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Reduction of proteinuria by therapeutic intervention improves the renal outcome of elderly patients with IgA nephropathy

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A Commentary to this article was published on 21 July 2016

Abstract

Background

The number of elderly patients with IgA nephropathy (IgAN) is increasing in parallel with the increased longevity in the general population. However, information is limited regarding the characteristics of such patients.

Methods

IgAN patients who were ≥60 years of age at diagnosis were retrospectively analyzed. The clinicopathological features at biopsy, therapies during the follow-up period, renal outcomes and extrarenal complications were evaluated.

Results

The characteristics of a total of 87 patients were as follows (mean values): 65 years of age, an eGFR of 47 mL/min/1.73 m2, and urinary protein excretion (UPE) of 1.9 g/day. In the initial 1-year follow-up period, UPE decreased from 2.4 to 0.4 g/day in patients treated with corticosteroids and 1.4 to 0.8 g/day in patients treated with conservative therapies, including renin–angiotensin system blockade. During the observation period, 26 % of the patients who received corticosteroids and 38 % of the patients treated with conservative therapies showed a ≥30 % decrease in their eGFR or reached end-stage renal disease. In the analysis of all patients, UPE at 1 year after the diagnosis was identified to be an independent predictor of the subsequent loss of renal function. However, neither corticosteroid therapy nor conservative therapies was identified to be an independent valuable. There was no significant difference in the incidence of the extrarenal complications between patients treated with corticosteroids and those with conservative therapies.

Conclusion

In elderly IgAN patients, the reduction of proteinuria by therapeutic interventions may lead to better renal outcomes without causing severe extrarenal complications.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8641, Japan

    Yusuke Okabayashi, Nobuo Tsuboi, Kotaro Haruhara, Go Kanzaki, Kentaro Koike, Akihiro Shimizu, Yoichi Miyazaki, Iwao Ohno, Tetsuya Kawamura, Makoto Ogura & Takashi Yokoo

Authors
  1. Yusuke Okabayashi
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  2. Nobuo Tsuboi
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  3. Kotaro Haruhara
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  4. Go Kanzaki
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  5. Kentaro Koike
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  6. Akihiro Shimizu
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  7. Yoichi Miyazaki
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  8. Iwao Ohno
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  9. Tetsuya Kawamura
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  10. Makoto Ogura
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  11. Takashi Yokoo
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Corresponding author

Correspondence to Nobuo Tsuboi.

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The authors have declared that they have no conflicts of interest.

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Okabayashi, Y., Tsuboi, N., Haruhara, K. et al. Reduction of proteinuria by therapeutic intervention improves the renal outcome of elderly patients with IgA nephropathy. Clin Exp Nephrol 20, 910–917 (2016). https://doi.org/10.1007/s10157-016-1239-y

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  • DOI: https://doi.org/10.1007/s10157-016-1239-y

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