Treatment and clinical outcomes of elderly idiopathic membranous nephropathy

A multicenter cohort study in Korea

Eunjin Bae, Sung Woo Lee, Seokwoo Park, Dong Ki Kim, Hajeong Lee, Hyuk Huh, Ho Jun Chin, Shina Lee, Dong Ryeol Ryu, Ji In Park, Sejoong Kim, Dong Jun Park, Shin-Wook Kang, Yon Su Kim, Yun Kuy Oh, Yong Chul Kim, Chun Soo Lim, Jung Tak Park, Jung Pyo Lee

Research output: Contribution to journalArticle

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Abstract

Idiopathic membranous nephropathy (MN) is the most common glomerulonephritis in elderly patients showing nephrotic syndrome. However, little is known about its treatment options and outcomes in elderly MN patients at long term follow-up. We retrospectively enrolled patients with biopsy-proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of MN and subnephrotic-range proteinuria. We evaluated the presenting features and clinical outcomes and analyzed the all-cause mortality, renal outcomes, infection, and remission with respect to age. During the median follow-up at 77.2 months, 198 younger patients (<65 years) and 133 elderly patients (≥65 years) were enrolled. Age was an independent risk factor for all-cause mortality, renal outcome, and infection (for all P < 0.05) except remission. In elderly patients, there was no significant factor associated with mortality rate. The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) was significantly associated with renal outcome and infection (renal outcome, hazard ration [HR] 0.06, 95% confidence intervals [CI] 0.01–0.36, P = 0.003; infection, HR 0.20, 95% CI 0.04–0.94, P = 0.041). Immunosuppressant therapy significantly increased renal outcome (P = 0.045) and infection (P = 0.029) compared with conservative therapy. In conclusion, old age is one of the clinically important predictors for MN patients. Among the treatment of elderly MN patients, only ACEI or ARB was associated with beneficial effects on renal outcome and infection. Elderly MN patients need a more tailored regimen considering their comorbidities and condition.

Original languageEnglish
Pages (from-to)175-181
Number of pages7
JournalArchives of Gerontology and Geriatrics
Volume76
DOIs
Publication statusPublished - 2018 May 1

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Membranous Glomerulonephritis
Korea
Multicenter Studies
Cohort Studies
Kidney
mortality
Infection
cause
confidence
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
comorbidity
Mortality
old age
Confidence Intervals
Nephrotic Syndrome
Immunosuppressive Agents
Glomerulonephritis
Proteinuria
Tertiary Care Centers

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Ageing
  • Gerontology
  • Geriatrics and Gerontology

Cite this

Bae, Eunjin ; Lee, Sung Woo ; Park, Seokwoo ; Kim, Dong Ki ; Lee, Hajeong ; Huh, Hyuk ; Chin, Ho Jun ; Lee, Shina ; Ryu, Dong Ryeol ; Park, Ji In ; Kim, Sejoong ; Park, Dong Jun ; Kang, Shin-Wook ; Kim, Yon Su ; Oh, Yun Kuy ; Kim, Yong Chul ; Lim, Chun Soo ; Park, Jung Tak ; Lee, Jung Pyo. / Treatment and clinical outcomes of elderly idiopathic membranous nephropathy : A multicenter cohort study in Korea. In: Archives of Gerontology and Geriatrics. 2018 ; Vol. 76. pp. 175-181.
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abstract = "Idiopathic membranous nephropathy (MN) is the most common glomerulonephritis in elderly patients showing nephrotic syndrome. However, little is known about its treatment options and outcomes in elderly MN patients at long term follow-up. We retrospectively enrolled patients with biopsy-proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of MN and subnephrotic-range proteinuria. We evaluated the presenting features and clinical outcomes and analyzed the all-cause mortality, renal outcomes, infection, and remission with respect to age. During the median follow-up at 77.2 months, 198 younger patients (<65 years) and 133 elderly patients (≥65 years) were enrolled. Age was an independent risk factor for all-cause mortality, renal outcome, and infection (for all P < 0.05) except remission. In elderly patients, there was no significant factor associated with mortality rate. The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) was significantly associated with renal outcome and infection (renal outcome, hazard ration [HR] 0.06, 95{\%} confidence intervals [CI] 0.01–0.36, P = 0.003; infection, HR 0.20, 95{\%} CI 0.04–0.94, P = 0.041). Immunosuppressant therapy significantly increased renal outcome (P = 0.045) and infection (P = 0.029) compared with conservative therapy. In conclusion, old age is one of the clinically important predictors for MN patients. Among the treatment of elderly MN patients, only ACEI or ARB was associated with beneficial effects on renal outcome and infection. Elderly MN patients need a more tailored regimen considering their comorbidities and condition.",
author = "Eunjin Bae and Lee, {Sung Woo} and Seokwoo Park and Kim, {Dong Ki} and Hajeong Lee and Hyuk Huh and Chin, {Ho Jun} and Shina Lee and Ryu, {Dong Ryeol} and Park, {Ji In} and Sejoong Kim and Park, {Dong Jun} and Shin-Wook Kang and Kim, {Yon Su} and Oh, {Yun Kuy} and Kim, {Yong Chul} and Lim, {Chun Soo} and Park, {Jung Tak} and Lee, {Jung Pyo}",
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Bae, E, Lee, SW, Park, S, Kim, DK, Lee, H, Huh, H, Chin, HJ, Lee, S, Ryu, DR, Park, JI, Kim, S, Park, DJ, Kang, S-W, Kim, YS, Oh, YK, Kim, YC, Lim, CS, Park, JT & Lee, JP 2018, 'Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea', Archives of Gerontology and Geriatrics, vol. 76, pp. 175-181. https://doi.org/10.1016/j.archger.2018.03.002

