Clinical Impact of Renal Biopsy on Outcomes in Elderly Patients with Nephrotic Syndrome

Yoon, Hye Eun; Shin, Mi Jung; Kim, Young Soo; Choi, Bum Soon; Kim, Byung Soo; Choi, Young Jin; Kim, Young Ok; Yoon, Sun Ae; Kim, Yong Soo; Yang, Chul Woo

doi:10.1159/000319643

Cited by 15 publications

(8 citation statements)

References 38 publications

(58 reference statements)

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“…A recent study in patients aged over 60 years (defined as elderly by the authors) with nephrotic syndrome showed greater survival as a result of biopsy-based diagnosis [32]. Renal biopsy enables a rapid and accurate diagnosis to made, with few complications, and, consequently, specific treatment to be applied.…”

Section: Discussionmentioning

confidence: 99%

Renal Biopsy in Very Elderly Patients: Data from the Spanish Registry of Glomerulonephritis

et al. 2012

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Background: Studies on renal histology results in very elderly patients are extremely rare. Methods: We analyzed histology and clinical findings in patients aged over 85 years undergoing renal biopsy and whose data were included in the Spanish Registry of Glomerulonephritis between 1994 and 2009. Results: A total of 17,680 native kidney biopsies were taken: 71 (0.4%) were from patients aged over 85 years. Acute kidney injury (AKI) was the main indication for biopsy (47%), followed by nephrotic syndrome (32%). Amyloidosis was the most common histological diagnosis (16.9%), followed by crescentic glomerulonephritis type 3 associated with systemic vasculitis (14.1%). When histological findings were correlated with clinical syndromes, we found that amyloidosis was the leading cause of AKI (18.8%), and also the main determinant of nephrotic syndrome, with the same frequency as membranous nephropathy (22%). Crescentic glomerulonephritis type 3 associated with vasculitis was related to a greater diversity of clinical syndromes, especially chronic kidney disease (40%) and AKI (40%). Conclusions: Renal biopsy in the very elderly provides us with useful information, despite the advanced age of the patients. AKI and nephrotic syndrome are the main indication for renal biopsy in this subgroup of patients, and amyloidosis is the most frequent histological pattern associated with both syndromes.

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Section: Discussionmentioning

confidence: 99%

Renal Biopsy in Very Elderly Patients: Data from the Spanish Registry of Glomerulonephritis

et al. 2012

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“…Studies conducted in China and abroad have shown similar results about the pathological features of NS in elderly patients. The condition of approximately 50% of the patients with idiopathic membranous nephropathy and NS naturally progresses toward renal failure; however, in some patients, active treatment alleviates the proteinuria, and thus, improves the renal survival rate (Yoon et al, 2011;Brown et al, 2012;Verde et al, 2012). Cattran (2005) proposed that the patients with idiopathic membranous nephropathy should be treated according to the risk stratification.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the massive proteinuria and hypoalbuminemia, the clinical complications of membranous nephropathy include hypertension, renal failure, hyperlipidemia, infections, hypercoagulation, and thromboembolism (Cattran et al, 2001;Cattran et al, 2007;Ronco and Debiec, 2011). Therefore, our primary objectives were to reduce proteinuria, increase the plasma albumin levels, and improve the symptoms of nephrotic syndrome (NS); moreover, we aimed to decrease the complications associated with membranous nephropathy (Yoon et al, 2011;Brown et al, 2012;Verde et al, 2012). Currently, the treatment of membranous nephropathy is mainly based on the degree of proteinuria; the treatment includes administration of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) (Cattran, 2005;Lai, 2007;Waldman and Austin, 2012) and administration of a combination of hormones and immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%

Administration of low-dose cyclosporine alone for the treatment of elderly patients with membranous nephropathy

