Ueda Hiroyuki, Miyazaki Yoichi, Tsuboi Nobuo, Hirano Keita, Yokote Shinya, Kobayashi Emi, Ogura Makoto, Kawamura Tetsuya, Ryuzaki Munekazu, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Japan.
Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Japan.
Intern Med. 2019 Jan 1;58(1):31-38. doi: 10.2169/internalmedicine.1379-18. Epub 2018 Aug 10.
Objective This case series aimed to identify the clinical and pathological characteristics of elderly patients (≥60 years) with biopsy-proven IgA vasculitis with nephritis (IgAVN). Methods The clinical and pathological presentation and treatment outcomes were compared between two groups. Patients Patients with IgAVN who were ≥19 years old at the time of their renal biopsy were divided into elderly (≥60 years) and adult (19-59 years) groups. Results Of the 23 patients in our study, 13 were elderly. In the elderly group, the median age at the diagnosis was 68 years (range, 60-85 years), with a median follow-up period of 15 months (range, 3-80 months). Twelve elderly patients had comorbidities, including hypertension, diabetes mellitus, chronic kidney disease, cardiovascular disease, and malignancies. A decrease in the estimated glomerular filtration rate, as well as massive proteinuria and rapidly progressive nephritic syndrome, were more frequent in the elderly group than in the adult group. Furthermore, renal pathological changes, including cellular or fibrocellular crescents, interstitial fibrosis, tubular atrophy, and arteriosclerosis, were more severe among elderly patients than adult patients. All elderly patients were treated with glucocorticoids and had no incidence of end-stage renal disease at the final follow-up; in addition, nine elderly patients had reduced proteinuria with a preserved renal function. Adverse events, including infection, diabetes mellitus, and vascular disorders, were identified in nine patients. Three elderly patients died from severe infections. Conclusion IgAVN in elderly patients is characterized by severe renal involvement. Elderly patients are at higher risk than adults for treatment-related adverse events.
目的 本病例系列旨在确定经活检证实为IgA血管炎伴肾炎（IgAVN）的老年患者（≥60岁）的临床和病理特征。方法 比较两组患者的临床、病理表现及治疗结果。患者 将肾活检时年龄≥19岁的IgAVN患者分为老年组（≥60岁）和成年组（19 - 59岁）。结果 在我们研究的23例患者中，13例为老年人。老年组诊断时的中位年龄为68岁（范围60 - 85岁），中位随访期为15个月（范围3 - 80个月）。12例老年患者有合并症，包括高血压、糖尿病、慢性肾脏病、心血管疾病和恶性肿瘤。老年组估算肾小球滤过率下降、大量蛋白尿及快速进展性肾炎综合征的发生率高于成年组。此外，老年患者的肾脏病理改变，包括细胞性或纤维细胞性新月体、间质纤维化、肾小管萎缩和动脉硬化，比成年患者更严重。所有老年患者均接受糖皮质激素治疗，末次随访时无终末期肾病发生；此外，9例老年患者蛋白尿减少且肾功能得以保留。9例患者出现不良事件，包括感染、糖尿病和血管疾病。3例老年患者死于严重感染。结论 老年患者IgAVN的特点是肾脏受累严重。老年患者发生治疗相关不良事件的风险高于成年人。
