Nephrotic Syndrome in the Elderly

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1987.tb01350.x ◽

1987 ◽

Vol 35 (2) ◽

pp. 170-173 ◽

Cited By ~ 1

Author(s):

P. J. Murphy ◽

G. Wright ◽

G. S. Rai

Keyword(s):

Nephrotic Syndrome ◽

The Elderly

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Idiopathic nephrotic syndrome in the elderly

Geriatric Nephrology and Urology ◽

10.1007/bf01523981 ◽

1994 ◽

Vol 4 (3) ◽

pp. 189-195 ◽

Cited By ~ 2

Author(s):

Eduardo Lorca ◽

Claudio Ponticelli

Keyword(s):

Nephrotic Syndrome ◽

Idiopathic Nephrotic Syndrome ◽

The Elderly

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P0435PREDICTORS OF RENAL SURVIVAL IN ELDERLY NEPHROTIC SYNDROME

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0435 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tasnim Ben ayed ◽

Imen Gorsane ◽

Raja Trabelsi ◽

Mondher Ounissi ◽

Taieb Ben Abdallah

Keyword(s):

Nephrotic Syndrome ◽

Membranous Nephropathy ◽

Treatment Strategies ◽

The Elderly ◽

Albumin Level ◽

Glomerular Disease ◽

Renal Diseases ◽

Renal Survival ◽

Multivariate Study ◽

The Mean

Abstract Background and Aims With increasing longevity, the numbers of elderly patients presenting with renal diseases including glomerular disease are increasing. Nephrotic syndrome (NS) is a common presentation of glomerular disease in the elderly. We performed this study to assess predictors of renal survival in this population. Method A retrospective study including one hundred and six patients aged 65 years or more hospitalized for NS in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. A multivariate study was carried out, the dependent variable being the evolution towards end-stage renal disease (ESRD). Results We studied 106 patients with an average age of 70 ± 4.5years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.6 [3-19.5 g/l], the mean albumin level was 20 ± 5.6g/l and the mean protidemia was 50 ± 6.9 g/l. Nephrotic syndrome was impure in 89.6 % of patients with high blood pressure in 70.5 % of cases, hematuria ≥2 + in 34.7% of cases and renal failure in 88.4 % of cases. The renal biopsy was performed in 41 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (27 %). NS was secondary in 63.2 % of cases mainly to amyloidosis (35.8 %) and diabetes (19.8 %). Idiopathic nephropaty was dominated by membranous nephropathy (11.3 %) and primitive membranoproliferative glomerulonephritis (MPGN) (6.6 %). At the end of follow-up, 35 % of patients achieved complete or partial remission and 58.5 % progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD uremia ≥ 17 mmol/l (ORa =33.2 [1.3 - 837.7]; p<0.05), phosphoremia ≥ 1.6 mmol/l (ORa=22.1 [1.8-266.5]; p<0.05), potassium concentration ≥ 4.3mmol/l (ORa=24.7 [2.4,251.5]; p<0.01), extra-renal signs (ORa=38,9 [2.4 - 634.3]; p: 0.01), secondary nephropathy (ORa=74 [3.1 - 1788.2]; p<0.01) and MPGN (ORa=48[1.4 - 1675.5]; p<0.05). The protective factors were hemoglobinemia ≥ 9.3g/dl (ORa=0.007 [0 - 0.2]; p<0.01), kidneys well differentiated on ultrasound (ORa=0.032 [0.003 - 0.4]; p<0.01) and treatment with two diuretics (ORa=0.03 [0.003 - 0.4]; p<0.01). Conclusion Elderly NS was characterized by a poor prognosis, in particular secondary to delayed and non-uniform treatment strategies, hence the need for rising physician awarness about this decease and consultation on a standardized treatment strategies.

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Diagnosis and Treatment of Nephrotic Syndrome in the Elderly

Journal of Integrative Nephrology and Andrology ◽

10.4103/2225-1243.168530 ◽

2015 ◽

Vol 2 (4) ◽

pp. 123

Author(s):

Guang-yan Cai ◽

Min-xia Li

Keyword(s):

Nephrotic Syndrome ◽

The Elderly ◽

Diagnosis And Treatment

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P0314TREATMENT AND OUTCOMES OF IDIOPATHIC MEMBRANOUS NEPHROPATHY IN ELDERLY PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0314 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nessrine Breik ◽

