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International Urology and Nephrology

, Volume 33, Issue 1, pp 157–165 | Cite as

Characteristics and outcome of membranous nephropathy in older patients

  • C.A. O'Callaghan
  • J. Hicks
  • H. Doll
  • S.H. Sacks
  • J.S. Cameron
Article

Abstract

Many patients with idiopathic membranousnephropathy are elderly, but little is knownabout the natural or treated history of thesepatients. We have studied a cohort of 155patients with membranous nephropathy who wererecruited and followed up over a 20 yearperiod. We have compared the clinical featuresand outcome of the older (>60 years) andyounger age groups.There was a higher incidence of an identifiablecause for the nephropathy in older patients. Atpresentation with idiopathic disease, olderpatients were more often hypertensive and hadworse renal impairment than the younger cohort,but had a similar levels of proteinuria,hypoalbuminemia and hematuria. Thromboticcomplications and minor rheumatologicalcomplaints were more common in the olderpatients. Prognosis for life and renal survivalwas worse in the older onset patients.Treatment was well tolerated in selected olderpatients and was associated with a betteroutcome in those selected for treatment.

Elderly patients End stage renal failure Idiopathic membranous nephropathy Membranous glomerulonephritis Nephrotic syndrome Renal impairment 

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References

  1. 1.
    Cameron JS. Nephrotic Syndrome in the Elderly. Sem Nephrol 1996; 16: 319–329.Google Scholar
  2. 2.
    The Collaborative Study of the adult idiopathic nephrotic syndrome. A controlled study of short term prednisone treatment in adults with membranous nephropathy. N Eng J Med 1979; 301: 1301–1306.Google Scholar
  3. 3.
    Cameron JS, Healy MJR, Adu D. The Medical Research Council Trial of Short-term High-dose Alternate Day Prednisolone in Idiopathic Membranous Nephropathy with Nephrotic Syndrome in Adults. Q J Med 1990; 74: 133–156.Google Scholar
  4. 4.
    Ponticelli C, Zuchelli P, Passerini P, Cesana B. Methyl prednisolone plus chlorambucil as compared with methyl prednisolone alone for the treatment of idiopathic membranous nephropathy. N Engl J Med 1992; 327: 599–603.Google Scholar
  5. 5.
    Ponticelli C, Zuchelli P, Imbasciati E, Cagnoli L, Pozzi C, Passerini P, et al. Controlled Trial of Methylprednisolone and Chlorambucil in idiopathic membranous nephropathy. N Eng J Med 1984; 310: 946–950.Google Scholar
  6. 6.
    Ponticelli C, Zucchelli P, Passerini P, Cagnoli L, Cesana B, Pozzi C, et al. A randomized trial of methyl prednisolone and chlorambucil in idiopathic membranous nephropathy. N Eng J Med 1989; 320: 8–13.Google Scholar
  7. 7.
    Cattran DC, Delmore T, Roscoe J, Cole E, Cardella C, Charron R, et al. A randomized controlled trial of prednisone in patients with idiopathic membranous nephropathy. N Eng J Med 1989; 320: 210–215.Google Scholar
  8. 8.
    Sacks SH, Nomura S, Warner C, Naito S, Ogahara S. Molecular analysis of complement C4A and C4B loci in Caucasoids and Japanese with idiopathic membranous nephropathy. Kidney International 1992; 42: 882–887.Google Scholar
  9. 9.
    Couchond C, Laville M, Boissel JP. Treatment of membranous nephropathy: A meta-analysis. Nephrol Dial Transplant 1994; 9: 469–470.Google Scholar
  10. 10.
    Warwick GL, Geddes CG, Boulton-Jones JM. Prednisolone and chlorambucil therapy for idiopathic membranous nephropathy with progressive renal failure. Q J Med 1994; 87: 223–229.Google Scholar
  11. 11.
    O'Callaghan CA, Cameron JS, Sacks SH. Early prediction of treatment outcome in idiopathic membranous nephropathy. Q J Med 1995; 88: 889–894.Google Scholar
  12. 12.
    Ehrenreich T, Churg J. Pathology of membranous nephropathy. In: Sommers SC ed. Pathology Annual. New York: Appleton-Century-Crofts, 1968: 145–186.Google Scholar
  13. 13.
    Zent R, Nagai R, Cattran DC. Idiopathic membranous nephropathy in the elderly: A comparative study. Am J Kid Dis 1997; 29: 200–206.Google Scholar
  14. 14.
    Donadio JV. Treatment of glomerulonephritis in the elderly. American Journal of Kidney Disease. 1990; 16: 307–311.Google Scholar
  15. 15.
    Simon P, Ramee MP, Autuly V, Laruelle E, Charasse C, Cam G, et al. Epidemiology of primary glomerulopathies in a French region. Variations as a function of age in patients. Nephrologie 1995; 16: 191–201.Google Scholar
  16. 16.
    Cameron JS, Macias-Nunez JF. Renal Function in the elderly. In: Davison AM, Cameron JS, Grunfeld JP, Kerr DNS, Ritz E, Winnearls CG ed. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press, 1998: 77–91.Google Scholar
  17. 17.
    Cameron JS. The Nephrotic Syndrome: management, complications and pathophysiology. In: Davison AM, Cameron JS, Grunfeld JP, Kerr DNS, Ritz E, Winnearls CG ed. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press, 1998: 461–492.Google Scholar
  18. 18.
    Passerini P, Come G, Vigano E, Melis P, Pozzi C, Altieri P, et al. Idiopathic membranous nephropathy in the elderly. Nephrol Dial Transplant 1993; 8: 1321–1325.Google Scholar
  19. 19.
    Bizzarri D, Imperiali E, Duranti E, Sasdelli M. Idiopathic membranous glomerulonephritis in the elderly. Contrib Nephrol 1993; 105: 65–70.Google Scholar
  20. 20.
    Rollino C, Basolo B, Roccatello D, Vallero A, Funaro L, Piccoli G. Outcome of membranous glomerulonephritis in the elderly. Contrib Nephrol 1993; 105: 71–74.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • C.A. O'Callaghan
    • 1
  • J. Hicks
    • 1
  • H. Doll
    • 2
  • S.H. Sacks
    • 1
  • J.S. Cameron
    • 1
  1. 1.Renal UnitGuy's HospitalLondonUK
  2. 2.Health Services Research Unit, Dept of Public HealthUniversity of Oxford, Institute of Health SciencesOxfordUK

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