Clinicopathologic characteristics and outcomes of IgA nephropathy in elder patients

To investigate the clinical, pathological characteristics and outcomes of IgA nephropathy in the elderly.Seventy patients over age 60 with IgA nephropathy were studied and compared with 82 patients under 60 years in the clinical and pathological features as well as the outcomes.Compared with non-elderly group, elder group patients had higher blood pressure [systolic pressure (142.0+/-20.4) mmHg vs (124.2+/-16.9) mmHg (1mmHg=0.133 kPa), diastolic pressure (83.1+/-11.8) mmHg vs (78.9+/-12.3) mmHg], serum creatinine [(172.7+/-125.8) micromol/L vs (94.4+/-42.5) micromol/L], serum cholesterol[(5.7+/-1.6) mmol/L vs (5.1+/-1.6) mmol/L], 24 hj urinary protein excretion rate [(3.4+/-2.9) g/d vs (1.8+/-2.0) g/d], and the incidence of CKD stages 3-5(64.0% vs 14.6%)(P<0.05). No significant differences were seen in the disease courses, rate of gross hematuria, serum triglyceride and serum IgA level between two groups(P>0.05).Renal pathological investigation showed the chronic lesions were dominated in elder group. There was significant difference in portion of glomerular sclerosis [(19.7+/-20.1)% vs (13.4+/-17.8)%], renal tubule atrophy (>1 score,34.2% vs 25.6%), interstitial fibrosis (>1,score 34.2% vs 18.2%), and arteriolosclerosis (>2 score,20.0% vs 8.5%) between two groups (P<0.05). However, there were no significant difference in proportion of mesangial proliferation, crescent and interstitial inflammatory cell infiltration (P>0.05). After a mean post-biopsy follow-up of (34.6+/-33.3) months, the 3-year and the 5-year renal survival rates for elder group were 74.6% and 62.2%, respectively, which were lower than those of non-elder group (100% and 92.9%, P=0.002).Elder patients with IgA nephropathy were more likely to suffer from hypertension, hyperlipidemia, renal insufficiency and chronic pathologic lesions, which might be the risk factors for the patient's unfavorable prognosis.PubMed04401-44