IgA vasculitis nephritis-outcomes in adult-onset disease.

Autor:	Stanway J; UCL Centre for Nephrology, Royal Free Hospital, London, UK., Brown N; Department of Nephrology, Salford Royal Foundation Trust, Salford, UK., Pervez A; Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK., Van de Perre E; Vasculitis Clinic, Addenbrookes Hospital, Hills Road, Cambridge, UK., Tollitt J; Department of Nephrology, Salford Royal Foundation Trust, Salford, UK., Marketos N; Department of Clinical and Experimental Sciences and Department of Rheumatology, Linköping University, Linköping, Sweden., Wong N; Renal and Vascular Inflammation Section, Imperial College London, London, UK., Dhaygude A; Department of Nephrology, Royal Preston Hospital, Preston, UK., Ponnusamy A; Department of Nephrology, Royal Preston Hospital, Preston, UK., O'Riordan E; Department of Nephrology, Salford Royal Foundation Trust, Salford, UK., Venning M; Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK., Segelmark M; Department of Medical and Health Sciences and Department of Nephrology, Linköping University, Linköping, Sweden., Morgan M; Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK., Jayne D; Vasculitis Clinic, Addenbrookes Hospital, Hills Road, Cambridge, UK., Hamilton P; Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK., Pusey CD; Renal and Vascular Inflammation Section, Imperial College London, London, UK., Oni L; Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden., Salama AD; UCL Centre for Nephrology, Royal Free Hospital, London, UK.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Jan 25. Date of Electronic Publication: 2024 Jan 25.
DOI:	10.1093/rheumatology/keae030
Abstrakt:	Objectives: IgA vasculitis (IgAV) in adults has been relatively under-investigated. Since outcomes are worse in other forms of vasculitis with increasing age, we investigated the outcomes of IgAV comparing younger adults (18-34), middle aged adults (35-64) and elderly patients (≥64 years) focusing on kidney outcomes. Methods: We identified patients with renal biopsy confirmed IgAV nephritis and collected data regarding clinical features and progression to end stage kidney disease (ESKD). The relationship between patient factors and ESKD was analysed by regression. Results: We identified 202 cases, 34% aged 18-34, 43% aged 35-64 and 23% were elderly (>64 years). Median follow up was 44 months. Elderly patients were more likely to present with ESKD (23.9%) compared with middle aged (13.7%) and younger adults (2.9%)(χ2 11.6, p= 0.002). In patients with independent kidney function at biopsy, there was no difference in outcomes between age groups. Male gender, Black ethnicity, diabetes, histological evidence of chronic renal damage and eGFR < 30mls/min were risk factors for development of ESKD. In this observational study 68.3% of patients received glucocorticoids and 56.9% additional immunosuppression. Conclusions: Elderly patients with IgAV are more likely to have ESKD at presentation, but there is no difference in renal survival between age groups, among those presenting with independent renal function. Renal impairment at biopsy is an independent risk factor for subsequent development of ESKD. There is significant variability in the timing of kidney biopsy and management of these patients among specialist centres. Young adults have outcomes more in keeping with childhood IgAV. (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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