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PLoS One. 2018 May 8;13(5):e0196955. doi: 10.1371/journal.pone.0196955. eCollection 2018.

Distinct characteristics and outcomes in elderly-onset IgA vasculitis (Henoch-Schönlein purpura) with nephritis: Nationwide cohort study of data from the Japan Renal Biopsy Registry (J-RBR).

Author information

1
Department of Nephrology, University of Miyazaki Hospital, Miyazaki, Japan.
2
Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
3
Department of Nephrology, Nagoya University Graduate School of Medicine, Aichi, Japan.
4
Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
5
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan.
6
Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
7
Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
8
Department of Nephrology and Rheumatology, Iwate Prefectural Central Hospital, Iwate, Japan.
9
Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
10
Division of Nephrology and Hypertension, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan.
11
Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan.
12
Department of Nephrology, Sendai Shakai Hoken Hospital, Sendai, Japan.
13
Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
14
Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan.

Abstract

BACKGROUND:

The clinical presentation and prognosis of adult and elderly patients with IgA vasculitis (Henoch-Schönlein purpura) accompanied by nephritis (IgAV-N) have not been investigated in detail. We therefore surveyed the features and outcomes of IgAV-N based on nationwide data derived from the Japan Renal Biopsy Registry (J-RBR).

METHODS:

This multi-center cohort study compared the clinicopathological parameters at diagnosis, initial therapies and outcomes between 106 adult (age 19-64 years) and 46 elderly (≥65 years) patients with IgAV-N who were registered in the J-RBR between 2007 and 2012. The primary end-points comprised a 50% increase in serum creatinine (sCr) values or end-stage kidney disease. Factors affecting a decrease in renal function were assessed using Cox proportional hazards models.

RESULTS:

Rates of hypertension, impaired renal function, hypoalbuminemia and crescentic glomerulonephritis were significantly higher among the elderly, than the adult patients. About 80% and 60% of the patients in both groups were respectively treated with corticosteroid and a renin-angiotensin system (RAS) blockade. Both groups had favorable renal survival rates for nine years (93.6% and 91.4% of the adult and elderly patients, respectively). Significantly more elderly than adult patients developed a 50% increase in sCr during a mean observation period of 3.9 years (21.7% vs. 4.7%, p = 0.012), and significantly fewer elderly, than adult patients achieved clinical remission (23.9% vs. 46.2%, p = 0.016). Multivariate analysis selected advanced age (≥65 years) and lower serum albumin values as independent prognostic factors for a decline in renal function, whereas steroid pulse therapy helped to preserve renal function.

CONCLUSIONS:

The renal prognosis of adult and elderly patients with IgAV-N was favorable when treated aggressively with corticosteroid and RAS blockade. However, the course of renal function should be carefully monitored in patients aged over 65 years and those with hypoalbuminemia.

PMID:
29738576
PMCID:
PMC5940189
DOI:
10.1371/journal.pone.0196955
[Indexed for MEDLINE]
Free PMC Article

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