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The following is a summary of “Urinary CD4+ T cells Predict Renal Relapse in ANCA-Associated Vasculitis: Results of the PRE-FLARED Study,” published in the January 2024 issue of Nephrology by Luka et al.

Researchers conducted a retrospective study to determine if urinary T cell levels could predict renal relapse in remission in ANCA-associated vasculitis (AAV) patients.

They conducted the PRE-FLARED study, a prospective multicenter biomarker study with 102 AAV individuals in remission. They aimed to predict renal relapse by quantifying urinary CD4+ T cell subsets using flow cytometry at baseline, monitoring clinical outcomes over a six-month follow-up period.

The results showed that ten participants underwent renal relapses, two experienced non-renal flares, and 90 maintained stable remission. Patients with relapses exhibited a significantly higher median baseline urinary CD4+ T cell count than those in remission. Analysis of urinary CD4+ T cell counts through a Receiver Operator Characteristic (ROC) curve showed an Area Under the Curve (AUC) value of 0.88 for predicting renal flares, outperforming ANCA titers, hematuria, and proteinuria. Establishing a cutoff of 490 CD4+ T cells per 100 mL urine, the sensitivity and specificity in identifying patients with future renal flares were 60% and 97.8%, respectively. A post-hoc analysis suggested improved predictive performance in the PR3+ subgroup when combining urinary CD4+ T cell counts with PR3-ANCA levels. Additionally, the number of urinary CD4+ T cells exhibited a limited correlation with a decline in glomerular filtration rate (GFR) and increased proteinuria throughout the follow-up period.

They concluded that a simple urine test identified those at high risk of kidney relapses within 6 months in AAV patients.

Source: journals.lww.com/jasn/abstract/9900/urinary_cd4__t_cells_predict_renal_relapse_in.240.aspx