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学科主题: 临床医学
题名:
Clinical Features and Outcomes of Anti-Glomerular Basement Membrane Disease in Older Patients
作者: Cui, Zhao1; Zhao, Juan; Jia, Xiao-yu; Zhu, Sai-nan2; Zhao, Ming-hui
关键词: Anti-glomerular basement membrane disease ; crescentic glomerulonephritis ; Goodpasture disease ; old patient ; prognosis
刊名: AMERICAN JOURNAL OF KIDNEY DISEASES
发表日期: 2011-04-01
DOI: 10.1053/j.ajkd.2010.09.022
卷: 57, 期:4, 页:575-582
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Urology & Nephrology
研究领域[WOS]: Urology & Nephrology
关键词[WOS]: ANTI-GBM ANTIBODIES ; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS ; CHINESE PATIENTS ; MEDIATED GLOMERULONEPHRITIS ; GOODPASTURES-SYNDROME ; AUTOANTIBODIES ; SPECIFICITY ; ANCA ; PROGNOSIS ; SERA
英文摘要:

Background: Anti-glomerular basement membrane (GBM) disease is being recognized increasingly in older patients. Disease presentation and outcomes of these patients are unclear.

Study Design: Case series.

Setting & Participants: 221 consecutive Chinese patients with anti-GBM disease diagnosed in 1998-2008 in our tertiary referral center. Anti-GBM disease was defined as positive anti-GBM antibodies in circulation and/or linear immunoglobulin G deposition along the GBM on kidney biopsy.

Predictor: Older age, defined as 65 years or older, and antineutrophil cytoplasmic antibody, detected using immunofluorescence and enzyme-linked immunosorbent assay, at presentation.

Outcomes: Clinical features, kidney pathologic characteristics, end-stage renal disease (ESRD), and mortality. Multivariate Cox proportional hazard models were used to assess the contribution of age, sex, clinical measures, and treatments to ESRD and mortality.

Results: 50 of 221 (22.6%) patients were 65 years or older. Older patients had a male predominance (male/female ratio, 1.9:1). They had a higher proportion of positive antineutrophil cytoplasmic antibody results (46.0% vs 14.6%; P < 0.001), lower prevalence of hemoptysis (26.0% vs 46.2%; P = 0.01), lower urine protein excretion (1.4 +/- 1.0 vs 3.9 +/- 3.3 g/d; P = 0.001), and higher estimated glomerular filtration rate (eGFR) at presentation (8.4 vs 5.1 mL/min/1.73 m(2); P = 0.007) compared with younger patients. During follow-up, 30 of 37 (81.1%) and 21 of 37 (56.8%) patients developed ESRD and died in the older group compared with 115 of 139 (82.7%) and 35 of 139 (25.2%) in the younger group (P = 0.1 and P = 0.001, respectively). For older patients, multivariate Cox regression analysis showed that higher initial eGFR was an independent predictor for both ESRD (HR, 0.86; 95% CI, 0.78-0.96; P = 0.005) and death (HR, 0.79; 95% CI, 0.66-0.94; P = 0.008).

Limitations: Not all patients underwent kidney biopsy, especially those with very old age or ESRD at presentation.

Conclusions: Older patients with anti-GBM disease had milder kidney damage and less pulmonary involvement. Outcomes were predicted by initial eGFR. Thus, early diagnosis was crucial to improve outcomes. Am J Kidney Dis. 57(4):575-582. (C) 2011 by the National Kidney Foundation, Inc.

语种: 英语
所属项目编号: 30700752 ; 30725034 ; 7082094
项目资助者: Natural Science Fund of China ; Natural Science Fund of Beijing
WOS记录号: WOS:000288657100381
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/63282
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.Peking Univ, Key Lab Renal Dis, Minist Hlth China, Renal Div,Dept Med,Hosp 1,Inst Nephrol, Beijing 100034, Peoples R China
2.Peking Univ, Dept Biostat, Hosp 1, Beijing 100034, Peoples R China

Recommended Citation:
Cui, Zhao,Zhao, Juan,Jia, Xiao-yu,et al. Clinical Features and Outcomes of Anti-Glomerular Basement Membrane Disease in Older Patients[J]. AMERICAN JOURNAL OF KIDNEY DISEASES,2011,57(4):575-582.
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