Minimal change glomerulonephritis in the elderly--the role of renal biopsy

We describe the case histories of three septuagenarians with nephrotic syndrome who would not have been thought likely to have had minimal change disease on clinical grounds. Yet in the three patients all non-sclerosed glomeruli were normal on light microscopy and glomerular immunofluorescence was negative. All three showed a good clinical response to steroids. It is clear from our findings that, in the elderly, clinical criteria are not a reliable guide to renal histology and may lead to a potentially treatable condition, minimal change nephropathy, being overlooked. Because of the high incidence of side effects, a trial of steroids in the elderly is hazardous. From the evidence given we conclude that renal biopsy, in adults with nephrotic syndrome, becomes increasingly useful with advancing age.