Session Title: Vasculitis III
Session Type: Abstract Submissions (ACR)
The antineutrophil cytoplasmic autoantibody (ANCA)- associated vasculitides (AAVs) include microscopic polyangiitis (MPA), granulomatosis with polyangitis (GPA; formerly Wegener’s), and eosinophilic granulomatosis with polyangitis (EGPA). These small-vessel vasculitides are characterized by necrotizing inflammation of the vessel wall, particularly affecting small arteries, arterioles, and capillaries in systemic organs, and the kidney is one of the most frequently involved organs. We have already reported that T cells and macrophages appear in the urine of patients with glomerulonephritis, accompanied by active cellular infiltration such as cellular crescent formation and diffuse interstitial cell infiltration, but not in the urine of patients with glomerulonephritis without the active inflammatory lesions. In this study, we examined the correlation between the numbers of urinary inflammatory cells and disease activity in AAVs, and assessed the utility of urinary immune cell analysis.
Thirty patients with AAVs (MPA; n=26, GPA; n=3, EGPA; n=1), who had been referred to Niigata University Hospital between 2004 and 2012, were recruited for this study. The patients were divided into two groups according to clinical renal function (renal involvement (RI) group, n=24); non-renal involvement (non-RI) group, n=6)). Flow-cytometric analysis of urinary inflammatory cells was performed for each subject. Numbers of urinary T cells or macrophages were determined by multiplying the number of viable cells in the gated mononuclear cell region in each sample by the percentage of urinary CD3-positive or CD14-positive cells in the population, respectively. The numbers of urinary CD3-positive cells and CD14-positive cells, laboratory data including the titers of serum ANCA, serum creatinine and C-reactive protein, and the Birmingham vasculitis activity score (BVAS), were examined in each subject, and compared between the RI and non-RI groups. We then examined the correlations between the numbers of CD3-positive or CD-14-positive cells and laboratory data and BVAS by Spearman’s rank correlation coefficient in all subjects.
The total numbers of urinary CD3-positive cells and CD14-positive cells were significantly elevated (>120/ml urine) in all patients in the RI group and 5 of 6 patients in the non-RI group. The number of urinary CD3-positive cells was positively correlated with the titer of serum ANCA (r=0.41, p=0.02) and BVAS (r=0.38, p=0.038), while the number of urinary CD14-positive cells was positively correlated with serum Cr (r=0.38, p=0.038) and negatively correlated with eGFR (r=-0.38, p=0.03).
These results indicate the usefulness of urinary immune cell analysis for assessment of both kidney function and disease activity in patients with AAVs.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/urinary-inflammatory-cells-strongly-reflect-the-disease-activity-and-renal-function-in-antineutrophil-cytoplasmic-autoantibody-associated-vasculitis/