engleski

Outcome in elderly patients with ANCA – associated glomerulonephritis managed with immunosuppressive treatment

The most common cause of rapidly progressive glomerulonephritis in elderly, anti- neutrophil 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.

antineutrophil cytoplasmic antibodies ; glomerulonephritis ; elderly ; immunosuppression ; mortality ; kidney failure

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