IgA Nephropathy in Elderly Patients
Por:
Sevillano, AM, Diaz, M, Caravaca-Fontan, F, Barrios, C, Bernis, C, Cabrera, J, Calvino, J, Castillo, L, Cobelo, C, Delgado-Mallen, P, Espinosa, M, Fernandez-Juarez, G, Fernandez-Reyes, MJ, Garcia-Osuna, R, Garcia, P, Goicoechea, M, Gonzalez-Cabrera, F, Guzman, DA, Heras, M, Martin-Reyes, G, Martinez, A, Olea, T, Pena, JK, Quintana, LF, Rabasco, C, Lopez Revuelta, K, Rodas, L, Rodriguez-Mendiola, N, Rodriguez, E, San Miguel, L, Sanchez de la Nieta, MD, Shabaka, A, Sierra, M, Valera, A, Velo, M, Verde, E, Ballarin, J, Noboa, O, Moreno, JA, Gutierrez, E, Praga, M
Publicada:
7 ago 2019
Resumen:
Background and objectivesSome 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, & measurementsIn 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.ResultsWe 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.ConclusionsThe 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.
Filiaciones:
Sevillano, AM:
Hosp 12 Octubre, Dept Nephrol, Avda Cordoba S-N, E-28041 Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Diaz, M:
Fdn Puigvert, Dept Nephrol, Barcelona, Spain
Caravaca-Fontan, F:
Hosp 12 Octubre, Dept Nephrol, Avda Cordoba S-N, E-28041 Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Barrios, C:
Hosp del Mar, Dept Nephrol, Barcelona, Spain
Bernis, C:
Hosp Univ La Princesa, Dept Nephrol, Madrid, Spain
Cabrera, J:
Hosp Clin Montevideo, Soc Uruguaya Nefrol Ctr Nefrol, Programa Prevenc & Tratamiento Glomerulopaties PP, Montevideo, Uruguay
Calvino, J:
Hosp Lucus Augusti, Dept Nephrol, Lugo, Spain
Castillo, L:
Hosp Univ Joan XXIII, Dept Nephrol, Tarragona, Spain
Cobelo, C:
Hosp Lucus Augusti, Dept Nephrol, Lugo, Spain
Delgado-Mallen, P:
Hosp Univ Canarias, Dept Nephrol, Santa Cruz De Tenerife, Spain
Espinosa, M:
Hosp Univ Reina Sofia, Dept Nephrol, Cordoba, Spain
Fernandez-Juarez, G:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Alcorcon, Spain
Fernandez-Reyes, MJ:
Hosp Gen Segovia, Dept Nephrol, Segovia, Spain
Garcia-Osuna, R:
Hosp Palamos, Dept Nephrol, Palamos, Spain
Garcia, P:
Hosp Virgen Victoria, Dept Nephrol, Malaga, Spain
Goicoechea, M:
Hosp Univ Gregorio Maranon, Dept Nephrol, Madrid, Spain
Gonzalez-Cabrera, F:
Hosp Univ Gran Canaria Dr Negrin, Dept Nephrol, Gran Canaria, Spain
Guzman, DA:
Hosp Reg Univ Malaga, Dept Nephrol, Malaga, Spain
Heras, M:
Hosp Gen Segovia, Dept Nephrol, Segovia, Spain
Martin-Reyes, G:
Hosp Reg Univ Malaga, Dept Nephrol, Malaga, Spain
Martinez, A:
Hosp Univ Joan XXIII, Dept Nephrol, Tarragona, Spain
Olea, T:
Hosp Univ La Paz, Dept Nephrol, Madrid, Spain
Pena, JK:
Hosp Principe Asturias, Dept Nephrol, Alcala De Henares, Spain
Quintana, LF:
Hosp Clin Barcelona, Dept Nephrol, Barcelona, Spain
Rabasco, C:
Hosp Univ Reina Sofia, Dept Nephrol, Cordoba, Spain
Lopez Revuelta, K:
Hosp Univ Fdn Alcorcon, Dept Nephrol, Alcorcon, Spain
Rodas, L:
Hosp Clin Barcelona, Dept Nephrol, Barcelona, Spain
Rodriguez-Mendiola, N:
Hosp Univ Ramon & Cajal, Dept Nephrol, Madrid, Spain
Rodriguez, E:
Hosp del Mar, Dept Nephrol, Barcelona, Spain
San Miguel, L:
Fdn Puigvert, Dept Nephrol, Barcelona, Spain
Sanchez de la Nieta, MD:
Hosp Gen Univ Ciudad Real, Dept Nephrol, Ciudad Real, Spain
Shabaka, A:
Hosp Clin Madrid, Dept Nephrol, Madrid, Spain
Sierra, M:
Hosp San Pedro, Dept Nephrol, Logrono, Spain
Valera, A:
Hosp Virgen Victoria, Dept Nephrol, Malaga, Spain
Velo, M:
Hosp Clin Madrid, Dept Nephrol, Madrid, Spain
Verde, E:
Hosp Univ Gregorio Maranon, Dept Nephrol, Madrid, Spain
Ballarin, J:
Fdn Puigvert, Dept Nephrol, Barcelona, Spain
Noboa, O:
Republ Univ, Dept Med, Hosp Clin, Nephrol Ctr, Montevideo, Uruguay
Moreno, JA:
Univ Cordoba, Maimonides Biomed Res Inst Cordoba, Dept Cell Biol Physiol & Immunol, Cordoba, Spain
Gutierrez, E:
Hosp 12 Octubre, Dept Nephrol, Avda Cordoba S-N, E-28041 Madrid, Spain
Praga, M:
Hosp 12 Octubre, Dept Nephrol, Avda Cordoba S-N, E-28041 Madrid, Spain
Univ Complutense Madrid, Dept Med, Madrid, Spain
Bronze, Green Published
|