severity and renal outcomes in MPO-ANCA-associated vasculitis: a retrospective cohort study.

Fangyuan Wang, Yanli Jin, Fangyu Zhou, Liying Luo, Jiale Tang, Lingyu Huang, Xinyue Hu, Zhonghua Liao, Yuanyuan Jiang, Linzi Dengshuang and 5 more

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Article in Journal of nephrology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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3 · Its place in the literature

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2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

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15 authors.

Fangyuan WangDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Yanli JinDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Fangyu ZhouDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Liying LuoDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Jiale TangCenter of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Lingyu HuangDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Xinyue HuCenter of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Zhonghua LiaoDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Yuanyuan JiangDepartment of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Linzi DengshuangCenter of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Huan GeCenter of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Danni SunDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Gong XiaoDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China.
Juntao FengCenter of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
Xiaozhao LiDepartment of Nephrology, Xiangya Hospital, Central South University, Changsha, China. lixiaozhao@csu.edu.cn.ORCID http://orcid.org/0000-0003-2222-9095

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHematuria is common in myeloperoxidase anti-neutrophil cytoplasmic antibody associated vasculitis (ANCA-MPO). Previous studies have mainly focused on urinary dysmorphic red blood cells and few have reported the clinical significance of isomorphic urinary red blood cells. Therefore, the main aim of this study was to assess the predictive yield  of urinary isomorphic red blood cells for disease severity and renal outcomes in patients with ANCA-MPO associated vasculitis.

methodsA total of 191 patients with ANCA-MPO associated vasculitis with hematuria were retrospectively selected and were divided into two groups (with isomorphic red blood cells versus dysmorphic red blood cells) according to the percentage of isomorphic red blood cells on urinary sediment analysis. Clinical, biological and pathological data at diagnosis were compared. Patients were followed up for a median of 25 months and progression to end-stage kidney disease and death were regarded as main outcome events. Additionally, univariate and multivariate Cox regression models were used to estimate the risk factors for end-stage kidney disease.

resultsOut of 191 patients, 115 (60%) had ≥ 70% and 76 (40%) had < 30% urine isomorphic red blood cells. Compared with patients in the dysmorphic red blood cell group, patients in the isomorphic red blood cell group had a significantly lower estimated glomerular filtration rate (eGFR) [10.41 mL/min (IQR 5.84-17.06) versus 12.53 (6.81-29.26); P = 0.026], higher Birmingham Vasculitis Activity Score [16 (IQR 12-18) versus 14 (10-18); P = 0.005] and more often received plasma exchange [40.0% versus 23.7% (P = 0.019)] at diagnosis. Kidney biopsies revealed a higher proportion of patients with glomerular basement membrane fracture in the isomorphic red blood cell group [46.3% versus 22.9% (P = 0.033)]. Furthermore, patients with predominant urinary isomorphic red blood cells were more likely to progress to end-stage kidney disease [63.5% versus 47.4% (P = 0.028)] and had a higher risk of death [31.3% versus 19.7% (P = 0.077)]. The end-stage kidney disease-free survival was lower in patients in the isomorphic red blood cell group (P = 0.024). However, urine isomorphic red blood cells ≥ 70% could not predict the presence of end-stage kidney disease in multivariate Cox analysis.

conclusionMyeloperoxidase-anti-neutrophil cytoplasmic antibody associated vasculitis patients with predominant urinary isomorphic red blood cells at diagnosis had more severe clinical manifestations and a higher risk of poor renal outcomes. In this respect, urinary isomorphic red blood cells could be viewed as a promising biomarker of ANCA_MPO vasculitis severity and progression.

Indexed as

Anti-Neutrophil Cytoplasmic Antibody-Associated VasculitisKidney Failure, ChronicAntibodies, Antineutrophil CytoplasmicHematuriaHumansKidneyPatient AcuityPeroxidaseRetrospective StudiesAntibodies, Antineutrophil CytoplasmicPeroxidaseANCA-associated vasculitisDysmorphic RBCsHematuriaIsomorphic RBCsRenal outcome

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PMID37395920

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