Primary IgA nephropathy in elderly patients.
OBJECTIVE
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.


CONCLUSIONS
IgAN diagnosed at age >65 years tends to have a faster renal disease progression and higher patient mortality.
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Wisit
W
Cheungpasitporn
Samih H
SH
Nasr
Charat
C
Thongprayoon
Michael A
MA
Mao
Qi
Q
Qian
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001706:Biopsy; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D015897:Comorbidity; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents
chronic kidney disease; elderly patient; end-stage renal failure; kidney disease progression; mortality; primary IgA nephropathy