Outcome in Elderly Patients with Anca – Associated Glomerulonephritis Managed with Immunosuppressive Treatment

Abstract

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.

Keywords

• Antineutrophil Cytoplasmic antibodies
• Glomerulonephritis
• Elderly
• Immunosuppression
• Mortality
• Kidney failure