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IgA Nephropathy in the Elderly
Dana V Rizk1, Emily Dryer1,2, Ashutosh Tamhane1
1Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Kidney International Reports
|August 15, 2025
Summary
IgA nephropathy (IgAN) in elderly patients presents severely and has a poor prognosis. Older adults diagnosed with IgAN face a high risk of kidney failure and death.
Area of Science:
- Nephrology
- Geriatric Medicine
- Immunology
Background:
- Limited knowledge exists regarding the clinical presentation and prognosis of IgA nephropathy (IgAN) in elderly patients.
- IgAN is a common primary glomerulonephritis, but its impact on older populations requires further investigation.
Purpose of the Study:
- To assess the clinical and histologic findings in patients aged 60 years or older at the time of IgAN diagnosis.
- To examine factors associated with the risk of kidney failure and death in this elderly cohort.
Main Methods:
- A retrospective analysis of 127 elderly patients diagnosed with IgAN between 1996 and 2020.
- Clinical data, including estimated glomerular filtration rate (eGFR) and proteinuria, along with histologic MEST-C classification, were collected. Outcomes of kidney failure and death were ascertained using the USRDS and NDI.
- Cause-specific Cox hazards regression and standard Cox proportional hazards regression were used to analyze predictors of kidney failure and mortality.
Main Results:
- Elderly IgAN patients presented with a median eGFR of 25 ml/min/1.73 m², with 81% having significant proteinuria.
- Forty-five patients progressed to kidney failure (median time 11.3 years) and 86 died (median time 7.5 years).
- Male sex, advanced CKD stages (3-5) at diagnosis, increasing age, and advanced CKD were associated with higher risks of kidney failure and mortality.
Conclusions:
- IgA nephropathy diagnosed in elderly individuals is characterized by a severe clinical phenotype.
- Elderly patients with IgAN face a poor prognosis, with a substantial risk of kidney failure and premature death.
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