From the Guidelines
Prevalence of IgA Nephropathy in 80-Year-Old Individuals with Impaired Renal Function
The prevalence of IgA nephropathy in individuals aged 80 years is estimated to be approximately 3.6% based on renal biopsy data 1. This condition is often characterized by hematuria, proteinuria, and impaired renal function, with serum creatinine levels typically ranging from 1.5 to 3.0 mg/dL.
Key Characteristics and Treatment
Key characteristics of IgA nephropathy include:
- Hematuria: presence of blood in the urine
- Proteinuria: presence of excess proteins in the urine
- Impaired renal function: decreased kidney function, which can be measured by glomerular filtration rate (GFR)
Treatment may involve administration of:
- Angiotensin-converting enzyme inhibitors, such as lisinopril, at a dose of 10-20 mg daily
- Angiotensin receptor blockers, such as losartan, at a dose of 50-100 mg daily for a duration of at least 6-12 months to slow disease progression 2, 3, 4, 5.
Considerations for Impaired Renal Function
In individuals with impaired renal function, it is essential to consider the age-related decline in GFR and adjust drug dosages accordingly 2, 3, 4, 5. The prevalence of chronic kidney disease increases with age, with approximately 17% of persons older than 60 years of age having an estimated GFR less than 60 mL/min per 1.73 m2 2, 3, 4, 5.
Management and Prognosis
Management of IgA nephropathy involves a multifaceted approach, including optimized supportive care, blood pressure control, and cardiovascular risk minimization 1. The prognosis of IgA nephropathy depends on various factors, including the severity of kidney damage and the effectiveness of treatment. Regular monitoring of kidney function and adjustment of treatment as needed are crucial to slow disease progression and improve outcomes.
From the Research
Prevalence of IgA Nephropathy in Elderly Individuals
- The prevalence of IgA nephropathy in elderly individuals, particularly those with impaired renal function, is not well-studied 6.
- However, a study published in 2019 found that the diagnosis of IgA nephropathy among older adults in Spain has progressively increased in recent years 6.
- The study analyzed a cohort of 151 patients aged 65 years or older with biopsy-proven IgA nephropathy and found that the incidence of IgA nephropathy increased significantly over time, from six patients in 1990-1995 to 62 patients in 2011-2015 6.
Clinical Presentation and Outcomes
- IgA nephropathy can present with various clinical manifestations, including asymptomatic urinary abnormalities, acute kidney injury (AKI), and nephrotic syndrome 6, 7.
- A study published in 2004 found that patients with crescentic proliferative IgA nephropathy had a more rapid decline in renal function and were more likely to progress to end-stage renal disease 7.
- Another study published in 2004 found that steroid therapy was effective in reducing proteinuria and maintaining serum creatinine levels in patients with advanced IgA nephropathy and impaired renal function, particularly those with active glomerular lesions 8.
Treatment and Prognosis
- The treatment of IgA nephropathy typically involves renin-angiotensin-aldosterone system blockers, glucocorticoids, and immunosuppressive agents 9, 10.
- A study published in 2009 found that combined treatment with renin-angiotensin system blockers and polyunsaturated fatty acids reduced proteinuria in patients with IgA nephropathy more effectively than renin-angiotensin system blockers alone 9.
- The prognosis of IgA nephropathy is generally poor, with approximately 30% of patients progressing to end-stage renal disease within 20 years of diagnosis 10.