Primary IgA nephropathy in elderly patients.

Area of Science:

• Nephrology
• Immunology
• Geriatric Medicine

Background:

• Limited data exists on the clinicopathological features, treatment, and outcomes of Immunoglobulin A nephropathy (IgAN) specifically in elderly populations.
• Understanding IgAN in older adults is crucial due to potential differences in disease presentation and progression compared to younger demographics.

Purpose of the Study:

• To investigate the clinicopathological characteristics, treatment approaches, and patient outcomes of IgA nephropathy in elderly patients (age ≥65 years).
• To compare the features and outcomes of IgAN in elderly patients with those in younger adult patients.

Main Methods:

• Retrospective analysis of 1084 native kidney biopsies diagnosed with IgAN (1994-2013) at Mayo Clinic Rochester.
• Identification of 45 elderly IgAN patients (≥65 years) and comparison with 162 younger adult IgAN patients (18-64 years).
• Exclusion of secondary causes of IgAN and adjustment for age and comorbidities in outcome analysis.

Main Results:

• Elderly IgAN patients exhibited higher rates of chronic hypertension, increased pulse pressures, and required more antihypertensive medications.
• Pathological examination revealed greater tubulointerstitial fibrosis and vascular sclerosis in elderly kidneys.
• Despite similar treatments, elderly patients experienced more rapid progression to end-stage renal disease and significantly higher 6-month and 5-year mortality.

Conclusions:

• IgA nephropathy diagnosed in individuals over 65 years old is associated with more aggressive renal disease progression.
• Elderly patients with IgAN face a substantially higher risk of patient mortality compared to their younger counterparts.