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Idiopathic membranous nephropathy in the elderly
P Passerini1, G Como, E Viganò
1Division of Nephrology and Dialysis, IRCCS, Ospedale Maggiore, Milano, Italy.
Abstract:
In this retrospective non-randomized study we reviewed the outcome for 41 patients with membranous nephropathy older than 65 years at onset and followed for at least 1 year. Twelve of the patients never received any specific treatment (group A), 15 were treated with a 6-month course of methylprednisolone alternated to chlorambucil every other month (group B), and 14 received corticosteroids alone for 3-12 months (group C). At the end of a mean follow-up of 92 +/- 61 months in group A, 53 +/- 35 in group B, and 38 +/- 25 in group C there were significantly more remissions of nephrotic syndrome in group B than in group A (P = 0.035) or in group C (P = 0.010). Moreover patients in group B spent a significantly longer period without nephrotic syndrome than patients in group A (P = 0.000) and C (P = 0.000). Three patients in group A and one in group B died. During the follow-up six patients of group A, two of group B, and five of group C developed renal function deterioration. In patients followed for at least 5 years the mean plasma creatinine increased from a basal of 112 +/- 29 to 239 +/- 287 mumol/l at the 5th year in group A and from 113 +/- 14 to 124 +/- 30 mumol/l in group B. The mean urine protein excretion remained unchanged in group A (basal 4.6 +/- 2.3 versus 4.8 +/- 5.7 g/day at 5 years) while it decreased in group B (from a basal of 6.8 +/- 3.5 to 1.1 +/- 0.4 g/day at 5 years).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Treatment with methylprednisolone and chlorambucil significantly improved remission rates and reduced nephrotic syndrome duration in elderly patients with membranous nephropathy.
Area of Science:
- Nephrology
- Internal Medicine
- Geriatrics
Background:
- Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
- Management of MN in elderly patients (>65 years) presents unique challenges due to comorbidities and potential treatment toxicity.
Purpose of the Study:
- To evaluate the efficacy and safety of different treatment regimens for membranous nephropathy in elderly patients.
- To compare outcomes between patients treated with methylprednisolone and chlorambucil, corticosteroids alone, or no specific treatment.
Main Methods:
- Retrospective, non-randomized study of 41 elderly patients with MN.
- Patients were divided into three groups: no treatment (A), methylprednisolone/chlorambucil (B), and corticosteroids alone (C).
- Outcomes including remission of nephrotic syndrome, duration of remission, and renal function deterioration were assessed over a mean follow-up of 38-92 months.
Main Results:
- Group B (methylprednisolone/chlorambucil) showed significantly higher remission rates compared to groups A and C (P=0.035, P=0.010).
- Patients in group B experienced significantly longer periods without nephrotic syndrome (P=0.000 for both comparisons).
- Renal function deterioration was observed in some patients across all groups, with a notable increase in plasma creatinine in untreated patients over 5 years.
Conclusions:
- Combination therapy with methylprednisolone and chlorambucil appears to be the most effective treatment for inducing remission and maintaining remission in elderly patients with membranous nephropathy.
- Further prospective studies are warranted to confirm these findings and optimize treatment strategies for this population.