Idiopathic membranous nephropathy in the elderly

In this retrospective non-randomized study we reviewed the outcomefor 41 patients with membranous nephropathy older than 65 yearsat onset and followed for at least 1 year. Twelve of the patientsnever received any specific treatment (group A), 15 were treatedwith a 6-month course of methylpredniso-lone alternated to chlorambucilevery other month (group B), and 14 received corticosteroidsalone for 3–12 months (group C). At the end of a meanfollow-up of 92±61 months in group A, 53±35 ingroup B, and 38±25 in group C there were significantlymore remissions of nephrotic syndrome in group B than in groupA (P=0.035) or in group C (P = 0.010). Moreover patients ingroup B spent a significantly longer period without nephroticsyndrome than patients in group A (P=0.000) and C (P=0.000).Three patients in group A and one in group B died. During thefollow-up six patients of group A, two of group B, and fiveof group C developed renal function deterioration. In patientsfollowed for at least 5 years the mean plasma creatinine increasedfrom a basal of 112±29 to 239±287 µmol/lat the 5th year in group A and from 113±14 to 124±30µmol/l in group B. The mean urine protein excretion remainedunchanged in group A (basal 4.6±2.3 versus 4.8±5.7g/day at 5 years) while it decreased in group B (from a basalof 6.8±3.5 to 1.1±0.4 g/day at 5 years). The natural course of membranous nephropathy in older patientsis similar to that of patients of the second age. Corticosteroidsalone do not modify the outcome. Corticosteroids alternatedwith chlorambucil seem to improve the chances of remission andto protect from renal dysfunction, but elderly patients aremore exposed to the side-effects of this regimen. Thus thistreatment should be limited to patients with severe nephroticsyndrome and/or incipient renal insufficiency, using some particularcautions.