Dataset Information

IgA Nephropathy in Elderly Patients.

ABSTRACT:

Background and objectives

Some studies suggest that the incidence of IgA nephropathy is increasing in older adults, but there is a lack of information about the epidemiology and behavior of the disease in that age group.

Design, setting, participants, & measurements

In this retrospective multicentric study, we analyzed the incidence, forms of presentation, clinical and histologic characteristics, treatments received, and outcomes in a cohort of 151 patients ≥65 years old with biopsy-proven IgA nephropathy diagnosed between 1990 and 2015. The main outcome was a composite end point of kidney replacement therapy or death before kidney replacement therapy.

Results

We found a significant increase in the diagnosis of IgA nephropathy over time from six patients in 1990-1995 to 62 in 2011-2015 (P value for trend =0.03). After asymptomatic urinary abnormalities (84 patients; 55%), AKI was the most common form of presentation (61 patients; 40%). Within the latter, 53 (86%) patients presented with hematuria-related AKI (gross hematuria and tubular necrosis associated with erythrocyte casts as the most important lesions in kidney biopsy), and eight patients presented with crescentic IgA nephropathy. Six (4%) patients presented with nephrotic syndrome. Among hematuria-related AKI, 18 (34%) patients were receiving oral anticoagulants, and this proportion rose to 42% among the 34 patients older than 72 years old who presented with hematuria-related AKI. For the whole cohort, survival rates without the composite end point were 74%, 48%, and 26% at 1, 2, and 5 years, respectively. Age, serum creatinine at presentation, and the degree of interstitial fibrosis in kidney biopsy were risk factors significantly associated with the outcome, whereas treatment with renin-angiotensin-aldosterone blockers was associated with a lower risk. Immunosuppressive treatments were not significantly associated with the outcome.

Conclusions

The diagnosis of IgA nephropathy among older adults in Spain has progressively increased in recent years, and anticoagulant therapy may be partially responsible for this trend. Prognosis was poor.

Podcast

This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_07_16_CJASNPodcast_19_08_.mp3.

SUBMITTER: Sevillano AM

PROVIDER: S-EPMC6682823 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

IgA Nephropathy in Elderly Patients.

Sevillano Angel M AM Diaz Monserrat M Caravaca-Fontán Fernando F Barrios Clara C Bernis Carmen C Cabrera Jimena J Calviño Jesus J Castillo Lorena L Cobelo Carmen C Delgado-Mallén Patricia P Espinosa Mario M Fernandez-Juarez Gema G Fernandez-Reyes Maria Jose MJ Garcia-Osuna Rosa R Garcia Patricia P Goicoechea Marian M Gonzalez-Cabrera Fayna F Guzmán Diomaris A DA Heras Manuel M Martín-Reyes Guillermo G Martinez Alberto A Olea Teresa T Peña Jessy Korina JK Quintana Luis F LF Rabasco Cristina C López Revuelta Katia K Rodas Lida L Rodriguez-Mendiola Nuria N Rodriguez Eva E San Miguel Luz L Sanchez de la Nieta Maria Dolores MD Shabaka Amir A Sierra Milagros M Valera Alfonso A Velo Mercedes M Verde Eduardo E Ballarin Jose J Noboa Oscar O Moreno Juan Antonio JA Gutiérrez Eduardo E Praga Manuel M

Clinical journal of the American Society of Nephrology : CJASN 20190716 8

<h4>Background and objectives</h4>Some studies suggest that the incidence of IgA nephropathy is increasing in older adults, but there is a lack of information about the epidemiology and behavior of the disease in that age group.<h4>Design, setting, participants, & measurements</h4>In this retrospective multicentric study, we analyzed the incidence, forms of presentation, clinical and histologic characteristics, treatments received, and outcomes in a cohort of 151 patients ≥65 years old with biop ...[more]

PMID: 31311818

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Project description:Immunoglobulin A Nephropathy (IgAN) is a complex multifactorial disease whose genetic bases remain unknown. Distinct linkage and genome-wide association studies in both familial and sporadic IgAN suggest that there is a strong genetic component in IgAN. In this context, an intriguing role could be ascribed to copy number variants (CNVs) that have been recognized as an important source of genetic variation in humans. Here, we performed a whole-genome screening of CNVs in IgAN patients, their healthy relatives and healthy subjects (HS). A total of 217 individuals consisting of 51 IgAN cases and 166 healthy relatives were included in the initial screening. The high-throughput analysis of structural genetic variations, to find concordant aberrations across classes of samples, identified 178 IgAN-specific aberrations, specifically 114 loss and 64 gain. Several CNVs overlapped with regions evidenced by previous genome-wide genetic studies. Moreover, we found that IgAN patients characterized by deteriorated renal function carried low copy numbers of a CNV in chromosome 3 (chr3_loss:52031010-52260722). This CNV contained the TLR9 gene whose expression significantly correlated with the loss aberration in patients with progressive renal damage. Conversely, IgAN patients with normal renal function had no chr3_loss:52031010-52260722 and the TLR9 mRNA was expressed at the same level as in HS, still maintaining a strong correlation with the CNV. In conclusion, here we performed the first genome-wide CNV study in IgAN identifying some structural variants specific to IgAN patients and providing a collection of new candidate genes and loci that could help to dissect the complex genomic setting of the disease. Moreover, we identified a specific CNV, spanning the TLR9 gene, which could explain the disease severity in IgAN patients. To perform a genome-wide CNV study in IgAN identifying some structural variants specific to IgAN patients and providing a collection of new candidate genes and loci that could help to dissect the complex genomic setting of the disease.

Dataset Information

IgA Nephropathy in Elderly Patients.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Podcast

Publications

IgA Nephropathy in Elderly Patients.

Similar Datasets

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