Vasculitides with predominantly renal involvement: influence of age on the mode of presentation

Vasculitis with predominant renal involvement are increasingly observed in elderly patients. It predominantly involves patients with microscopic polyangiitis, Wegener's granulomatosis, renal limited vasculitis and, in a smaller proportion, Churg Strauss syndrome. The elderly patients present very few obvious symptoms or signs of vasculitis such as hemoptysis and pulmonary infiltrates, and they are often submitted to: 1/renal biopsy when renal failure is already advanced; 2/ have more severe renal disease than do young and middle-aged patients (81% of acute and/or rapidly progressive renal failure versus 62%, and 30% of oliguria versus 6%); and 3/ a worse prognosis compared with younger individuals (probability of survival at 3 months, 1 year and 5 years of 93%, 93% and 92% in patients under 65, versus 67%, 62% and 46% in the elderly). Management of all patients with vasculitis and predominant renal involvement requires a quick diagnosis and immunosuppressive treatment aimed at controlling the disease. Treatment is mantained for 18 to 24 months. Nevertheless, relapses do occur (between 20% to 52%) of all patients with microscopic polyangiitis and Wegener's granulomatosis.