Abstract
The assessment of glomerular disease in the elderly has its own set of unique challenges. Issues range from controversies in the diagnosis and treatment of specific disease entities, the spectrum of multi-morbidity, to the competing balance of conservative care to maximise quality of life with more aggressive/interventional treatment options. The range of lesions and relative frequency of each individual histological lesion observed in the elderly patient biopsied for renal dysfunction is different to that observed in younger patients. This chapter focusses on the commonest glomerulopathies encountered in elderly patients, and reviews the available treatment strategies, with attention to the nuances to the older patient.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Rule AD, Amer H, Cornell LD, Taler SJ, Cosio FG, Kremers WK, et al. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med. 2010;152(9):561–7.
Glassock RJ, Rule AD. The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Kidney Int. 2012;82(3):270–7.
Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33(4):278–85.
Hogan JJ, Mocanu M, Berns JS. The native kidney biopsy: update and evidence for best practice. Clin J Am Soc Nephrol. 2016;11(2):354–62.
Zhu P, Zhou FD, Zhao MH. The renal histopathology spectrum of elderly patients with kidney diseases: a study of 430 patients in a single Chinese center. Medicine (Baltimore). 2014;93(28):e226.
Yokoyama H, Sugiyama H, Sato H, Taguchi T, Nagata M, Matsuo S, et al. Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR). Clin Exp Nephrol. 2012;16(6):903–20.
Verde E, Quiroga B, Rivera F, Lopez-Gomez JM. Renal biopsy in very elderly patients: data from the Spanish registry of glomerulonephritis. Am J Nephrol. 2012;35(3):230–7.
Rollino C, Ferro M, Beltrame G, Quattrocchio G, Massara C, Quarello F, et al. Renal biopsy in patients over 75: 131 cases. Clin Nephrol. 2014;82(4):225–30.
Nair R, Bell JM, Walker PD. Renal biopsy in patients aged 80 years and older. Am J Kidney Dis. 2004;44(4):618–26.
Moutzouris DA, Herlitz L, Appel GB, Markowitz GS, Freudenthal B, Radhakrishnan J, et al. Renal biopsy in the very elderly. Clin J Am Soc Nephrol. 2009;4(6):1073–82.
Harmankaya O, Okuturlar Y, Kocoglu H, Kaptanogullari H, Yucel SK, Ozkan H, et al. Renal biopsy in the elderly: a single-center experience. Int Urol Nephrol. 2015;47(8):1397–401.
Haas M, Spargo BH, Wit E-JC, Meehan SM. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis. 2000;35(3):433–47.
Brown CM, Scheven L, O’Kelly P, Dorman AM, Walshe JJ. Renal histology in the elderly: indications and outcomes. J Nephrol. 2012;25(2):240–4.
Perkowska-Ptasinska A, Deborska-Materkowska D, Bartczak A, Stompor T, Liberek T, Bullo-Piontecka B, et al. Kidney disease in the elderly: biopsy based data from 14 renal centers in Poland. BMC Nephrol. 2016;17(1):194.
Liangos O, Wald R, O’Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol. 2006;1(1):43–51.
Liano F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50(3):811–8.
Death NCEiPOa. NCEPOD acute kidney injury: adding insult to injury report. 2009. Available from: http://www.ncepod.org.uk/2009.
Carter CE, Gansevoort RT, Scheven L, Heerspink HJ, Shlipak MG, de Jong PE, et al. Influence of urine creatinine on the relationship between the albumin-to-creatinine ratio and cardiovascular events. Clin J Am Soc Nephrol. 2012;7(4):595–603.
Fotheringham J, Campbell MJ, Fogarty DG, El Nahas M, Ellam T. Estimated albumin excretion rate versus urine albumin-creatinine ratio for the estimation of measured albumin excretion rate: derivation and validation of an estimated albumin excretion rate equation. Am J Kidney Dis. 2014;63(3):405–14.
Sharma SG, Bomback AS, Radhakrishnan J, Herlitz LC, Stokes MB, Markowitz GS, et al. The modern spectrum of renal biopsy findings in patients with diabetes. Clin J Am Soc Nephrol. 2013;8(10):1718–24.
Dhaun N, Bellamy CO, Cattran DC, Kluth DC. Utility of renal biopsy in the clinical management of renal disease. Kidney Int. 2014;85(5):1039–48.
Fogo AB, Lusco MA, Najafian B, Alpers CE. AJKD atlas of renal pathology: membranous nephropathy. Am J Kidney Dis. 2015;66(3):e15–7.
Ohtani H, Wakui H, Komatsuda A, Okuyama S, Masai R, Maki N, et al. Distribution of glomerular IgG subclass deposits in malignancy-associated membranous nephropathy. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2004;19(3):574–9.
Beck LH Jr, Bonegio RG, Lambeau G, Beck DM, Powell DW, Cummins TD, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11–21.
Hofstra JM, Beck LH Jr, Beck DM, Wetzels JF, Salant DJ. Anti-phospholipase A(2) receptor antibodies correlate with clinical status in idiopathic membranous nephropathy. Clin J Am Soc Nephrol. 2011;6(6):1286–91.
Deegens JK, Wetzels JF. Membranous nephropathy in the older adult: epidemiology, diagnosis and management. Drugs Aging. 2007;24(9):717–32.
Lefaucheur C, Stengel B, Nochy D, Martel P, Hill GS, Jacquot C, et al. Membranous nephropathy and cancer: epidemiologic evidence and determinants of high-risk cancer association. Kidney Int. 2006;70(8):1510–7.
