Background and Aim of Study
We examined the differences in clinical characteristics of minimal change nephrotic syndrome (MCNS) in elderly and young patients.
Patients and Methods
Patients with MCNS diagnosed by renal biopsy were divided into the elderly (65 years or older) and young (18–64 years old) groups and were evaluated for the results of basic statistical analysis, clinical items, and treatment.
Results
A total of 18 patients were evaluated: 8 in the elderly group and 10 in the young group, with a mean age of 70.4 ± 5.1 and 35.2 ± 15.5 years, respectively. The follow-up periods were 88.5 ± 50.0 months in the elderly group and 59.9 ± 37.3 months in the young group. The urine protein-to-creatinine ratios at baseline in the elderly and young groups were comparable at 7.9 ± 2.9 and 8.8 ± 3.7 g/g Cre, respectively, whereas the selectivity index was favorable in both groups at 0.131 ± 0.05 and 0.143 ± 0.05, respectively. All patients in the young group started treatment with prednisolone (PSL) and achieved complete remission (CR). In the elderly group, 7 patients received treatment with PSL in combination with cyclosporine or cyclophosphamide (CPA), whereas only 1 patient started treatment with PSL alone. Only 1 patient who received the combination of PSL and CPA had incomplete remission type I; excluding this one patient, the time to remission in patients with CR was 153 ± 178.6 days in the elderly group and 35 ± 59.8 days in the young group, showing a longer trend in the elderly. Recurrences occurred in 4 of 7 elderly patients and 8 of 10 young patients, and the numbers of recurrences were 1.3 ± 1.6 and 3.0 ± 2.4, respectively, showing a higher trend in young patients for both the frequency and number of recurrences. In renal function, however, no deterioration in creatinine level was observed in either group during the follow-up period. Concerning complications during the treatment period, 2 elderly patients had Pneumocystis pneumonia.
Conclusion
Whereas there was no difference in the remission induction rate between elderly and young patients, the time to remission induction was longer in the elderly. Accordingly, as the risk of complications such as infection may be high in elderly patients, it considered necessary to continuously evaluate the treatment up to remission induction in the future.