Seokchan Hong1, Soo Min Ahn1, Doo-Ho Lim1, Byeongzu Ghang1, Won Seok Yang2, Sang Koo Lee2, Yong-Gil Kim1, Chang-Keun Lee1, Bin Yoo3. 1. Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 2. Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. 3. Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. byoo@amc.seoul.kr.
Abstract
OBJECTIVES: The aim of this study was to determine whether adult IgA vasculitis patients who developed the disease at an older age differ from early-onset patients in terms of clinical features and outcomes. METHODS: All consecutive adult patients who were diagnosed with IgA vasculitis between January 1997 and December 2014 were reviewed retrospectively. Patients who developed the disease at an older age (≥60 years; late-onset) were compared with those with an earlier onset of disease (<60 years; early-onset). Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml/minute. RESULTS: In total, 100 adult patients were diagnosed with IgA vasculitis (mean age, 45.61 ± 17.24 years), of whom 31 (31%) had late-onset disease. Compared to early-onset patients, late-onset patients were less likely to have a preceding upper respiratory tract infection (0/31, 0.0% vs. 14/69, 20.3%; p=0.004), and more likely to have renal involvement at presentation (27/31, 87.1% vs. 43/69, 62.3%; p=0.017). At the last follow-up visit, late-onset patients were more likely to have chronic renal insufficiency, including end-stage renal disease (18/28, 64.3% vs. 7/62, 11.3%; p=0.000). Multivariate Cox analysis revealed that late-onset was a significant risk factor for renal insufficiency at follow-up (hazard ratio, 16.980, 95% confidence intervals, 4.380-65.830; p=0.000). CONCLUSIONS: Patients with late-onset IgA vasculitis in adults exhibit distinct clinical features characterized by greater renal involvement and worse renal outcomes. Thus, watchful follow-up might be needed for adult IgA vasculitis patients, in particular those with late-onset disease.
OBJECTIVES: The aim of this study was to determine whether adult IgA vasculitispatients who developed the disease at an older age differ from early-onset patients in terms of clinical features and outcomes. METHODS: All consecutive adult patients who were diagnosed with IgA vasculitis between January 1997 and December 2014 were reviewed retrospectively. Patients who developed the disease at an older age (≥60 years; late-onset) were compared with those with an earlier onset of disease (<60 years; early-onset). Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml/minute. RESULTS: In total, 100 adult patients were diagnosed with IgA vasculitis (mean age, 45.61 ± 17.24 years), of whom 31 (31%) had late-onset disease. Compared to early-onset patients, late-onset patients were less likely to have a preceding upper respiratory tract infection (0/31, 0.0% vs. 14/69, 20.3%; p=0.004), and more likely to have renal involvement at presentation (27/31, 87.1% vs. 43/69, 62.3%; p=0.017). At the last follow-up visit, late-onset patients were more likely to have chronic renal insufficiency, including end-stage renal disease (18/28, 64.3% vs. 7/62, 11.3%; p=0.000). Multivariate Cox analysis revealed that late-onset was a significant risk factor for renal insufficiency at follow-up (hazard ratio, 16.980, 95% confidence intervals, 4.380-65.830; p=0.000). CONCLUSIONS:Patients with late-onset IgA vasculitis in adults exhibit distinct clinical features characterized by greater renal involvement and worse renal outcomes. Thus, watchful follow-up might be needed for adult IgA vasculitispatients, in particular those with late-onset disease.
Authors: David T Selewski; Josephine M Ambruzs; Gerald B Appel; Andrew S Bomback; Raed Bou Matar; Yi Cai; Daniel C Cattran; Aftab S Chishti; Vivette D D'Agati; Cynthia J D'Alessandri-Silva; Rasheed A Gbadegesin; Jonathan J Hogan; Sandra Iragorri; J Charles Jennette; Bruce A Julian; Myda Khalid; Richard A Lafayette; Helen Liapis; Francesca Lugani; Sarah A Mansfield; Sherene Mason; Patrick H Nachman; Cynthia C Nast; Carla M Nester; Damien G Noone; Jan Novak; Michelle M O'Shaughnessy; Heather N Reich; Michelle N Rheault; Dana V Rizk; Manish K Saha; Neil S Sanghani; C John Sperati; Rajasree Sreedharan; Tarak Srivastava; Agnieszka Swiatecka-Urban; Katherine Twombley; Tetyana L Vasylyeva; Donald J Weaver; Hong Yin; Jarcy Zee; Ronald J Falk; Ali G Gharavi; Brenda W Gillespie; Debbie S Gipson; Larry A Greenbaum; Lawrence B Holzman; Matthias Kretzler; Bruce M Robinson; William E Smoyer; Michael Flessner; Lisa M Guay-Woodford; Krzysztof Kiryluk Journal: Kidney Int Rep Date: 2018-08-03