Ishod starijih bolesnika s ANCA glomerulonefritisom liječenih imunosupresivnom terapijom

Abstract

The most common cause of rapidly progressive glomerulonephritis in elderly, antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN), demands immunosuppressive therapy (IS) regimen in a multi-morbid disease burdened population. Our aim was to assess outcome differences in two age groups. The study included a total of 38 ANCA-GN renal limited patients (18 men) treated from 1990 to 2018, of which 11 were 65 years of age and older (median 70, min. - max. 66 - 79 years), and 27 younger than 65 (median 55, min. - max. 23 - 64 years). All patients were treated with mono/combination of IS. Most commonly applied IS in elderly was combination of IV cyclophosphamide and corticosteroids (CS) (in 9 [81.8%]), while in younger it was a combination of CS and cyclophosphamide or rituximab (59.2%). Older patients had comparable mortality (3, [14.8%] vs. 4, [27.3%]; P = 0.369), malignancies (1, [3.7%] vs. 1, [9.1%]; P = 0.5) and infectious complications (10, [46.7%] vs. 7, [63.6%]; P = 0.388). Ten patients at the end of the follow up were at renal replacement therapy (RRT ), with no difference between age groups (6, [22.2%] vs. 4, [36.4%]; P = 0.369). Interestingly, from initial need for RRT , half of the younger and older patients recovered with IS. Our findings give more credit to the current paradigm to treat elderly ANCA-GN patients with IS therapy due to the similar outcome of elderly as younger ones.Najčešći uzrok brzoprogresivnog glomerulonefritisa u starijih je glomerulonefritis s antineutrofilnim citoplazmatskim protutijelima (ANCA-GN, od eng. antineutrophil cytoplasmic antibody related glomerulonephritis), a s obzirom na komorbiditete predstavlja izazov u odluci oko primjene imunosupresivne terapije (IS). Cilj ovog istraživanja je usporediti razlike u ishodu dvije dobne skupine bolesnika. Istraživanje je obuhvatilo slučajeve ANCA-GN ograničenih na bubrege, liječene od 1990. do 2018. godine, njih 38 (18 muških), od kojih 11 ima 65 ili više godina (medijan 70, min.-max. 66 - 79 godina) a 27 mlađih (medijan 55, min. - max. 23 - 64 godina). Svi bolesnici su liječeni monoterapijom ili kombinacijom IS-a. Najčešće primjenjena IS u starijoj populaciji bila je kombinacija intravenskog ciklofosfamida i kortikosteroida (KS) (u 9 (81,8%)), u mlađoj kombinacija KS s ciklofosfamidom ili rituksimabom (59,2%). Stariji pacijenti imali su sličnu učestalost smrtnosti (3, 14,8% vs 4, 27,3%; P = 0.369), zloćudnih bolesti (1, 3,7% vs 1, 9,1%; P = 0.5) i infektivnih komplikacija (10, 46,7% vs 7, 63,6%); P = 0.388). Deset bolesnika je na kraju praćenja bila ovisno o nadomještanju bubrežne funkcije (NBF) bez razlike u dobnoj skupini (6, 22,2% vs 4, 36,4%; P = 0.369). Međutim, od inicijalne potrebe NBF-om se uz IS oporavila polovica starijih i mlađih bolesnika. Naši rezultati su u skladu trenutačnim stajalištima koja podupiru primjenu IS terapije kod starijih bolesnika sa ANCA-GN zbog usporedivih ishoda i rizika komplikacija kao u mlađih bolesnika