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Glomerulopathies in the Elderly

  • Arunraj NavaratnarajahEmail author
  • Michelle WillicombeEmail author
Chapter

Abstract

The assessment of glomerular disease in the elderly has its own set of unique challenges. Issues range from controversies in the diagnosis and treatment of specific disease entities, the spectrum of multi-morbidity, to the competing balance of conservative care to maximise quality of life with more aggressive/interventional treatment options. The range of lesions and relative frequency of each individual histological lesion observed in the elderly patient biopsied for renal dysfunction is different to that observed in younger patients. This chapter focusses on the commonest glomerulopathies encountered in elderly patients, and reviews the available treatment strategies, with attention to the nuances to the older patient.

Keywords

Glomerular disease Elderly Renal biopsy Immunosuppression Prognosis 

References

  1. 1.
    Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, et al. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med. 2010;152(9):561–7.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Glassock RJ, Rule AD. The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Kidney Int. 2012;82(3):270–7.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33(4):278–85.PubMedCrossRefGoogle Scholar
  4. 4.
    Hogan JJ, Mocanu M, Berns JS. The native kidney biopsy: update and evidence for best practice. Clin J Am Soc Nephrol. 2016;11(2):354–62.PubMedCrossRefGoogle Scholar
  5. 5.
    Zhu P, Zhou FD, Zhao MH. The renal histopathology spectrum of elderly patients with kidney diseases: a study of 430 patients in a single Chinese center. Medicine (Baltimore). 2014;93(28):e226.CrossRefGoogle Scholar
  6. 6.
    Yokoyama H, Sugiyama H, Sato H, Taguchi T, Nagata M, Matsuo S, et al. Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR). Clin Exp Nephrol. 2012;16(6):903–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Verde E, Quiroga B, Rivera F, Lopez-Gomez JM. Renal biopsy in very elderly patients: data from the Spanish registry of glomerulonephritis. Am J Nephrol. 2012;35(3):230–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Rollino C, Ferro M, Beltrame G, Quattrocchio G, Massara C, Quarello F, et al. Renal biopsy in patients over 75: 131 cases. Clin Nephrol. 2014;82(4):225–30.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Nair R, Bell JM, Walker PD. Renal biopsy in patients aged 80 years and older. Am J Kidney Dis. 2004;44(4):618–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Moutzouris DA, Herlitz L, Appel GB, Markowitz GS, Freudenthal B, Radhakrishnan J, et al. Renal biopsy in the very elderly. Clin J Am Soc Nephrol. 2009;4(6):1073–82.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Harmankaya O, Okuturlar Y, Kocoglu H, Kaptanogullari H, Yucel SK, Ozkan H, et al. Renal biopsy in the elderly: a single-center experience. Int Urol Nephrol. 2015;47(8):1397–401.PubMedCrossRefGoogle Scholar
  12. 12.
    Haas M, Spargo BH, Wit E-JC, Meehan SM. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis. 2000;35(3):433–47.CrossRefGoogle Scholar
  13. 13.
    Brown CM, Scheven L, O’Kelly P, Dorman AM, Walshe JJ. Renal histology in the elderly: indications and outcomes. J Nephrol. 2012;25(2):240–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Perkowska-Ptasinska A, Deborska-Materkowska D, Bartczak A, Stompor T, Liberek T, Bullo-Piontecka B, et al. Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland. BMC Nephrol. 2016;17(1):194.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50(3):811–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Death NCEiPOa. NCEPOD acute kidney injury: adding insult to injury report. 2009. Available from: http://www.ncepod.org.uk/2009.
  18. 18.
    Carter CE, Gansevoort RT, Scheven L, Heerspink HJ, Shlipak MG, de Jong PE, et al. Influence of urine creatinine on the relationship between the albumin-to-creatinine ratio and cardiovascular events. Clin J Am Soc Nephrol. 2012;7(4):595–603.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Fotheringham J, Campbell MJ, Fogarty DG, El Nahas M, Ellam T. Estimated albumin excretion rate versus urine albumin-creatinine ratio for the estimation of measured albumin excretion rate: derivation and validation of an estimated albumin excretion rate equation. Am J Kidney Dis. 2014;63(3):405–14.PubMedCrossRefGoogle Scholar
  20. 20.
    Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, et al. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718–24.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Dhaun N, Bellamy CO, Cattran DC, Kluth DC. Utility of renal biopsy in the clinical management of renal disease. Kidney Int. 2014;85(5):1039–48.PubMedCrossRefGoogle Scholar
  22. 22.
    Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD atlas of renal pathology: membranous nephropathy. Am J Kidney Dis. 2015;66(3):e15–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Ohtani H, Wakui H, Komatsuda A, Okuyama S, Masai R, Maki N, et al. Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2004;19(3):574–9.Google Scholar
  24. 24.
