Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea
•Old age is an independent predictor of clinical outcomes and renal outcome risk was increased steeply above age 65 years in idiopathic membranous nephropathy (MN).•The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) has a beneficial effect on renal out...
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| Veröffentlicht in: | Archives of gerontology and geriatrics 2018-05, Vol.76, p.175-181 |
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| creator | 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 Kyu Kim, Yong Chul Lim, Chun Soo Park, Jung Tak Lee, Jung Pyo |
| description | •Old age is an independent predictor of clinical outcomes and renal outcome risk was increased steeply above age 65 years in idiopathic membranous nephropathy (MN).•The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) has a beneficial effect on renal outcome and infection in elderly MN patients.•Immunosuppressive therapy did not show superior clinical outcomes compared to conservative therapy in elderly MN patients.•In elderly MN patients, the risk factors for clinical outcome and treatment should be different from those of young age MN patients.
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 ( |
| doi_str_mv | 10.1016/j.archger.2018.03.002 |
| format | Article |
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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.</description><identifier>ISSN: 0167-4943</identifier><identifier>EISSN: 1872-6976</identifier><identifier>DOI: 10.1016/j.archger.2018.03.002</identifier><identifier>PMID: 29525605</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Age Factors ; Aged ; Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor ; Angiotensin Receptor Antagonists - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Elderly ; Female ; Glomerulonephritis, Membranous - drug therapy ; Humans ; Male ; Membranous nephropathy ; Middle Aged ; Retrospective Studies</subject><ispartof>Archives of gerontology and geriatrics, 2018-05, Vol.76, p.175-181</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-a55be4cf09e3b18fb4546a2a1bb4d83bebc18cfe2485080c58a88463e04afff23</citedby><cites>FETCH-LOGICAL-c431t-a55be4cf09e3b18fb4546a2a1bb4d83bebc18cfe2485080c58a88463e04afff23</cites><orcidid>0000-0002-4714-1260</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0167494318300384$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29525605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bae, Eunjin</creatorcontrib><creatorcontrib>Lee, Sung Woo</creatorcontrib><creatorcontrib>Park, Seokwoo</creatorcontrib><creatorcontrib>Kim, Dong Ki</creatorcontrib><creatorcontrib>Lee, Hajeong</creatorcontrib><creatorcontrib>Huh, Hyuk</creatorcontrib><creatorcontrib>Chin, Ho Jun</creatorcontrib><creatorcontrib>Lee, Shina</creatorcontrib><creatorcontrib>Ryu, Dong-Ryeol</creatorcontrib><creatorcontrib>Park, Ji In</creatorcontrib><creatorcontrib>Kim, Sejoong</creatorcontrib><creatorcontrib>Park, Dong Jun</creatorcontrib><creatorcontrib>Kang, Shin-Wook</creatorcontrib><creatorcontrib>Kim, Yon Su</creatorcontrib><creatorcontrib>Oh, Yun Kyu</creatorcontrib><creatorcontrib>Kim, Yong Chul</creatorcontrib><creatorcontrib>Lim, Chun Soo</creatorcontrib><creatorcontrib>Park, Jung Tak</creatorcontrib><creatorcontrib>Lee, Jung Pyo</creatorcontrib><title>Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea</title><title>Archives of gerontology and geriatrics</title><addtitle>Arch Gerontol Geriatr</addtitle><description>•Old age is an independent predictor of clinical outcomes and renal outcome risk was increased steeply above age 65 years in idiopathic membranous nephropathy (MN).•The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) has a beneficial effect on renal outcome and infection in elderly MN patients.•Immunosuppressive therapy did not show superior clinical outcomes compared to conservative therapy in elderly MN patients.•In elderly MN patients, the risk factors for clinical outcome and treatment should be different from those of young age MN patients.
