Outcomes of Older Patients (≥60 years) with New-Onset Idiopathic Nephrotic Syndrome Receiving Immunosuppressive Regimen: A Multicentre Study of 116 Patients

Abstract

Because of its rarity, renal presentation and outcomes of idiopathic nephrotic syndrome (INS; minimal changes disease or focal and segmental glomerulosclerosis) has poorly been described in elderly patients, precluding an individualized therapy procedure. Whether immunosuppressive regimens formerly designed in children and young adults are safe and efficient in elderly remains elusive. In a large multicentric retrospective study that included 116 patients with INS and onset ≥ 60 years of age, we showed that cumulative incidence of renal response was 95% after frontline therapy, with an age-dependent median time-to-response (60 days before 70 years of age at the onset vs. 120 days after; p = 0.03). Cumulative incidence of relapse was 90% at 7 years, with relapse occurring continuously over time. After a median follow-up of 34 months (IQR (12; 57)), 7 patients had died (6%) and 5 reached end-stage renal disease. Complications were highly prevalent: diabetes mellitus (23.3%), hypertension (24.1%), infection requiring hospitalization (21.6%) and acute kidney injury (9.5%). Thus, in older patients with INS and receiving steroids, renal response is delayed and relapse is the rule. Alternative immunosuppressive regimens, including B-cells depleting agents as frontline therapy, should be tested in this subset of patients to improve the mid- to long-term outcomes.

Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys

“…Colliou et al. 44 showed that 85% of patients developing INS after the age of 60 years have a complete or partial renal response on corticosteroids and/or immunosuppressive regimens. In the POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome) study, Muso et al.…”

Efficacy of Rituximab for Minimal Change Disease and Focal Segmental Glomerulosclerosis with Frequently Relapsing or Steroid-Dependent Nephrotic Syndrome in Adults: A Chinese Multicenter Retrospective Study

“…In a retrospective cohort study that included patients with an average age of 51.5 ± 20.1 years, the relapse frequency decreased significantly after rituximab treatment, from 0.83 (0.18, 1.92) to 0.00 (0.00, 0.71) times per year [28]. Another study involving elderly patients aged 60 or older with MCD or FSGS showed that rituximab-induced complete or partial remission in 18 out of 23 patients [29]. Despite the age difference in our study (median age 25.0, range 20.0–40.5), our results were consistent with these previous studies in which rituximab reduced relapse frequency and corticosteroid exposure.…”

Adjusting the Lens: Real World Outcomes in Nephrotic Syndrome

“…Even for minimal change disease, only 50% had entered complete remission by 6 months, much lower than that reported in the literature. [6][7][8] Given the nature of routine data, there are of course limitations to the study, although these have been addressed where possible. The major issues concern the very limited information about baseline comorbidities, and relatively small numbers, particularly for models of subgroups in which many estimates have wide confidence intervals.…”

“…Even for minimal change disease, only 50% had entered complete remission by 6 months, much lower than that reported in the literature. 6 , 7 , 8 …”