Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Division of Nephrology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Korean J Intern Med. 2019 Sep;34(5):1091-1099. doi: 10.3904/kjim.2018.139. Epub 2019 Aug 14.
BACKGROUND/AIMS: Membranous nephropathy (MN) is the most common primary glomerular disease diagnosed in older patients. Few reports describe the clinical outcomes in older patients with idiopathic MN.
The outcomes of 135 patients with histologically proven MN were analyzed. 'Older' was defined as 60 years of age or older at the time of the renal biopsy. The rates of complete remission (CR), progression to end-stage renal disease (ESRD) and infection were compared between older and younger patients.
The cumulative event rate for achieving CR was inferior (p = 0.012) and that for requiring renal replacement was higher (p = 0.015) in older patients, and they had a greater risk of infection (p = 0.005). Older age was a significant predictor of a lower rate of CR (adjusted odds ratio [OR], 0.51; 95% confidence interval [CI], 0.26 to 0.98), and was a robust predictor of infection (adjusted OR, 5.27; 95% CI, 1.31 to 21.20). Conservative treatment was associated with a lower remission rate (p = 0.036) and corticosteroid treatment was less effective in achieving CR (p = 0.014), in preventing progression to ESRD (p = 0.013) and in reducing infection (p = 0.033) in older patients. Cyclosporine treatment had similar clinical outcomes with regard to CR, ESRD progression, and infection in older patients.
Older age was independently associated with inferior rates of CR and greater risk of infection. Treatment modalities affected the outcomes of older patients differently in that cyclosporine treatment is predicted to be more useful than corticosteroids.
背景/目的：膜性肾病（MN）是在老年患者中诊断出的最常见的原发性肾小球疾病。很少有报道描述特发性 MN 老年患者的临床结局。
分析了 135 例经组织学证实的 MN 患者的结局。“老年”定义为肾活检时年龄在 60 岁或以上。比较了老年和年轻患者完全缓解（CR）率、进展为终末期肾病（ESRD）率和感染率。
老年患者达到 CR 的累积事件率较低（p=0.012），需要肾脏替代治疗的比率较高（p=0.015），且感染风险较高（p=0.005）。老年是 CR 率较低的显著预测因素（调整后的优势比[OR]，0.51；95%置信区间[CI]，0.26 至 0.98），也是感染的有力预测因素（调整后的 OR，5.27；95%CI，1.31 至 21.20）。保守治疗与缓解率较低相关（p=0.036），皮质类固醇治疗在老年患者中对 CR 的疗效较差（p=0.014），对防止 ESRD 进展（p=0.013）和减少感染（p=0.033）的效果较差。环孢素治疗在 CR、ESRD 进展和感染方面对老年患者的临床结局具有相似的影响。
老年与 CR 率较低和感染风险较高独立相关。治疗方式对老年患者的结局影响不同，环孢素治疗预计比皮质类固醇更有用。
