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      Renal Vasculitis: Increasingly a Disease of the Elderly?

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          Background/Aims: The majority of patients presenting to our district general hospital with renal vasculitis are elderly. Older patients respond less well to treatment and have a poorer prognosis. We investigated the relationship between age and outcome of renal vasculitis in our centre and examined the evidence regarding treatment of elderly patients with this condition. Methods: Patients presenting over a 2-year period with renal vasculitis were identified by clinical and histological features and by antineutrophil cytoplasmic autoantibody positivity. They were followed for a mean of 15 months and outcomes were recorded. Results were compared with published studies. Results: The mean age at presentation of 21 patients was 69 years. Forty-eight percent required dialysis and there was a 33% overall mortality. The mean age of patients in previous treatment studies has been between 50 and 55 years. Conclusions: The greater severity of disease at presentation and poorer outcome than previously described is likely to be due to the high proportion of elderly patients. The incidence of vasculitis is increasing in the elderly but as this group has been poorly represented in clinical trials in renal vasculitis, applying the findings of these trials to their treatment may be hazardous. Future research should determine which treatments are safe and effective in the elderly.

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          Epidemiology of systemic vasculitis: a ten-year study in the United Kingdom.

          To describe the epidemiology of the primary systemic vasculitides (PSV; Wegener's granulomatosis, Churg-Strauss syndrome, microscopic polyangiitis, polyarteritis nodosa) in a well-defined population over a 10-year period. An inception cohort of patients from the Norwich Health Authority (NHA) who were >15 years of age and had PSV first diagnosed between January 1, 1988 and December 31, 1997 was collected. Incidence rates were adjusted for age and sex to the 1992 population. The prevalence of PSV in this cohort was estimated on December 31, 1997. Patients were classified according to the American College of Rheumatology 1990 vasculitis criteria and the Chapel Hill Consensus definitions. Eighty-two NHA residents fulfilled the inclusion criteria. There were 47 men and 35 women, with a mean age of 62.9 years (median 65.0 years). The overall annual incidence of PSV among NHA residents was 19.8/million (95% confidence interval [95% CI] 15.8-24.6). The point prevalence on December 31, 1997 was 144.5/million (95% CI 110.4-185.3). PSV was more common in males (23.5/million; 95% CI 17.3-31.3) than females (16.4/million; 95% CI 11.4-22.8). The age- and sex-specific incidence showed a clear increase with age, with an overall peak in the 65-74 year age group (60.1/million). In our study population, the annual incidence of PSV is slowly increasing with time and the incidence is greatest in the elderly.
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            Update on the European Vasculitis Study Group trials

             David Jayne (2001)

              Author and article information

              Nephron Clin Pract
              Nephron Clinical Practice
              S. Karger AG
              August 2004
              17 November 2004
              : 97
              : 4
              : c142-c146
              aAcademic Renal Unit, University of Bristol, Southmead Hospital, Bristol, and bRenal Unit, Royal Devon and Exeter Hospital, Exeter, UK
              79173 Nephron Clin Pract 2004;97:c142–c146
              © 2004 S. Karger AG, Basel

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              Page count
              Figures: 2, Tables: 2, References: 18, Pages: 1
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/79173
              Original Paper


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