Therapeutic strategy of nephrotic syndrome in patients over eighty

In the present paper, we report four very elderly patients (80 years of age or older) with primary nephrotic syndrome. In all patients, oral prednisolone (PSL) alternative day therapy was attempted and three patients responded very well (complete remission 2, partial remission 1). However, one patient exhibited no effect of PSL and died from acute oliguric renal failure in spite of aggressive measures including hemodialysis. Fracture of the femoral neck occurred in one patient during PSL therapy, although the relationship between the fracture and PSL therapy was uncertain. In addition to our reported cases, 5 cases of nephrotic syndrome in similar patients reported elsewhere are analyzed together with our cohort. PSL was commonly effective in inducing remission in very elderly patients (7 of 9 patients; 78%). Very elderly patients with nephrotic syndrome frequently suffer from oliguric renal failure, which has a potentially high mortality. Based on these data, we conclude that PSL therapy can ameliorate primary nephrotic syndrome in patients over the age of eighty years. However, the complications both of the disease and its treatment, (e.g., acute oliguric renal failure, hip fracture) must be carefully monitored.