Abstract: TH-PO1017
Characteristics of IgA Nephropathy in the Elderly: Results from a Multicenter, Large-Scale, Long-Term Observational Cohort Study
Session Information
- Glomerular Diseases: Minimal Change Disease, FSGS, IgAN
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Tsunoda, Ryoya, University of Tsukuba, Tsukuba-City, Japan
- Usui, Joichi, University of Tsukuba, Tsukuba-City, Japan
- Hoshino, Junichi, Toranomon Hospital, Tokyo, Japan
- Fujii, Takayuki, Seirei Sakura Citizen Hospital, Sakura-City, Japan
- Suzuki, Satoshi, Seirei Sakura Citizen Hospital, Sakura-City, Japan
- Ubara, Yoshifumi, Toranomon Hospital Kajigaya, Kawasaki, Japan
- Takaichi, Kenmei, Toranomon Hospital, Tokyo, Japan
- Yamagata, Kunihiro, University of Tsukuba, Tsukuba-City, Japan
Background
Aging of population is a worldwide matter. Especially in Japan, more than 10 years passed after super-aged society had come. Due to increasing number of kidney biopsy underwent for elderly people, the number of aged people who diagnosed IgA nephropathy is also growing. However, little is known about characteristics of IgA nephropathy in the elderly. The indication of corticosteroids or renin-angiotensin system inhibitors is unclear.
Methods
We defined “elderly patients” as patients aged 65 or over at the diagnosis, and “younger patients” as 15-64 years old. Using our multicenter, large-scale, long-term retrospective cohort of IgA nephropathy diagnosed by kidney biopsy during 1981-2013, we extracted elderly patients and investigated their cross-sectional clinical characteristics, pathological features, and renal survival compared to younger patients. Survival analysis was performed by Kaplan-Meier method.
Results
The age at kidney biopsy was dramatically increasing during 30 years of registration period. Among 1,924 patients, 151 (7.8%) patients were aged 65 or older. Their median follow-up period was 46 [18-95] month, and their estimated glomerular filtration rate (eGFR, mL/min/1.73m2) was 42.7 [27.1-53.4]. The proportion of CKD stage G1-2 in elderly patients was only 16%, while 60% in younger patients. Amount of urine protein was 1.0 [0.42-2.2] g/gCr. Twenty-five percent of elderly patients had diabetes, while only 5% of younger patients had. The percentage of totally sclerosed glomeruli in elderly patients was higher than that of younger patients. In survival analysis, elderly patients with proteinuria ≥1g/gCr, those having diabetes, and those with global sclerosis in more than half of glomeruli, were significantly associated with poor renal prognosis. Similar to younger patients, corticosteroids were used for 37.7% of elderly patients. However, use of corticosteroids or renin-angiotensin system inhibitors for the elderly patients were not associated with better long-term renal outcome.
Conclusion
Population of IgA nephropathy rapidly aged in Japan. IgA nephropathy in the elderly was characterized by progressed CKD with decreased eGFR and global sclerosis of glomeruli. We need to establish a strategy for treatment for IgA nephropathy in the elderly.
Funding
- Government Support - Non-U.S.