IGA NEPHROPATHY IN PATIENTS OVER 50 YEARS OF AGE - A MULTICENTER, PROSPECTIVE-STUDY

Background. IgA nephropathy (IgAN) is considered as a disease of young men under 30 years of age. Findings on clinical and histological pres entation and outcome in older patients have rarely been published. Met hods. In a prospective cohort of IgAN patients, recruited over 3 years , 33 patients over age 50 were compared to 96 patients under age 50, a ccording to clinical and histological findings. Actuarial renal surviv al rate was studied after a mean post-biopsy follow-up of 41 months. R esults. Both groups of patients were comparable at baseline for freque ncy of proteinuria, microscopic haematuria and gross haematuria, but o lder patients had a significantly higher incidence of hypertension (65 vs 24%, P<0.01). Time between onset and diagnosis of IgAN was similar in both groups. Proteinuria/day, systolic blood pressure, and serum I gA. levels were significantly higher, and C-cr was significantly lower in the older patients at the time renal biopsy was performed, but ser um creatinine and albumin were not. No difference was observed between the two groups for the presence of glomerular or tubulo-terstitial le sions. Only endarteritis was significantly more common in older patien ts (75 vs 34%, P<0.01). End-stage renal failure (ESRF) was confirmed i n five patients over 50 and 17 under 50. Renal actuarial survival curv es did not show any significant difference between the two groups, eve n though the six patients who died were classified as ESRF. Conclusion s. When the histological diagnosis of IgAN was established, factors th at carry a poor prognosis, i.e. proteinuria, high blood pressure, and decreased C-cr were more commonly present in patients over 50 than und er 50. However, after the completion of a relatively short follow-up p eriod, renal survival was identical in the two study groups. Prolonged follow-up is necessary to confirm this trend.