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Management of Elderly Patients with Rapidly Progressive Glomerulonephritis.
- Source :
-
Blood purification [Blood Purif] 2018; Vol. 45 (1-3), pp. 213-217. Date of Electronic Publication: 2018 Jan 26. - Publication Year :
- 2018
-
Abstract
- Background: Rapidly progressive glomerulonephritis (RPGN) is characterized by a rapid deterioration of renal function and by extracapillary proliferation in >50% of glomeruli. The most common type of RPGN is "pauci-immune" glomerulonephritis caused by anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV).<br />Summary: The incidence of AAV increases with age and pauci-immune glomerulonephritis is the most common diagnosis found in renal biopsies in the elderly population. Age was identified as an independent negative risk factor for both death and end-stage renal disease in AAV, and the mortality of older patients was uniformly higher than in younger patients in all retrospective studies. Early diagnosis may be difficult particularly in elderly patients with renal-limited disease but is important for the good outcome of the patients. Immunosuppressive treatment options include cyclophosphamide or rituximab combined with corticosteroids with or without plasma exchange in case of severe disease. Data from randomized trials are completely missing for patient aged >75 years. Based on retrospective studies, elderly patients seem to respond to immunosuppressive drugs just as younger patients are able to, but they are at a higher risk of adverse events. Key Messages: RPGN is relatively common in the elderly patients. Immunosuppressive treatment in older patients with AAV or RPGN may be useful but needs to be strictly individualized with all the risks taken into consideration. Further studies are needed to examine the role of novel therapeutic options in the elderly population with RPGN.<br /> (© 2018 S. Karger AG, Basel.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis blood
Antibodies, Antineutrophil Cytoplasmic blood
Female
Glomerulonephritis blood
Humans
Kidney Failure, Chronic blood
Male
Randomized Controlled Trials as Topic
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis therapy
Glomerulonephritis therapy
Kidney Failure, Chronic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9735
- Volume :
- 45
- Issue :
- 1-3
- Database :
- MEDLINE
- Journal :
- Blood purification
- Publication Type :
- Academic Journal
- Accession number :
- 29478046
- Full Text :
- https://doi.org/10.1159/000485368