The nephrotic syndrome in the elderly: clinico-pathological correlations in 317 patients

We have used the Medical Research Council's Glomerulonephritis (GN) registry to review the clinicopathological findings in a large group (317) of patients over 60 years of age and presenting with the nephrotic syndrome. A wide variety of histological appearances were seen to underlie this clinical diagnosis with the most frequent being membranous nephropathy (36.6%), minimal change nephrotic syndrome (11.0%) and renal amyloid (10.7%). Clinical parameters measured at the time of biopsy were unhelpful in distinguishing between the individual histological groups. A secondary cause for the nephrotic syndrome was identified in 103 (32%) patients, and a malignancy was known to be present at the time of biopsy in 15 patients. As confusion currently surrounds the treatment of these patients (particularly those with membranous nephropathy) and as histology cannot be predicted by clinical parameters, we believe that renal biopsy is an important investigation in the management of elderly adults with the nephrotic syndrome.