FEATURES AND TREATMENT OUTCOMES OF PAUCI-IMMUNE RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS IN ELDERLY PATIENTS

Abstract

Background: Pauci-immune rapidly progressive glomerulonephritis (RPGN) is a rare and often overlooked condition, particularly in the older adult. In Vietnam, there have been no reported case series or studies focusing on this disease in older adults. Therefore, we conducted this study to describe some clinical, paraclinical, and histopathological characteristics of a series of pauci-immune RPGN cases in the older adult, and to provide a preliminary assessment of treatment outcomes.

Case presentation: We conducted a descriptive study of three patients diagnosed with pauci-immune rapidly progressive glomerulonephritis at the Department of Nephrology and Dialysis, Thong Nhat Hospital, Ho Chi Minh City, between 2022 and 2025. All of them were male, and the median age was 70 years. Notable clinical and laboratory features included: edema and hypertension (100%); nephrotic-range proteinuria (33%); hematuria (66%); vasculitis skin lesions (66%); positive ANCA-serology (33%). Renal biopsy findings consistent with pauci-immune rapidly-progressive glomerulonephritis. Crescent formation was observed in all cases (100%) and tubular, interstitial lessions. All patients were treated with pulse corticosteroid therapy followed by corticosteroids combined with oral cyclophosphamide. 02 patients (66%) recevied therapeutic plasma exchange and 01 patient (33%) required temporary dialysis. All patients demonstrated improvement in kidney function at discharge. Of these, 02 patients achieved complete recovery of renal function after a 2-year follow-up period.

Conclusion: Pauci-immune rapidly-progressive glomerulonephritis is not uncommon condition in elderly patients. A constellation of clinical, laboratory, and kidney biopsy findings is critical for dianosing and treatment. The treatment regimen with pulse corticosteroid followed by low-dose of corticosteroids combined with oral cyclophosphamide and plasma exchange (in patients presenting with severe kidney failure), demonstrated a favorable initial response.

Keywords: rapidly-progressive glomerulonephritis; pauci-immune glomerulonephritis; elderly patient