Treatment and clinical outcomes of elderly idiopathic membranous nephropathy : A multicenter cohort study in Korea. / Bae, Eunjin; Lee, Sung Woo; Park, Seokwoo; Kim, Dong Ki; Lee, Hajeong; Huh, Hyuk; Chin, Ho Jun; Lee, Shina; Ryu, Dong Ryeol; Park, Ji In; Kim, Sejoong; Park, Dong Jun; Kang, Shin-Wook; Kim, Yon Su; Oh, Yun Kuy; Kim, Yong Chul; Lim, Chun Soo; Park, Jung Tak; Lee, Jung Pyo.

In: Archives of Gerontology and Geriatrics, Vol. 76, 01.05.2018, p. 175-181.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Treatment and clinical outcomes of elderly idiopathic membranous nephropathy

T2 - A multicenter cohort study in Korea

AU - Bae, Eunjin

AU - Lee, Sung Woo

AU - Park, Seokwoo

AU - Kim, Dong Ki

AU - Lee, Hajeong

AU - Huh, Hyuk

AU - Chin, Ho Jun

AU - Lee, Shina

AU - Ryu, Dong Ryeol

AU - Park, Ji In

AU - Kim, Sejoong

AU - Park, Dong Jun

AU - Kang, Shin-Wook

AU - Kim, Yon Su

AU - Oh, Yun Kuy

AU - Kim, Yong Chul

AU - Lim, Chun Soo

AU - Park, Jung Tak

AU - Lee, Jung Pyo

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Idiopathic membranous nephropathy (MN) is the most common glomerulonephritis in elderly patients showing nephrotic syndrome. However, little is known about its treatment options and outcomes in elderly MN patients at long term follow-up. We retrospectively enrolled patients with biopsy-proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of MN and subnephrotic-range proteinuria. We evaluated the presenting features and clinical outcomes and analyzed the all-cause mortality, renal outcomes, infection, and remission with respect to age. During the median follow-up at 77.2 months, 198 younger patients (<65 years) and 133 elderly patients (≥65 years) were enrolled. Age was an independent risk factor for all-cause mortality, renal outcome, and infection (for all P < 0.05) except remission. In elderly patients, there was no significant factor associated with mortality rate. The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) was significantly associated with renal outcome and infection (renal outcome, hazard ration [HR] 0.06, 95% confidence intervals [CI] 0.01–0.36, P = 0.003; infection, HR 0.20, 95% CI 0.04–0.94, P = 0.041). Immunosuppressant therapy significantly increased renal outcome (P = 0.045) and infection (P = 0.029) compared with conservative therapy. In conclusion, old age is one of the clinically important predictors for MN patients. Among the treatment of elderly MN patients, only ACEI or ARB was associated with beneficial effects on renal outcome and infection. Elderly MN patients need a more tailored regimen considering their comorbidities and condition.

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