IgA vasculitis nephritis-outcomes in adult-onset disease

James Stanway, Nina Brown, Afeera Pervez, Els Van de Perre, James Tollitt, Nikolaos Marketos, Nikki Wong, Ajay Dhaygude, Arvind Ponnusamy, Ed O'Riordan, Michael Venning, Mårten Segelmark, Matthew Morgan, David Jayne, Patrick Hamilton, Charles D Pusey, Louise Oni, Alan D Salama

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: IgA vasculitis (IgAV) in adults has been relatively under-investigated. Since outcomes are worse in other forms of vasculitis with increasing age, we investigated the outcomes of IgAV comparing younger adults (18-34), middle aged adults (35-64) and elderly patients (≥64 years) focusing on kidney outcomes.

METHODS: We identified patients with renal biopsy confirmed IgAV nephritis and collected data regarding clinical features and progression to end stage kidney disease (ESKD). The relationship between patient factors and ESKD was analysed by regression.

RESULTS: We identified 202 cases, 34% aged 18-34, 43% aged 35-64 and 23% were elderly (>64 years). Median follow up was 44 months. Elderly patients were more likely to present with ESKD (23.9%) compared with middle aged (13.7%) and younger adults (2.9%)(χ2 11.6, p= 0.002). In patients with independent kidney function at biopsy, there was no difference in outcomes between age groups. Male gender, Black ethnicity, diabetes, histological evidence of chronic renal damage and eGFR < 30mls/min were risk factors for development of ESKD. In this observational study 68.3% of patients received glucocorticoids and 56.9% additional immunosuppression.

CONCLUSIONS: Elderly patients with IgAV are more likely to have ESKD at presentation, but there is no difference in renal survival between age groups, among those presenting with independent renal function. Renal impairment at biopsy is an independent risk factor for subsequent development of ESKD. There is significant variability in the timing of kidney biopsy and management of these patients among specialist centres. Young adults have outcomes more in keeping with childhood IgAV.

Original languageEnglish
Article number1
Pages (from-to)1
Number of pages1
JournalRheumatology (Oxford, England)
Volume1
Issue number1
Early online date25 Jan 2024
DOIs
Publication statusPublished - 25 Jan 2024

Bibliographical note

© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Keywords

  • Henoch-Schonlein purpura
  • IgA vasculitis
  • adult
  • Elderly
  • end stage renal disease
  • ESKD

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