Comparison of clinical and pathological features of idiopathic membranous nephropathy between elderly and non-elderly patients / 中华老年医学杂志

ABSTRACT

Objective To explore the differences in clinical and pathological characteristics of idiopathic membranous nephropathy between elderly and non elderly patients.Methods The clinical and pathological data,which were used for biopsy diagnosing idiopathic membranous nephropathy in elderly patients (aged ≥65 years) versus non elderly patients (aged ＜65 years) in our hospital during the recently 10 years,were retrospectively analyzed and compared.Results The elderly patients with idiopathic membranous nephropathy accounted for 26.29％ and patients aged less than 45 years with idiopathic membranous nephropathy accounted for 25.26％.The proportions of idiopathic membranous nephropathy in the two different age groups were similar.The occurrence rate of hypertension and microscopic hematuria as well as levels of blood serum creatinine and urinary N-acetyl-β-D-glucosaminidase were higher,while the urinary osmotic pressure,estimated glomerular filtration rate (eGFR) and blood albumin were lower in elderly group than in non-elderly group (all P＜0.05).The proportions of glomerulosclerosis,tubulointerstitial lesions and vascular lesions were higher in elderly group than in non-elderly patients (all P＜ 0.05).There were no significant differences in the immunofluorescence intensity of IgG,positive rates of IgA,C3,C4 and Fi between the two groups,while the positive rate of C1q was lower in elderly group than in non elderly.Among 51 patients receiving IgG4 immunohistochemical staining,the positive rate of IgG4 staining and the intensity were higher in elderly group than in non-elderly [100.00％ vs.81.25％,(2.11±0.46) vs.(1.59 ± 0.95),both P ＜ 0.05].Conclusions The proportion of idiopathic membranous nephropathy is increased in non-elderly patients.Elderly patients are more susceptible to hypertension,hematuria and renal dysfunction.The positive rate and the intensity of IgG4 are higher and the positive rate of C1q is lower in elderly group than in non-elderly group,which indicate that patients with negative IgG4 and positive C1q have secondary causes which have not yet been demonstrated,and they should be closely observed during the follow-up.