    Beck LH Jr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11–21.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Hofstra JM, Beck LH Jr, Beck DM, Wetzels JF, Salant DJ. Anti-phospholipase A(2) receptor antibodies correlate with clinical status in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. 2011;6(6):1286–91.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Deegens JK, Wetzels JF. Membranous nephropathy in the older adult: epidemiology, diagnosis and management. Drugs Aging. 2007;24(9):717–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Lefaucheur C, Stengel B, Nochy D, Martel P, Hill GS, Jacquot C, et al. Membranous nephropathy and cancer: epidemiologic evidence and determinants of high-risk cancer association. Kidney Int. 2006;70(8):1510–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Ruggenenti P, Fervenza FC, Remuzzi G. Treatment of membranous nephropathy: time for a paradigm shift. Nat Rev Nephrol. 2017;13(9):563–79.PubMedCrossRefGoogle Scholar
  29. 29.
    KDIGO. KDIGO clinical practice guidelines for glomerulonephritis. Kidney Int. 2012;Suppl 2.Google Scholar
  30. 30.
    Perna A, Schieppati A, Zamora J, Giuliano GA, Braun N, Remuzzi G. Immunosuppressive treatment for idiopathic membranous nephropathy: a systematic review. Am J Kidney Dis. 2004;44(3):385–401.PubMedCrossRefGoogle Scholar
  31. 31.
    Praga M, Barrio V, Juarez GF, Luno J, Grupo Espanol de Estudio de la Nefropatia M. Tacrolimus monotherapy in membranous nephropathy: a randomized controlled trial. Kidney Int. 2007;71(9):924–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Chen M, Li H, Li XY, Lu FM, Ni ZH, Xu FF, et al. Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial. Am J Med Sci. 2010;339(3):233–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Cattran DC, Greenwood C, Ritchie S, Bernstein K, Churchill DN, Clark WF, et al. A controlled trial of cyclosporine in patients with progressive membranous nephropathy. Canadian Glomerulonephritis Study Group. Kidney Int. 1995;47(4):1130–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Vivarelli M, Massella L, Ruggiero B, Emma F. Minimal change disease. Clin J Am Soc Nephrol. 2017;12(2):332–45.PubMedCrossRefGoogle Scholar
  35. 35.
    Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol. 2007;2(3):445–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Tse KC, Lam MF, Yip PS, Li FK, Choy BY, Lai KN, et al. Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2003;18(7):1316–20.Google Scholar
  37. 37.
    D’Agati VD, Kaskel FJ, Falk RJ. Focal segmental glomerulosclerosis. N Engl J Med. 2011;365(25):2398–411.PubMedCrossRefGoogle Scholar
  38. 38.
    Rosenberg AZ, Kopp JB. Focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2017;12(3):502–17.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science. 2010;329(5993):841–5.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Shi L. Anti-neutrophil cytoplasmic antibody-associated vasculitis: prevalence, treatment, and outcomes. Rheumatol Int. 2017;37(11):1779–88.PubMedCrossRefGoogle Scholar
  41. 41.
    Jennette JC, Wilkman AS, Falk RJ. Diagnostic predictive value of ANCA serology. Kidney Int. 1998;53(3):796–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, et al. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010;21(10):1628–36.PubMedCrossRefGoogle Scholar
  43. 43.
    Tanna A, Guarino L, Tam FW, Rodriquez-Cubillo B, Levy JB, Cairns TD, et al. Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2015;30(7):1185–92.Google Scholar
  44. 44.
    Nachman PH, Hogan SL, Jennette JC, Falk RJ. Treatment response and relapse in antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. 1996;7(1):33–9.PubMedGoogle Scholar
  45. 45.
    McAdoo SP, Pusey CD. Anti-glomerular basement membrane disease. Clin J Am Soc Nephrol. 2017;12(7):1162–72.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol. 2011;22(1):187–95.PubMedCrossRefGoogle Scholar
  47. 47.
    Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19(10):1855–64.PubMedCrossRefGoogle Scholar
  48. 48.
    Nasr SH, D’Agati VD. IgA-dominant postinfectious glomerulonephritis: a new twist on an old disease. Nephron Clin Pract. 2011;119(1):c18–25. discussion c6PubMedCrossRefGoogle Scholar
  49. 49.
    Oshima Y, Moriyama T, Itabashi M, Takei T, Nitta K. Characteristics of IgA nephropathy in advanced-age patients. Int Urol Nephrol. 2015;47(1):137–45.PubMedCrossRefGoogle Scholar
  50. 50.
    Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91(5):1014–21.PubMedCrossRefGoogle Scholar
  51. 51.
    Steiner N, Gobel G, Suchecki P, Prokop W, Neuwirt H, Gunsilius E. Monoclonal gammopathy of renal significance (MGRS) increases the risk for progression to multiple myeloma: an observational study of 2935 MGUS patients. Oncotarget. 2018;9(2):2344–56.PubMedCrossRefGoogle Scholar
  52. 52.
    Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP, et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015;87(4):698–711.PubMedCrossRefGoogle Scholar
  53. 53.
    Kumar SK, Rajkumar V, Kyle RA, van Duin M, Sonneveld P, Mateos MV, et al. Multiple myeloma. Nat Rev Dis Primers. 2017;3:17046.PubMedCrossRefGoogle Scholar
  54. 54.
    Mangoni AA, Jackson SH. The implications of a growing evidence base for drug use in elderly patients. Part 1. Statins for primary and secondary cardiovascular prevention. Br J Clin Pharmacol. 2006;61(5):494–501.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Mangoni AA, Jackson SH. The implications of a growing evidence base for drug use in elderly patients part 2. ACE inhibitors and angiotensin receptor blockers in heart failure and high cardiovascular risk patients. Br J Clin Pharmacol. 2006;61(5):502–12.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Timlin H, Lee SM, Manno RL, Seo P, Geetha D. Rituximab for remission induction in elderly patients with ANCA-associated vasculitis. Semin Arthritis Rheum. 2015;45(1):67–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.West London Renal and Transplant Centre, Hammersmith Hospital, Imperial NHS Healthcare TrustLondonUK

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