Idiopathic membranous nephropathy in older patients: Clinical features and outcomes

Abstract

Background Various factors can affect renal and patient outcome in idiopathic membranous nephropathy (iMN). We aimed to identify predictors of renal and patient survival in patients with iMN, with a special focus on outcomes among older patients. Methods We retrieved data on 1,776 patients (mean age 53.0 ± 14.7 years; 1,075 [60.5%] males) diagnosed with iMN from the Korean GlomeruloNEphritis sTudy (KoGNET), a database compiled from 18 centers in Korea. Results The cohort included 428 (24.1%) patients over 65 years old. Compared to younger patients, this group had lower hemoglobin and serum albumin levels, a higher incidence of nephroticrange proteinuria, and higher prevalences of hypertension and diabetes. At last follow-up, complete or partial remission rates were not significantly different between the older and younger groups. Older age (HR: 0.98, 95%CI: 0.97-0.99), elevated hemoglobin (HR: 0.82, 95%CI: 0.72-0.93), high serum albumin (HR: 0.66, 95%CI: 0.44-0.99), and a high estimated glomerular filtration rate (HR: 0.96, 95%CI: 0.95-0.97) at biopsy were good predictors of renal outcomes. Significant risk factors for patient survival were older age (HR: 1.04, 95%CI: 1.01-1.10) and hypertension at biopsy (HR: 2.76, 95%CI: 1.30-5.90). Conclusions Older patients with iMN had favorable renal outcomes, but poor patient survival, compared to younger patients. Prognostic information on outcomes in this study might be helpful for optimizing the management of patients with iMN.

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B Cells in Primary Membranous Nephropathy: Escape from Immune Tolerance and Implications for Patient Management

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