Abstract: TH-OR025

Prognosis of Henoch-Schönlein Purpura Nephritis among Adult and Elderly Patients: Nationwide Cohort Study Based on the Japan Renal Biopsy Registry

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Komatsu, Hiroyuki, University of Miyazaki, Miyazaki, Japan
  • Fujimoto, Shouichi, University of Miyazaki, Miyazaki, Japan
  • Sugiyama, Hitoshi, Okayama University Graduate School, Okayama, Japan
  • Sato, Hiroshi, Tohoku University, Sendai, Japan
  • Yokoyama, Hitoshi, Kanazawa Medical University, Ishikawa, Japan

Group or Team Name

  • HSPN study group of J-RBR in Japan
Background

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

Methods

This multi-center cohort study compared the clinico-pathological parameters at diagnosis, initial therapies and outcomes between 106 adult (age 19 - 64 years), and 46 elderly (age ≥ 65 years) patients with HSPN 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 a Cox proportional hazards model.

Results

The rates of hypertension, impaired renal function, hypoalbuminemia, and crescentic glomerulonephritis were significantly higher among the elderly, compared with the adult patients. About 80% and 60% of the patients in both groups were respectively treated with corticosteroid and renin-angiotensin system (RAS) inhibitors. 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). In addition, significantly fewer elderly than adult patients achieved clinical remission (24% vs. 46%, p = 0.016). Multivariate analysis revealed that advanced age (≥ 65 years) was an independent prognostic factor for a decline in renal function (HR, 6.08; p = 0.018).

Conclusion

The renal prognosis of adult and elderly patients with HSPN was favorable when treated aggressively with corticosteroid and RAS inhibitors. However, the course of renal function should be carefully monitored in patients aged over 65 years.