title: ANCA-associated glomerulonephritis in the very elderly.
abstract: Antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis (GN) is the most common finding in very elderly patients biopsied for acute kidney injury. Appropriate treatment strategies in this age group are currently undefined since it is unclear whether the benefits of immunosuppression exceed the risks. We retrospectively evaluated a cohort of 78 cases of biopsy-proven pauci-immune GN in individuals aged >80 years of whom 72% were p-ANCA and 20% were c-ANCA positive. The patients treated with immunosuppression had a significantly lower incidence of end-stage renal disease (ESRD) 1 year after biopsy (36%) compared with untreated patients (73%; P=0.03). Only peak serum creatinine before biopsy and the use of immunosuppression influenced progression to ESRD. There was no significant difference in the 1-year mortality rates between these groups (46 vs 64%; P=0.3). However, when follow-up was extended beyond 2 years, immunosuppression was associated with a lower risk of death (HR 0.33, 95% CI 0.11-0.97) and death or ESRD (HR 0.16, 95% CI 0.06-0.42) in multivariable models.
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. asb68@columbia.edu
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Bomback
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Appel
authors.forename: Jai
authors.initials: J
authors.lastname: Radhakrishnan
authors.forename: Shayan
authors.initials: S
authors.lastname: Shirazian
authors.forename: Leal C
authors.initials: LC
authors.lastname: Herlitz
authors.forename: Barry
authors.initials: B
authors.lastname: Stokes
authors.forename: Vivette D
authors.initials: VD
authors.lastname: D'Agati
authors.forename: Glen S
authors.initials: GS
authors.lastname: Markowitz
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D009519:New York City; D016017:Odds Ratio; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers; D007166:Immunosuppressive Agents; D003404:Creatinine