The most common glomerular disease in the >80 age group is ANCA associated vasculitis and usually anti MPO in nature. This is now well established. A Recent paper in Kidney International retrospectively looks at treatment of this entity in this age group. Many of us would not treat given the heavy immunosuppresive burden and anticipating increase risk. The investigators in this study, looked at 78 cases that were biopsy proven ANCA vasculitis and showed that the patients with treatment with the agents had a significant lower incidence of ESRD 1 year biopsy with significant p value. No difference in terms of mortality between the two groups in one year. When followed for 2 years, the immunosuppresive group had a better advantage.
Only 35% had extra renal involvement, so most were pure renal involved vasculitis
70% were anti MPO
Majority of them were caucasian
15% had cancer(at the time diagnosed)
58% of the treated group got Steroids + PO cytoxan
24% got IV cytoxan + steroids, few got MMF
Majority, 34% had no maintenance, Followed by steroids alone and steroids + cytoxan.
Infection was higher in treatment arm.
No particular regimen is suggested from this article, just that immunosuppresion will help in the long run.
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