AIM: Data on clinicopathological features, treatment and outcomes of IgA nephropathy (IgAN) in elderly patients are limited. METHODS: Native kidney biopsies with a pathological diagnosis of IgAN (n = 1084) from Mayo Clinic Rochester in the years 1994-2013 were examined. After exclusion of the secondary IgAN, 45 elderly IgAN patients (age ≥65 years) were identified. One hundred sixty-two younger adults (age 18-64 years) with IgAN were randomly selected for comparison. RESULTS: Compared with younger adults, elderly patients showed a higher rate of chronic hypertension (62.2 vs 27.2%), higher pulse pressures (65 ± 17 vs 51 ± 15 mmHg), requiring greater number of antihypertensive medications (2.5 ± 1.2 vs 1.7 ± 0.7) and lower blood haemoglobin (11.1 ± 2.3 vs 12.7 ± 2.1 g/dL) at time of kidney biopsy, all P < 0.001. Pathologically, elderly kidneys showed a higher degree of tubulointerstitial fibrosis (P = 0.04) and vascular sclerosis (P < 0.001). Treatments (including the use of angiotensin-converting enzyme inhibitor (ACEI) inhibitor, angiotensin II receptor blocker (ARB) and immunosuppressants) were similar in the two cohorts. Elderly patients had more end-stage renal disease at 6 months (HR 5.51; 95% CI 1.46-22.3, P = 0.01) and higher 6-month and 5-year mortality (HR 2.31; 95% CI 1.04-5.17, P = 0.04) after adjusting the age and comorbidities. CONCLUSION: IgAN diagnosed at age >65 years tends to have a faster renal disease progression and higher patient mortality.
AIM: Data on clinicopathological features, treatment and outcomes of IgA nephropathy (IgAN) in elderly patients are limited. METHODS: Native kidney biopsies with a pathological diagnosis of IgAN (n = 1084) from Mayo Clinic Rochester in the years 1994-2013 were examined. After exclusion of the secondary IgAN, 45 elderly IgANpatients (age ≥65 years) were identified. One hundred sixty-two younger adults (age 18-64 years) with IgAN were randomly selected for comparison. RESULTS: Compared with younger adults, elderly patients showed a higher rate of chronic hypertension (62.2 vs 27.2%), higher pulse pressures (65 ± 17 vs 51 ± 15 mmHg), requiring greater number of antihypertensive medications (2.5 ± 1.2 vs 1.7 ± 0.7) and lower blood haemoglobin (11.1 ± 2.3 vs 12.7 ± 2.1 g/dL) at time of kidney biopsy, all P < 0.001. Pathologically, elderly kidneys showed a higher degree of tubulointerstitial fibrosis (P = 0.04) and vascular sclerosis (P < 0.001). Treatments (including the use of angiotensin-converting enzyme inhibitor (ACEI) inhibitor, angiotensin II receptor blocker (ARB) and immunosuppressants) were similar in the two cohorts. Elderly patients had more end-stage renal disease at 6 months (HR 5.51; 95% CI 1.46-22.3, P = 0.01) and higher 6-month and 5-year mortality (HR 2.31; 95% CI 1.04-5.17, P = 0.04) after adjusting the age and comorbidities. CONCLUSION:IgAN diagnosed at age >65 years tends to have a faster renal disease progression and higher patient mortality.
Authors: Angel M Sevillano; Monserrat Diaz; Fernando Caravaca-Fontán; Clara Barrios; Carmen Bernis; Jimena Cabrera; Jesus Calviño; Lorena Castillo; Carmen Cobelo; Patricia Delgado-Mallén; Mario Espinosa; Gema Fernandez-Juarez; Maria Jose Fernandez-Reyes; Rosa Garcia-Osuna; Patricia Garcia; Marian Goicoechea; Fayna Gonzalez-Cabrera; Diomaris A Guzmán; Manuel Heras; Guillermo Martín-Reyes; Alberto Martinez; Teresa Olea; Jessy Korina Peña; Luis F Quintana; Cristina Rabasco; Katia López Revuelta; Lida Rodas; Nuria Rodriguez-Mendiola; Eva Rodriguez; Luz San Miguel; Maria Dolores Sanchez de la Nieta; Amir Shabaka; Milagros Sierra; Alfonso Valera; Mercedes Velo; Eduardo Verde; Jose Ballarin; Oscar Noboa; Juan Antonio Moreno; Eduardo Gutiérrez; Manuel Praga Journal: Clin J Am Soc Nephrol Date: 2019-07-16 Impact factor: 8.237