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Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea

Authors
 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 Kyu Oh  ;  Yong Chul Kim  ;  Chun Soo Lim  ;  Jung Tak Park  ;  Jung Pyo Lee 
Citation
 Archives of Gerontology and Geriatics, Vol.76 : 175-181, 2018 
Journal Title
 Archives of Gerontology and Geriatics 
ISSN
 0167-4943 
Issue Date
2018
Keywords
Angiotensin II receptor blocker or angiotensin-converting enzyme inhibitor ; Elderly ; Membranous nephropathy
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 (<65years) 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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162201
Full Text
https://www.sciencedirect.com/science/article/pii/S0167494318300384
DOI
10.1016/j.archger.2018.03.002
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
강신욱(Kang, Shin Wook) ORCID logo https://orcid.org/0000-0002-5677-4756
박정탁(Park, Jung Tak) ORCID logo https://orcid.org/0000-0002-2325-8982
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