Ruggenenti P, Fervenza FC, Remuzzi G. Treatment of membranous nephropathy: time for a paradigm shift. Nat Rev Nephrol. 2017;13(9):563–79.
KDIGO. KDIGO clinical practice guidelines for glomerulonephritis. Kidney Int. 2012;Suppl 2.
Perna A, Schieppati A, Zamora J, Giuliano GA, Braun N, Remuzzi G. Immunosuppressive treatment for idiopathic membranous nephropathy: a systematic review. Am J Kidney Dis. 2004;44(3):385–401.
Praga M, Barrio V, Juarez GF, Luno J, Grupo Espanol de Estudio de la Nefropatia M. Tacrolimus monotherapy in membranous nephropathy: a randomized controlled trial. Kidney Int. 2007;71(9):924–30.
Chen M, Li H, Li XY, Lu FM, Ni ZH, Xu FF, et al. Tacrolimus combined with corticosteroids in treatment of nephrotic idiopathic membranous nephropathy: a multicenter randomized controlled trial. Am J Med Sci. 2010;339(3):233–8.
Cattran DC, Greenwood C, Ritchie S, Bernstein K, Churchill DN, Clark WF, et al. A controlled trial of cyclosporine in patients with progressive membranous nephropathy. Canadian Glomerulonephritis Study Group. Kidney Int. 1995;47(4):1130–5.
Vivarelli M, Massella L, Ruggiero B, Emma F. Minimal change disease. Clin J Am Soc Nephrol. 2017;12(2):332–45.
Waldman M, Crew RJ, Valeri A, Busch J, Stokes B, Markowitz G, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol. 2007;2(3):445–53.
Tse KC, Lam MF, Yip PS, Li FK, Choy BY, Lai KN, et al. Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2003;18(7):1316–20.
D’Agati VD, Kaskel FJ, Falk RJ. Focal segmental glomerulosclerosis. N Engl J Med. 2011;365(25):2398–411.
Rosenberg AZ, Kopp JB. Focal segmental glomerulosclerosis. Clin J Am Soc Nephrol. 2017;12(3):502–17.
Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, et al. Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science. 2010;329(5993):841–5.
Shi L. Anti-neutrophil cytoplasmic antibody-associated vasculitis: prevalence, treatment, and outcomes. Rheumatol Int. 2017;37(11):1779–88.
Jennette JC, Wilkman AS, Falk RJ. Diagnostic predictive value of ANCA serology. Kidney Int. 1998;53(3):796–8.
Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, et al. Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2010;21(10):1628–36.
Tanna A, Guarino L, Tam FW, Rodriquez-Cubillo B, Levy JB, Cairns TD, et al. Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors. Nephrol Dial Transpl Off Publ Eur Dial Transpl Assoc – Eur Ren Assoc. 2015;30(7):1185–92.
Nachman PH, Hogan SL, Jennette JC, Falk RJ. Treatment response and relapse in antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol. 1996;7(1):33–9.
McAdoo SP, Pusey CD. Anti-glomerular basement membrane disease. Clin J Am Soc Nephrol. 2017;12(7):1162–72.
Nasr SH, Fidler ME, Valeri AM, Cornell LD, Sethi S, Zoller A, et al. Postinfectious glomerulonephritis in the elderly. J Am Soc Nephrol. 2011;22(1):187–95.
Rodriguez-Iturbe B, Musser JM. The current state of poststreptococcal glomerulonephritis. J Am Soc Nephrol. 2008;19(10):1855–64.
Nasr SH, D’Agati VD. IgA-dominant postinfectious glomerulonephritis: a new twist on an old disease. Nephron Clin Pract. 2011;119(1):c18–25. discussion c6
Oshima Y, Moriyama T, Itabashi M, Takei T, Nitta K. Characteristics of IgA nephropathy in advanced-age patients. Int Urol Nephrol. 2015;47(1):137–45.
Trimarchi H, Barratt J, Cattran DC, Cook HT, Coppo R, Haas M, et al. Oxford classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91(5):1014–21.
Steiner N, Gobel G, Suchecki P, Prokop W, Neuwirt H, Gunsilius E. Monoclonal gammopathy of renal significance (MGRS) increases the risk for progression to multiple myeloma: an observational study of 2935 MGUS patients. Oncotarget. 2018;9(2):2344–56.
Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP, et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015;87(4):698–711.
Kumar SK, Rajkumar V, Kyle RA, van Duin M, Sonneveld P, Mateos MV, et al. Multiple myeloma. Nat Rev Dis Primers. 2017;3:17046.
Mangoni AA, Jackson SH. The implications of a growing evidence base for drug use in elderly patients. Part 1. Statins for primary and secondary cardiovascular prevention. Br J Clin Pharmacol. 2006;61(5):494–501.
Mangoni AA, Jackson SH. The implications of a growing evidence base for drug use in elderly patients part 2. ACE inhibitors and angiotensin receptor blockers in heart failure and high cardiovascular risk patients. Br J Clin Pharmacol. 2006;61(5):502–12.
Timlin H, Lee SM, Manno RL, Seo P, Geetha D. Rituximab for remission induction in elderly patients with ANCA-associated vasculitis. Semin Arthritis Rheum. 2015;45(1):67–9.
Author information
Authors and Affiliations
Corresponding authors
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Navaratnarajah, A., Willicombe, M. (2019). Glomerulopathies in the Elderly. In: Musso, C., Jauregui, J., Macías-Núñez, J., Covic, A. (eds) Clinical Nephrogeriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-18711-8_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-18711-8_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-18710-1
Online ISBN: 978-3-030-18711-8
eBook Packages: MedicineMedicine (R0)