학술논문
OUTCOME IN ELDERLY PATIENTS WITH ANCA - ASSOCIATED GLOMERULONEPHRITIS MANAGED WITH IMMUNOSUPPRESSIVE TREATMENT
Original Scientific Paper
Original Scientific Paper
Document Type
Report
Author
Source
Acta Clinica Croatica. January 2021, Vol. 60 Issue S1, p148, 7 p.
Subject
Language
English
ISSN
0353-9466
Abstract
Introduction Anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA - GN) is a clinical entity in which ANCA-associated vasculitis (AAV) is limited to the kidneys, most commonly resulting in rapid progressive kidney failure [...]
The most common cause of rapidly progressive glomerulonephritis in elderly, antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN), demands immunosuppressive therapy (IS) regimen in a multi-morbid disease burdened population. Our aim was to assess outcome differences in two age groups. The study included a total of 38 ANCA-GN renal limited patients (18 men) treated from 1990 to 2018, of which 11 were 65 years of age and older (median 70, min. - max. 66 - 79 years), and 27 younger than 65 (median 55, min. - max. 23 - 64 years). All patients were treated with mono/combination of IS. Most commonly applied IS in elderly was combination of IV cyclophosphamide and corticosteroids (CS) (in 9 [81.8%]), while in younger it was a combination of CS and cyclophosphamide or rituximab (59.2%). Older patients had comparable mortality (3, [14.8%] vs. 4, [27.3%]; P = 0.369), malignancies (1, [3.7%] vs. 1, [9.1%]; P = 0.5) and infectious complications (10, [46.7%] vs. 7, [63.6%]; P = 0.388). Ten patients at the end of the follow up were at renal replacement therapy (RRT), with no difference between age groups (6, [22.2%] vs. 4, [36.4%]; P = 0.369). Interestingly, from initial need for RRT, half of the younger and older patients recovered with IS. Our findings give more credit to the current paradigm to treat elderly ANCA-GN patients with IS therapy due to the similar outcome of elderly as younger ones. Key words: Antineutrophil Cytoplasmic antibodies, Glomerulonephritis, elderly, Immunosuppression, Mortality, Kidney failure
The most common cause of rapidly progressive glomerulonephritis in elderly, antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN), demands immunosuppressive therapy (IS) regimen in a multi-morbid disease burdened population. Our aim was to assess outcome differences in two age groups. The study included a total of 38 ANCA-GN renal limited patients (18 men) treated from 1990 to 2018, of which 11 were 65 years of age and older (median 70, min. - max. 66 - 79 years), and 27 younger than 65 (median 55, min. - max. 23 - 64 years). All patients were treated with mono/combination of IS. Most commonly applied IS in elderly was combination of IV cyclophosphamide and corticosteroids (CS) (in 9 [81.8%]), while in younger it was a combination of CS and cyclophosphamide or rituximab (59.2%). Older patients had comparable mortality (3, [14.8%] vs. 4, [27.3%]; P = 0.369), malignancies (1, [3.7%] vs. 1, [9.1%]; P = 0.5) and infectious complications (10, [46.7%] vs. 7, [63.6%]; P = 0.388). Ten patients at the end of the follow up were at renal replacement therapy (RRT), with no difference between age groups (6, [22.2%] vs. 4, [36.4%]; P = 0.369). Interestingly, from initial need for RRT, half of the younger and older patients recovered with IS. Our findings give more credit to the current paradigm to treat elderly ANCA-GN patients with IS therapy due to the similar outcome of elderly as younger ones. Key words: Antineutrophil Cytoplasmic antibodies, Glomerulonephritis, elderly, Immunosuppression, Mortality, Kidney failure