Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
Kidney Int. 2011 Apr;79(7):757-64. doi: 10.1038/ki.2010.489. Epub 2010 Dec 15.
Antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune glomerulonephritis (GN) is the most common finding in very elderly patients biopsied for acute kidney injury. Appropriate treatment strategies in this age group are currently undefined since it is unclear whether the benefits of immunosuppression exceed the risks. We retrospectively evaluated a cohort of 78 cases of biopsy-proven pauci-immune GN in individuals aged >80 years of whom 72% were p-ANCA and 20% were c-ANCA positive. The patients treated with immunosuppression had a significantly lower incidence of end-stage renal disease (ESRD) 1 year after biopsy (36%) compared with untreated patients (73%; P=0.03). Only peak serum creatinine before biopsy and the use of immunosuppression influenced progression to ESRD. There was no significant difference in the 1-year mortality rates between these groups (46 vs 64%; P=0.3). However, when follow-up was extended beyond 2 years, immunosuppression was associated with a lower risk of death (HR 0.33, 95% CI 0.11-0.97) and death or ESRD (HR 0.16, 95% CI 0.06-0.42) in multivariable models.
抗中性粒细胞胞浆抗体（ANCA）相关性少免疫性肾小球肾炎（GN）是老年急性肾损伤患者活检中最常见的发现。由于尚不清楚免疫抑制的益处是否超过风险，因此目前尚未确定该年龄组的适当治疗策略。我们回顾性评估了 78 例经活检证实的高龄 (>80 岁) 患者的少免疫性 GN 队列，其中 72%为 p-ANCA 阳性，20%为 c-ANCA 阳性。与未接受治疗的患者（73%；P=0.03）相比，接受免疫抑制治疗的患者在活检后 1 年时终末期肾病（ESRD）的发生率显著降低（36%）。只有活检前血清肌酐峰值和免疫抑制的使用影响了 ESRD 的进展。这些组之间的 1 年死亡率没有显著差异（46%与 64%；P=0.3）。然而，当随访时间超过 2 年时，免疫抑制与死亡风险降低相关（HR 0.33，95%CI 0.11-0.97）和死亡或 ESRD（HR 0.16，95%CI 0.06-0.42）在多变量模型中。
