Treatment of membranous nephropathy in the elderly

Abstract

MN is relatively common in the elderly and can lead to significant morbidity and mortality as a result of complications of the nephrotic syndrome and end-stage renal disease. Some cases of MN may be missed as asymptomatic urinary abnormalities and progressive renal disease may be attributed incorrectly to vascular disease or normal aging. Urinary abnormalities and changes in renal function should be evaluated in the elderly using the same criteria as applied in younger individuals. When MN is diagnosed in an elderly individual, it has the same risks for progression as in younger individuals; thus, therapy for hypertension, hyperlipidemia, edema, and proteinuria should be instituted. When appropriate, elderly individuals should receive immunosuppressive therapy to induce a remission of the nephrotic syndrome and reduce the risk for progressive loss of renal function using criteria similar to younger patients. Most studies show response rates to be comparable in all age groups examined. The only consistent recommendation is to avoid high-dose corticosteroids when possible. Recognize that drug dosages need to be modified and carefully monitored and that the elderly may be particularly prone to side effects and infectious complications of immunosuppressive therapy. Although treatment of MN in the elderly has unique challenges, reducing the need for renal replacement therapy in this population merits special attention. This is a US government work. There are no restrictions on its use.