Li¹,

Yu²,

Zhang³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. This study aimed to investigate the effects of administration of low-dose cyclosporine A (CsA) alone and the combination of low-dose CsA and a low-dose hormone for the treatment of elderly patients with membranous nephropathy. We divided 27 patients into two groups as follows: low-dose CsA group (group A) and the group receiving a combination of a low-dose hormone and low-dose CsA (group B). The treatment and follow-up times were ≥6 months. We observed no difference in gender, age, serum creatinine levels, estimated glomerular filtration rate (eGFR), and 24-h urinary protein levels between the two groups before treatment; in addition, the rates of complete and partial remission were not different 6 months after treatment. The rate of complications in group B was higher than that in group A (84.6 vs 35.7%, respectively; t = 0.018). While the pretreatment eGFR of patients who achieved remission was significantly higher than that of patients who did not achieve remission, the 24-h urinary protein levels and incidence of hypertension were significantly lower than those of patients who did not achieve remission (t = 0.042, 0.035 and 0.043, respectively). The efficacy of administration of low-dose CsA alone and in combination with a low-dose hormone was similar; the efficacy was related to eGFR, urinary protein levels, and the incidence of hypertension before the treatment. The side effects of administration of CsA alone were significantly lower than those of the combination treatment.

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“…Thorough clinical examination and appropriate laboratory screening excluded those with secondary causes for MN, leaving 135 patients diagnosed with idiopathic MN. We classified the study participants into ‘older’ and ‘younger’ groups, where ‘older’ was defined as 60 years of age or older at the time of the renal biopsy [9,10].…”

Section: Methodsmentioning

confidence: 99%

“…In these patients, the use of immunosuppressive agents may be justified to salvage failing kidneys and even for patient survival. However, little information is available about their outcomes because physicians are reluctant to use an aggressive treatment that may compromise the residual reservoir of already aged kidneys [9-11]. Therefore, information about the clinical outcomes of older patients compared with those in younger adults is vague and appropriate treatment modalities need to be determined and targeted to this aging population.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes and effects of treatment in older patients with idiopathic membranous nephropathy

Kim

Yoon

Chung

et al. 2019

Korean J Intern Med

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Background/Aims Membranous nephropathy (MN) is the most common primary glomerular disease diagnosed in older patients. Few reports describe the clinical outcomes in older patients with idiopathic MN. Methods The outcomes of 135 patients with histologically proven MN were analyzed. ‘Older’ was defined as 60 years of age or older at the time of the renal biopsy. The rates of complete remission (CR), progression to end-stage renal disease (ESRD) and infection were compared between older and younger patients. Results The cumulative event rate for achieving CR was inferior ( p = 0.012) and that for requiring renal replacement was higher ( p = 0.015) in older patients, and they had a greater risk of infection ( p = 0.005). Older age was a significant predictor of a lower rate of CR (adjusted odds ratio [OR], 0.51; 95% confidence interval [CI], 0.26 to 0.98), and was a robust predictor of infection (adjusted OR, 5.27; 95% CI, 1.31 to 21.20). Conservative treatment was associated with a lower remission rate ( p = 0.036) and corticosteroid treatment was less effective in achieving CR ( p = 0.014), in preventing progression to ESRD ( p = 0.013) and in reducing infection ( p = 0.033) in older patients. Cyclosporine treatment had similar clinical outcomes with regard to CR, ESRD progression, and infection in older patients. Conclusions Older age was independently associated with inferior rates of CR and greater risk of infection. Treatment modalities affected the outcomes of older patients differently in that cyclosporine treatment is predicted to be more useful than corticosteroids.

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Clinical Impact of Renal Biopsy on Outcomes in Elderly Patients with Nephrotic Syndrome

Cited by 15 publications

References 38 publications

Renal Biopsy in Very Elderly Patients: Data from the Spanish Registry of Glomerulonephritis

Renal Biopsy in Very Elderly Patients: Data from the Spanish Registry of Glomerulonephritis

Administration of low-dose cyclosporine alone for the treatment of elderly patients with membranous nephropathy

Clinical outcomes and effects of treatment in older patients with idiopathic membranous nephropathy

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