Researchers of a retrospective study of 102 adults aged 60 years or older with biopsy-proven IgA nephropathy (IgAN) found that many presented with advanced kidney disease and substantial comorbidity. Median eGFR at biopsy was 29.5 mL/min/1.73 m², 88% had hypertension, and more than half had chronic nephritic syndrome. Over a median 5-year follow-up, 31% progressed to end-stage kidney disease and 20% died. In multivariable analysis, older age, greater comorbidity burden, and higher proteinuria were independently associated with the composite outcome of kidney failure or death. Individual MEST-C histologic features were less predictive after adjustment.
The findings reinforce the importance of monitoring proteinuria, kidney function, and overall comorbidity burden when assessing risk in older adults with IgAN. Renin-angiotensin system blockade was associated with better outcomes in unadjusted analyses. Immunosuppressive therapy was not associated with improved survival or renal progression in this observational cohort. Because the study was retrospective and treatment was not randomized, those treatment findings should be interpreted cautiously. However, they support an individualized approach that weighs kidney risk, cardiovascular and infectious comorbidities, treatment tolerance, and competing mortality risks in older patients.
Reference: Ștefan G, Petre N, Zugravu A, Stancu S. Outcomes and predictors of kidney failure in elderly patients with biopsy-proven IgA nephropathy. Ren Fail. 2026 Dec;48(1):2629129. doi: 10.1080/0886022X.2026.2629129.
