Diagnosis and course of membranous nephropathy in adults: comparison by age group

Abstract

IntroductionThere have been few studies comparing younger and older adults with membranous nephropathy. The objective of this study was to compare younger and older patients with membranous nephropathy, in terms of the clinical, etiological, remission, and survival data.MethodThis was a retrospective study of patients with membranous nephropathy who underwent renal biopsy between 2009 and 2017. ResultsWe included 214 patients with membranous nephropathy. At diagnosis, 169 (79%) of those patients were < 60 years of age and 45 (21%) were >= 60 years of age. There was a predominance of males in both groups. The degree of proteinuria and the prevalence of hematuria did not differ significantly between the groups. However, the median serum creatinine level was higher in the >= 60-year group-1.50 mg/dL (1.00-2.36) vs. 1.00 mg/dL (0.75-1.40)-as was the prevalence of hypertension-71.1% vs. 43.7%-the differences being significant (p = 0.0011 for both). Of the 214 patients evaluated, 36 (16.8%) had secondary membranous nephropathy. Although the proportions of infectious and autoimmune causes were comparable between the two groups, neoplastic etiologies were more common in the >= 60-year group. A total of 111 patients were followed long term (86 in the < 60-year group and 25 in the >= 60-year group), 16 (14.4%) of whom progressed to requiring dialysis: eight (9.3%) of the < 60-year group patients and eight (32.0%) of the >= 60-year group patients (p = 0.0045). However, partial or complete remission was achieved in 68.5% and 68.0% of the younger and older patients, respectively.ConclusionDespite having worse renal function at diagnosis, older patients with membranous nephropathy appear to have remission rates comparable to those of younger patients with the disease, which demonstrates the benefits of seeking diagnosis and treatment.