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IgA vasculitis nephritis - outcomes in adult-onset disease

Stanway, James ; Brown, Nina ; Pervez, Afeera ; Van De Perre, Els ; Tollitt, James ; Marketos, Nikolaos ; Wong, Nikki ; Dhaygude, Ajay ; Ponnusamy, Arvind and O'Riordan, Ed , et al. (2025) In Rheumatology 64(2). p.690-696
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% elderly (>64 years). Median follow-up was 44 months. Elderly patients were more likely to present... (More)

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% 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 estimated glomerular filtration rate < 30 ml/min were risk factors for development of ESKD. In this observational study 68.3% of patients received glucocorticoids and 56.9% additional immunosuppression. Conclusion: 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adult, elderly, end stage renal disease (ESKD), Henoch-Schonlein purpura, IgA vasculitis
in
Rheumatology
volume
64
issue
2
pages
7 pages
publisher
Oxford University Press
external identifiers
  • pmid:38273659
  • scopus:85217119537
ISSN
1462-0324
DOI
10.1093/rheumatology/keae030
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2024 The Author(s).
id
b63e3fdd-ac6d-40fb-997d-6f17a8c1bb5b
date added to LUP
2025-04-09 09:53:23
date last changed
2025-06-04 13:56:41
@article{b63e3fdd-ac6d-40fb-997d-6f17a8c1bb5b,
  abstract     = {{<p>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% elderly (&gt;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 estimated glomerular filtration rate &lt; 30 ml/min were risk factors for development of ESKD. In this observational study 68.3% of patients received glucocorticoids and 56.9% additional immunosuppression. Conclusion: 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.</p>}},
  author       = {{Stanway, James and Brown, Nina and Pervez, Afeera and Van De Perre, Els and Tollitt, James and Marketos, Nikolaos and Wong, Nikki and Dhaygude, Ajay and Ponnusamy, Arvind and O'Riordan, Ed and Venning, Michael and Segelmark, Mårten and Morgan, Matthew and Jayne, David and Hamilton, Patrick and Pusey, Charles D. and Oni, Louise and Salama, Alan D.}},
  issn         = {{1462-0324}},
  keywords     = {{adult; elderly; end stage renal disease (ESKD); Henoch-Schonlein purpura; IgA vasculitis}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{2}},
  pages        = {{690--696}},
  publisher    = {{Oxford University Press}},
  series       = {{Rheumatology}},
  title        = {{IgA vasculitis nephritis - outcomes in adult-onset disease}},
  url          = {{http://dx.doi.org/10.1093/rheumatology/keae030}},
  doi          = {{10.1093/rheumatology/keae030}},
  volume       = {{64}},
  year         = {{2025}},
}