VASCULITIS AND RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS IN THE ELDERLY

The proportion of patients with vasculitis and rapidly progressive nep hritis aged 70 years or over has risen from about 10% in the 1980s to over 30% in series reported in the 1990s. This study was undertaken to examine the presentation and outcome of such older patients. Seventee n of 56 patients (30%) who presented at two renal units were aged 70 y ears or over. Mean creatinine level at presentation was 530 mu mol/l, and five patients received dialysis at presentation. Outcome was depen dent on three factors, namely comorbid pathology, response to immunosu ppressive therapy, and the occurrence in three cases of temporary spon taneous partial remission. Overall patient survival at one and two yea rs was 62.5% and 50%, respectively, and 90% and 100% of surviving pati ents were independent of dialysis at one and two years, respectively. Response to chemotherapy was excellent, with full rehabilitation in ma ny cases and no deaths directly attributable to adverse effects of imm unosuppressive therapy. We conclude that diagnosis of vasculitis and r apidly progressive glomerulonephritis by renal biopsy and the subseque nt administration of chemotherapy (including cyclophosphamide in many cases) resulted in a worthwhile benefit in these elderly patients.