Treatment of glomerulonephritis in the elderly

Glomerular disease was assessed in persons who had renal biopsies and who were age 60 years and older in retrospective reviews of referral-based cohorts in Europe, the United States, and Japan. From a cumulative total of 514 patients reported from five centers, 337 (66%) patients had primary glomerular diseases and 177 (34%) had various secondary renal diseases. Amyloidosis was the largest histopathologic group among the secondary disorders. Idiopathic membranous nephropathy was the most common primary glomerulopathy (107/337 [32%] patients) and also comprised 46% of nephrotic patients. In our experience covering two consecutive 13-year periods from 1959 to 1984, there was an increase both in total number of patients, and in percentage more than 60 years old, with membranous nephropathy in the more recent study period compared with the earlier period reflecting a trend to more biopsy procedures that included older patients. Non-immune-mediated rapidly progressive glomerulonephritis (RPGN), thought by some to be more common in older adults, has been shown to represent a crescentic glomerulonephritis associated with systemic necrotizing vasculitis. Treatment with corticosteroids had a short-term favorable effect on renal function in this disorder over that achieved in antiglomerular basement membrane-associated or idiopathic RPGN. However, the 5-year patient survival was remarkably lower in older patients irrespective of the disease entity. On the other hand, age was not associated with progressive renal failure in patients with membranous nephropathy. Finally, minimal change glomerulopathy accounted for 35 of 204 (17%) nephrotic subjects, and complete remissions occurred after corticosteroid treatment at the same frequency (80% to 90%) observed in younger patients.