Mouna Jerbi ◽

Raja Aoudia ◽

Soumaya Chargui ◽

Hanen Guaied ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Side Effects ◽

Immunosuppressive Therapy ◽

Older Patients ◽

Symptomatic Treatment ◽

The Elderly ◽

The Other ◽

Group 4 ◽

Group 2 ◽

Group 1

Abstract Background and Aims The increase in life expectancy has led to increasing numbers of elderly patients in all medical disciplines, particularly in nephrology. Idiopathic membranous nephropathy (IMN) is common in the elderly and can lead to significant morbidity and mortality because of the complication of nephrotic syndrome (NS) and immunosuppressive therapy. The aim of this study is to analyze the diagnostic, therapeutic and evolutionary approach of IMN in elderly patiets. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Data collected included demographic, clinical and biological parameters in each patient. Data were entered and analyzed using SPSS software. Results Twenty-eight patients were collected. The mean age was 67.03 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 82.5% of cases. Sixteen patients were smokers (57.14%), 5 ethyl patients (17.8%), diabetes was present in 3 patients (10.7%) and hypertension in 11 patients (39.28%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery were dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (39.28%) and elevated creatinine level in 9 cases (32.14%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (75%), anasarca in 7 cases (25%), proteinuria in all cases and hematuria in 20 cases (71.14%). Biology revealed nephrotic syndrome (NS) in all cases, hypercholesterolemia in 23 cases (82.14%), high serum creatinine in 14 cases (50%) with an average creatinine level of 127,95 µmol/l, anemia in 17 cases (60.7%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Symptomatic treatment was indicated in all patients. Immunosuppressive therapy was started early in 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone (group 1), three patients received corticosteroid with mycofenolate mofetil (group 2) and one patient received corticosteroid with ciclosporin (group3). Fourteen patients received only symptomatic treatment (group 4). We noted partial remission in group 3, however complete remission in 37.5%, 14.28% and 12.5% from respectively group 1, group 4 and group 2. The side effects of immunosuppressive therapy were infectious complication in 8 patients (28.5%), osteoporosis in 3 patients (10.7%) and Steroid diabetes in one case. The side effects of NS were thrombotic complication in 5 patients (17.85%). Two patients had presented coronary syndrome and two other patients had presented hepatitis C. Two cases of death were noted whose etiology was pulmonary infection in one patient and undeterminate etiology in the other case. Conclusion Treatment of IMN in older patients has unique challenges, reducing the need for renal replacement therapy. Most studies report that the elderly respond to therapy with rates comparable with younger patients but in the other hand elderly are more susceptible to side effects of immunosuppressive therapy.

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What about NSAID and secondary minimal change disease in adult’s people? A case report and review of the literature

Journal of Renal Endocrinology ◽

10.34172/jre.2021.12 ◽

2021 ◽

Vol 7 (1) ◽

pp. e12-e12

Author(s):

Erica E Faure ◽

Jorge H. Mukdsi

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Clinical Presentation ◽

The Elderly ◽

Minimal Change ◽

Glomerular Injury ◽

Drug Induced ◽

History Of ◽

Histological Characteristics ◽

Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) have been used in the management of inflammatory disease for decades. The spectrum of nephrotoxicity attributed to NSAIDs includes mainly acute tubulointerstitial nephritis. However, much less attention has been given to drug-induced glomerular injury. NSAIDs treating patients presenting with nephrotic syndrome may have a variety of glomerular changes indistinguishable from those found in idiopathic minimal change disease (MCD), for example. The clinical presentation is typically abrupt with nephrotic syndrome while in the elderly it can present as acute renal failure from the beginning. We present an MCD-NSAID induced in elderly patient and discuss possible pathogenic mechanism, thinking about on the indiscriminate use of NSAIDs. Here we report the case of a 66-year-old woman with a history of nephrotic syndrome and hypertension without an apparent secondary etiology. However, an exhaustive history showed and indiscriminate use of NSAIDs. Renal biopsy showed a MCD with a mild interstitial nephritis. To our knowledge the morphology of drug-induced diseases often does not differ from the primary forms, making the distinction difficult. There are subtle clues, although the dialogue between clinician and pathologist is essential to reach an etiological diagnosis. Physicians should suspect glomerulonephritis in patients who receive drugs and its management must be determined based on the histological characteristics of the disease. Although corticosteroid therapy seems to be of value, the effectiveness of this approach must still be tested in randomized and multicentric clinical trials.

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INVESTIGATING ETIOLOGIES AND RENAL HISTOLOGIC PATTERNS IN 6 ELDERLY PATIENTS WITH NEPHROTIC SYNDROME

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.3.12 ◽

2015 ◽

pp. 85-92

Author(s):

Bach Nguyen ◽

Thi Thuy Trang Le ◽

Ngoc Linh Huynh

Keyword(s):

Nephrotic Syndrome ◽

Elderly Patients ◽

Kidney Biopsy ◽

The Elderly ◽

Minimal Change ◽

Renal Pathology ◽

Invasive Technique ◽

Renal Amyloidosis ◽

Glomerular Diseases

Background: Nephrotic syndrome (NS) is the most common manifestation of glomerular diseases in the elderly and a most common indication of kidney biopsy. NS in the elderly is not as common as the young but more difficult to make diagnosis of etiologies, classification of renal histologic patterns and treatment because NS is frequently associated with various coexisting conditions. In Vietnam, the elderly population has been increased significantly therefore frequency of the elderly patients with NS is also increasing. Kidney biopsy is an invasive technique that is useful in diagnosing etiologies and classifying renal pathology. During recent years, renal pathology and biochemical immunology have been progressing rapidly. Therefore, the results of kidney biopsy are usually potential and valuable in clinical practice. We reported 6 elderly patients with NS performed kidney biopsy in Department of Nephrology, HCMCity during the period from 2/2012 to 12/2014 to investigate etiologies and renal histologic patterns. Materials and method: case report. The reported clinical cases were primary renal amyloidosis, IgA nephropathy secondary to liver cancer, minimal change NS associated with diabetes, NS caused by renal lymphoma infiltration, NS with minimal change associated by interferon and thrombotic microangiopathy. Conclusions: Nephrotic syndrome in the elderly might be associated with coexisting conditions and caused by several primary and secondary causes. Therefore, kidney biopsy should be considered to perform to make exact diagnosis in etiology, and to classify histologic patterns. Key words: Nephrotic syndrome, elderly, histologic patterns, kidney biopsy

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P0465NEPHROTIC SYNDROME IN ELDERLY PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0465 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tasnim Ben ayed ◽

Imen Gorsane ◽

Raja Trabelsi ◽

Mondher Ounissi ◽

Taieb Ben Abdallah

Keyword(s):

Nephrotic Syndrome ◽

Membranous Nephropathy ◽

Immunosuppressive Treatment ◽

Treatment Strategies ◽

The Elderly ◽

Albumin Level ◽

Study Objective ◽

Multicentric Study ◽

Glomerular Lesions ◽

The Mean

Abstract Background and Aims Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly. Method This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS. Results We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD. Conclusion Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.

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