Nephrol Dial Transplant (1993) 8: 1321-1325
© 1993 European Renal Association-European Dialysis and Transplant Association
research-article
Idiopathic membranous nephropathy in the elderly
1Division of Nephrology and Dialysis, IRCCS, Ospedale Maggiore Milano 2Ospedale Brotzu Cagliari Italy 3Ospedale Civile Lecco Italy
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Patrizia Passerini, Divisione di Nefrologia e Dialisi, Ospedale Maggiore, via Commenda 15, 20122, Milano, Italy.
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 methylpredniso-lone 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 µmol/l at the 5th year in group A and from 113±14 to 124±30 µmol/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).
The natural course of membranous nephropathy in older patients is similar to that of patients of the second age. Corticosteroids alone do not modify the outcome. Corticosteroids alternated with chlorambucil seem to improve the chances of remission and to protect from renal dysfunction, but elderly patients are more exposed to the side-effects of this regimen. Thus this treatment should be limited to patients with severe nephrotic syndrome and/or incipient renal insufficiency, using some particular cautions.
Keywords: membranous nephropathy; immuno-suppressive therapy; corticosteroids; alkylating agents; glomerulonephritis; renal disease in the elderly