Renal vasculitis: increasingly a disease of the elderly?
OBJECTIVE
The majority of patients presenting to our district general hospital with renal vasculitis are elderly. Older patients respond less well to treatment and have a poorer prognosis. We investigated the relationship between age and outcome of renal vasculitis in our centre and examined the evidence regarding treatment of elderly patients with this condition.


METHODS
Patients presenting over a 2-year period with renal vasculitis were identified by clinical and histological features and by antineutrophil cytoplasmic autoantibody positivity. They were followed for a mean of 15 months and outcomes were recorded. Results were compared with published studies.


RESULTS
The mean age at presentation of 21 patients was 69 years. Forty-eight percent required dialysis and there was a 33% overall mortality. The mean age of patients in previous treatment studies has been between 50 and 55 years.


CONCLUSIONS
The greater severity of disease at presentation and poorer outcome than previously described is likely to be due to the high proportion of elderly patients. The incidence of vasculitis is increasing in the elderly but as this group has been poorly represented in clinical trials in renal vasculitis, applying the findings of these trials to their treatment may be hazardous. Future research should determine which treatments are safe and effective in the elderly.
Renal Unit, Royal Devon and Exeter Hospital, UK. s.c.satchell@bris.ac.uk
S C
SC
Satchell
A J
AJ
Nicholls
R J
RJ
D'Souza
M
M
Beaman
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000628:therapy; D014890:Granulomatosis with Polyangiitis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007668:Kidney / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D016019:Survival Analysis; D014657:Vasculitis / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy
D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents