IgA Nephropathy in Elderly Patients
Copyright © 2019 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: Some studies suggest that the incidence of IgA nephropathy is increasing in older adults, but there is a lack of information about the epidemiology and behavior of the disease in that age group.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective multicentric study, we analyzed the incidence, forms of presentation, clinical and histologic characteristics, treatments received, and outcomes in a cohort of 151 patients ≥65 years old with biopsy-proven IgA nephropathy diagnosed between 1990 and 2015. The main outcome was a composite end point of kidney replacement therapy or death before kidney replacement therapy.
RESULTS: We found a significant increase in the diagnosis of IgA nephropathy over time from six patients in 1990-1995 to 62 in 2011-2015 (P value for trend =0.03). After asymptomatic urinary abnormalities (84 patients; 55%), AKI was the most common form of presentation (61 patients; 40%). Within the latter, 53 (86%) patients presented with hematuria-related AKI (gross hematuria and tubular necrosis associated with erythrocyte casts as the most important lesions in kidney biopsy), and eight patients presented with crescentic IgA nephropathy. Six (4%) patients presented with nephrotic syndrome. Among hematuria-related AKI, 18 (34%) patients were receiving oral anticoagulants, and this proportion rose to 42% among the 34 patients older than 72 years old who presented with hematuria-related AKI. For the whole cohort, survival rates without the composite end point were 74%, 48%, and 26% at 1, 2, and 5 years, respectively. Age, serum creatinine at presentation, and the degree of interstitial fibrosis in kidney biopsy were risk factors significantly associated with the outcome, whereas treatment with renin-angiotensin-aldosterone blockers was associated with a lower risk. Immunosuppressive treatments were not significantly associated with the outcome.
CONCLUSIONS: The diagnosis of IgA nephropathy among older adults in Spain has progressively increased in recent years, and anticoagulant therapy may be partially responsible for this trend. Prognosis was poor.
PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_07_16_CJASNPodcast_19_08_.mp3.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2019 |
|---|---|
| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
|---|---|
| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 14(2019), 8 vom: 07. Aug., Seite 1183-1192 |
| Sprache: |
Englisch |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 22.10.2020 Date Revised 02.05.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.2215/CJN.13251118 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM299247031 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM299247031 | ||
| 003 | DE-627 | ||
| 005 | 20231225095925.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2019 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.2215/CJN.13251118 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0997.xml |
| 035 | |a (DE-627)NLM299247031 | ||
| 035 | |a (NLM)31311818 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sevillano, Angel M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a IgA Nephropathy in Elderly Patients |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 22.10.2020 | ||
| 500 | |a Date Revised 02.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Some studies suggest that the incidence of IgA nephropathy is increasing in older adults, but there is a lack of information about the epidemiology and behavior of the disease in that age group | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this retrospective multicentric study, we analyzed the incidence, forms of presentation, clinical and histologic characteristics, treatments received, and outcomes in a cohort of 151 patients ≥65 years old with biopsy-proven IgA nephropathy diagnosed between 1990 and 2015. The main outcome was a composite end point of kidney replacement therapy or death before kidney replacement therapy | ||
| 520 | |a RESULTS: We found a significant increase in the diagnosis of IgA nephropathy over time from six patients in 1990-1995 to 62 in 2011-2015 (P value for trend =0.03). After asymptomatic urinary abnormalities (84 patients; 55%), AKI was the most common form of presentation (61 patients; 40%). Within the latter, 53 (86%) patients presented with hematuria-related AKI (gross hematuria and tubular necrosis associated with erythrocyte casts as the most important lesions in kidney biopsy), and eight patients presented with crescentic IgA nephropathy. Six (4%) patients presented with nephrotic syndrome. Among hematuria-related AKI, 18 (34%) patients were receiving oral anticoagulants, and this proportion rose to 42% among the 34 patients older than 72 years old who presented with hematuria-related AKI. For the whole cohort, survival rates without the composite end point were 74%, 48%, and 26% at 1, 2, and 5 years, respectively. Age, serum creatinine at presentation, and the degree of interstitial fibrosis in kidney biopsy were risk factors significantly associated with the outcome, whereas treatment with renin-angiotensin-aldosterone blockers was associated with a lower risk. Immunosuppressive treatments were not significantly associated with the outcome | ||
| 520 | |a CONCLUSIONS: The diagnosis of IgA nephropathy among older adults in Spain has progressively increased in recent years, and anticoagulant therapy may be partially responsible for this trend. Prognosis was poor | ||
| 520 | |a PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_07_16_CJASNPodcast_19_08_.mp3 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Angiotensins | |
| 650 | 4 | |a Anticoagulants | |
| 650 | 4 | |a Biopsy | |
| 650 | 4 | |a Erythrocytes | |
| 650 | 4 | |a Glomerulonephritis, IGA | |
| 650 | 4 | |a Hematuria | |
| 650 | 4 | |a IgA nephropathy | |
| 650 | 4 | |a Incidence | |
| 650 | 4 | |a Kidney Function Tests | |
| 650 | 4 | |a Prognosis | |
| 650 | 4 | |a Renal Replacement Therapy | |
| 650 | 4 | |a Renin | |
| 650 | 4 | |a Retrospective Studies | |
| 650 | 4 | |a acute kidney injury | |
| 650 | 4 | |a acute renal failure | |
| 650 | 4 | |a aldosterone | |
| 650 | 4 | |a anticoagulation therapy | |
| 650 | 4 | |a creatinine | |
| 650 | 4 | |a hematuria | |
| 650 | 4 | |a nephrotic syndrome | |
| 650 | 4 | |a risk factors | |
| 700 | 1 | |a Diaz, Monserrat |e verfasserin |4 aut | |
| 700 | 1 | |a Caravaca-Fontán, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Barrios, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a Bernis, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Cabrera, Jimena |e verfasserin |4 aut | |
| 700 | 1 | |a Calviño, Jesus |e verfasserin |4 aut | |
| 700 | 1 | |a Castillo, Lorena |e verfasserin |4 aut | |
| 700 | 1 | |a Cobelo, Carmen |e verfasserin |4 aut | |
| 700 | 1 | |a Delgado-Mallén, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Espinosa, Mario |e verfasserin |4 aut | |
| 700 | 1 | |a Fernandez-Juarez, Gema |e verfasserin |4 aut | |
| 700 | 1 | |a Fernandez-Reyes, Maria Jose |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia-Osuna, Rosa |e verfasserin |4 aut | |
| 700 | 1 | |a Garcia, Patricia |e verfasserin |4 aut | |
| 700 | 1 | |a Goicoechea, Marian |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalez-Cabrera, Fayna |e verfasserin |4 aut | |
| 700 | 1 | |a Guzmán, Diomaris A |e verfasserin |4 aut | |
| 700 | 1 | |a Heras, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Martín-Reyes, Guillermo |e verfasserin |4 aut | |
| 700 | 1 | |a Martinez, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Olea, Teresa |e verfasserin |4 aut | |
| 700 | 1 | |a Peña, Jessy Korina |e verfasserin |4 aut | |
| 700 | 1 | |a Quintana, Luis F |e verfasserin |4 aut | |
| 700 | 1 | |a Rabasco, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a López Revuelta, Katia |e verfasserin |4 aut | |
| 700 | 1 | |a Rodas, Lida |e verfasserin |4 aut | |
| 700 | 1 | |a Rodriguez-Mendiola, Nuria |e verfasserin |4 aut | |
| 700 | 1 | |a Rodriguez, Eva |e verfasserin |4 aut | |
| 700 | 1 | |a San Miguel, Luz |e verfasserin |4 aut | |
| 700 | 1 | |a Sanchez de la Nieta, Maria Dolores |e verfasserin |4 aut | |
| 700 | 1 | |a Shabaka, Amir |e verfasserin |4 aut | |
| 700 | 1 | |a Sierra, Milagros |e verfasserin |4 aut | |
| 700 | 1 | |a Valera, Alfonso |e verfasserin |4 aut | |
| 700 | 1 | |a Velo, Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Verde, Eduardo |e verfasserin |4 aut | |
| 700 | 1 | |a Ballarin, Jose |e verfasserin |4 aut | |
| 700 | 1 | |a Noboa, Oscar |e verfasserin |4 aut | |
| 700 | 1 | |a Moreno, Juan Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Gutiérrez, Eduardo |e verfasserin |4 aut | |
| 700 | 1 | |a Praga, Manuel |e verfasserin |4 aut | |
| 700 | 0 | |a Spanish Group for the Study of Glomerular Diseases (GLOSEN) |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Clinical journal of the American Society of Nephrology : CJASN |d 2006 |g 14(2019), 8 vom: 07. Aug., Seite 1183-1192 |w (DE-627)NLM172123720 |x 1555-905X |7 nnns |
| 773 | 1 | 8 | |g volume:14 |g year:2019 |g number:8 |g day:07 |g month:08 |g pages:1183-1192 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.2215/CJN.13251118 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 14 |j 2019 |e 8 |b 07 |c 08 |h 1183-1192 | ||