Patient Age and the Prognosis of Idiopathic Membranous Nephropathy

Abstract

BackgroundIdiopathic membranous nephropathy (IMN) is increasingly seen in older patients. However, differences in disease presentation and outcomes between older and younger IMN patients remain controversial. We compared patient characteristics between younger and older IMN patients.MethodsWe recruited 171 Japanese patients with IMN, including 90 (52.6%) patients <65 years old, 40 (23.4%) patients 65–70 years, and 41 (24.0%) patients ≥71 years. Clinical characteristics and outcomes were compared between younger and older IMN patients.ResultsDuring a median observation period of 37 months, 103 (60.2%) patients achieved complete proteinuria remission, which was not significantly associated with patient age (P = 0.831). However, 13 (7.6%) patients were hospitalized because of infection. Multivariate Cox proportional hazards models identified older age [adjusted hazard ratio (HR) = 3.11, 95% confidence interval (CI): 1.45–7.49, per 10 years; P = 0.003], prednisolone use (adjusted HR = 11.8, 95% CI: 1.59–242.5; P = 0.014), and cyclosporine used in combination with prednisolone (adjusted HR = 10.3, 95% CI: 1.59–204.4; P = 0.012) as significant predictors of infection. A <25% decrease in proteinuria at 1 month after immunosuppressive therapy initiation also predicted infection (adjusted HR = 6.72, 95% CI: 1.51–37.8; P = 0.012).ConclusionsYounger and older IMN patients had similar renal outcomes. However, older patients were more likely to develop infection when using immunosuppressants. Patients with a poor response in the first month following the initiation of immunosuppressive therapy should be carefully monitored for infection and may require a faster prednisolone taper.

Complete Remission in the Nephrotic Syndrome Study Network

“…Frequencies of complete remission in NEPTUNE were similar for MCD and FSGS but were lower for MN. This may be related to the short minimum duration of observation required for this initial report and the longer time from diagnosis to remission that may be required for MN compared with MCD and FSGS (14). Significant predictors of CRever included initial proteinuria, kidney pathology, and IST in the FSGS and MN cohorts.…”

“…Previous publications reported frequencies of complete remission ranging from 70% to 87% in MCD, 20% to 34% in FSGS, and 60% in MN. This published MN estimate includes spontaneous remission as well as remission after therapy (11)(12)(13)(14). Frequencies of complete remission in NEPTUNE were similar for MCD and FSGS but were lower for MN.…”

The clinicopathological features of patients with membranous nephropathy

“…8 Data have revealed that MN is common in middle and old age groups with the peak age of 31-60 years. 9 The incidence of MN is different between men and women, and the ratio of male to female is approximately 2:1. 10 In previous studies, some typical clinical manifestations have been identified in patients with MN, such as NS, edema, hypertension, renal failure, and microscopic hematuria.…”

Tick-Tock Chimes the Kidney Clock – from Biology of Renal Ageing to Clinical Applications

“…In these conditions, biological age could replace chronological age as a prognostic indicator. Other kidney diseases with a less well-defined role of age on outcome include diabetic nephropathy [79], focal segmental glomerulosclerosis [80] and membranous nephropathy [81]. …”