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.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor</subject><subject>Angiotensin Receptor Antagonists - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Elderly</subject><subject>Female</subject><subject>Glomerulonephritis, Membranous - drug therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Membranous nephropathy</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><issn>0167-4943</issn><issn>1872-6976</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1v1DAQhi1ERZfCTwD5yCVh_JV1uKCqagFRqZdythxnzHqVxFvbQdp_j8suXDmNZD3PvOOXkHcMWgas-7hvbXK7n5haDky3IFoA_oJsmN7ypuu33Uuyqdy2kb0Ul-R1znsAkMC7V-SS94qrDtSGPD0mtGXGpVC7jNRNYQnOTjSuxcUZM42e4jRimo40jCEebNkFR2ech2SXuGa64GGX_rwfP9FrOq9TCa7uw0Rd3MVUaC7rWO2Ffo817A258HbK-PY8r8iPu9vHm6_N_cOXbzfX942TgpXGKjWgdB56FAPTfpBKdpZbNgxy1GLAwTHtPHKpFWhwSlutZScQpPXec3FFPpz2HlJ8WjEXM4fscJrsgvVuU2sTDFQvWUXVCXUp5pzQm0MKs01Hw8A8t2325tz2s6YNCFPbrt77c8Q6zDj-s_7WW4HPJwDrR3-FqmcXcHE4hoSumDGG_0T8Bu7flfI</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Bae, Eunjin</creator><creator>Lee, Sung Woo</creator><creator>Park, Seokwoo</creator><creator>Kim, Dong Ki</creator><creator>Lee, Hajeong</creator><creator>Huh, Hyuk</creator><creator>Chin, Ho Jun</creator><creator>Lee, Shina</creator><creator>Ryu, Dong-Ryeol</creator><creator>Park, Ji In</creator><creator>Kim, Sejoong</creator><creator>Park, Dong Jun</creator><creator>Kang, Shin-Wook</creator><creator>Kim, Yon Su</creator><creator>Oh, Yun Kyu</creator><creator>Kim, Yong Chul</creator><creator>Lim, Chun Soo</creator><creator>Park, Jung Tak</creator><creator>Lee, Jung Pyo</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4714-1260</orcidid></search><sort><creationdate>201805</creationdate><title>Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea</title><author>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 Kyu ; Kim, Yong Chul ; Lim, Chun Soo ; Park, Jung Tak ; Lee, Jung Pyo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-a55be4cf09e3b18fb4546a2a1bb4d83bebc18cfe2485080c58a88463e04afff23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor</topic><topic>Angiotensin Receptor Antagonists - therapeutic use</topic><topic>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</topic><topic>Elderly</topic><topic>Female</topic><topic>Glomerulonephritis, Membranous - drug therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Membranous nephropathy</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bae, Eunjin</creatorcontrib><creatorcontrib>Lee, Sung Woo</creatorcontrib><creatorcontrib>Park, Seokwoo</creatorcontrib><creatorcontrib>Kim, Dong Ki</creatorcontrib><creatorcontrib>Lee, Hajeong</creatorcontrib><creatorcontrib>Huh, Hyuk</creatorcontrib><creatorcontrib>Chin, Ho Jun</creatorcontrib><creatorcontrib>Lee, Shina</creatorcontrib><creatorcontrib>Ryu, Dong-Ryeol</creatorcontrib><creatorcontrib>Park, Ji In</creatorcontrib><creatorcontrib>Kim, Sejoong</creatorcontrib><creatorcontrib>Park, Dong Jun</creatorcontrib><creatorcontrib>Kang, Shin-Wook</creatorcontrib><creatorcontrib>Kim, Yon Su</creatorcontrib><creatorcontrib>Oh, Yun Kyu</creatorcontrib><creatorcontrib>Kim, Yong Chul</creatorcontrib><creatorcontrib>Lim, Chun Soo</creatorcontrib><creatorcontrib>Park, Jung Tak</creatorcontrib><creatorcontrib>Lee, Jung Pyo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of gerontology and geriatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bae, Eunjin</au><au>Lee, Sung Woo</au><au>Park, Seokwoo</au><au>Kim, Dong Ki</au><au>Lee, Hajeong</au><au>Huh, Hyuk</au><au>Chin, Ho Jun</au><au>Lee, Shina</au><au>Ryu, Dong-Ryeol</au><au>Park, Ji In</au><au>Kim, Sejoong</au><au>Park, Dong Jun</au><au>Kang, Shin-Wook</au><au>Kim, Yon Su</au><au>Oh, Yun Kyu</au><au>Kim, Yong Chul</au><au>Lim, Chun Soo</au><au>Park, Jung Tak</au><au>Lee, Jung Pyo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea</atitle><jtitle>Archives of gerontology and geriatrics</jtitle><addtitle>Arch Gerontol Geriatr</addtitle><date>2018-05</date><risdate>2018</risdate><volume>76</volume><spage>175</spage><epage>181</epage><pages>175-181</pages><issn>0167-4943</issn><eissn>1872-6976</eissn><abstract>•Old age is an independent predictor of clinical outcomes and renal outcome risk was increased steeply above age 65 years in idiopathic membranous nephropathy (MN).•The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) has a beneficial effect on renal outcome and infection in elderly MN patients.•Immunosuppressive therapy did not show superior clinical outcomes compared to conservative therapy in elderly MN patients.•In elderly MN patients, the risk factors for clinical outcome and treatment should be different from those of young age MN patients.
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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>29525605</pmid><doi>10.1016/j.archger.2018.03.002</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-4714-1260</orcidid></addata></record> |
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| subjects | Adult Age Factors Aged Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor Angiotensin Receptor Antagonists - therapeutic use Angiotensin-Converting Enzyme Inhibitors - therapeutic use Elderly Female Glomerulonephritis, Membranous - drug therapy Humans Male Membranous nephropathy Middle Aged Retrospective Studies |
| title | Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea |
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