Clinical prognostic factors of renal outcome in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis in elderly patients.

BACKGROUND

The purpose of the present study was to determine clinical prognostic factors on renal survival in 37 older patients with antineutrophil cytoplasmic autoantibody-associated pauci-immune necrotizing crescentic glomerulonephritis (ANCA-associated GN) who underwent renal biopsy at our Department between January 1996 and December 2000.

METHODS

The date of renal biopsy was used as the start date for entry into the study. Age, gender, 24 h proteinuria, serum creatinine level, blood pressure and ANCA were evaluated. The end-point for renal survival analysis was the start of chronic dialysis.

RESULTS

Twenty-six (70%) patients showed varying degrees of renal insufficiency, nine (24%) patients required dialysis, 13 (35%) were hypertensive (BP > or =140/90 mmHg) and 33 (89%) had proteinuria. During follow-up (31.73+/-17.39 months), 16% of the patients (6/37) developed end-stage renal disease (ESRD). The actuarial renal survival rate for all patients was 92% at 1 year and 76% at 3 years, for Wegener's granulomatosis 80% at 1 and 3 years, for microscopic polyangiitis 85% at 1 and 3 years, and for renal limited disease (GN) 75% at 1 and 37% at 3 years. Age (P = 0.024), arterial hypertension (P = 0.018), proteinuria (P = 0.037) and serum cre-atinine > or =400 micro mol/l (P = 0.047) were the most important risk factors for ESRD.

CONCLUSION

The actuarial renal survival rate in elderly patients with ANCA-associated GN was 92% at 1 year and 76% at 3 years. Older age, arterial hypertension, proteinuria and serum creatinine > or =400 micro mol/l related to ESRD.