Nephrotic syndrome in the elderly: epidemiological aspects, clinical data, and renal biopsy findings

Abstract

Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (Po0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.

Atypical Evolution of Collapsing FSGS in Extreme Elderly: Case Report

“…The sample contained 44 biopsies, revealing a prevalence of FSGS of 18.18%, 9.1% of which were collapsing. The most common glomerulopathy was membranous (29.5%) 10 .…”

Effect of extended home care on nursing compliance and quality of life in children with nephrotic syndrome

“…In practice, glucocorticoids are the most used drugs in the treatment of kidney diseases [14]. The use of this drug usually follows the principle of "adequate initial dose, slow reduction, and long maintenance", with prednisone as the representative drug, which can be replaced by the corresponding dose of prednisolone orally or intravenously when the patient has liver damage and severe edema [15]. Many studies have now con rmed the positive signi cance of extended home care on treatment compliance in nephrotic syndrome [16].…”

Epidemiología de enfermedades renales diagnosticadas por biopsia en Honduras: Una descripción clínica y patológica desde el 2016 al 2021

“…Teóricamente, las indicaciones para realizar una biopsia renal en los ancianos no deben diferir de los de un adulto no anciano, sin embargo, dado que estos pacientes tienen más probabilidades de presentar una función renal disminuida, comorbilidades, y peor salud general, es obligatoria una evaluación prudente y completa de los factores de riesgo para guiar la decisión de biopsia 9 . De acuerdo a los resultados de un estudio en Brasil en edades superiores a 65 años, el síndrome nefrótico fue la indicación más frecuente para la realización de biopsia renal en un 35.8 %, y los diagnósticos más frecuentes en orden descendente fueron la nefropatía membranosa, la amiloidosis, y la GEFS colapsante y GEFS no colapsante en igual cantidad 21 . Nuestros datos en pacientes mayor a 60 años reflejaron que para la muestra de 41 pacientes, solo 32 contaban con indicación para biopsia, de los cuales el 9.3 % presentó un síndrome nefrótico puro, y el 3.1 % presentaron proteinuria no nefrótica y síndrome nefrítico agudo en igual frecuencia.…”