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World J Nephrol. May 6, 2015; 4(2): 263-270
Published online May 6, 2015. doi: 10.5527/wjn.v4.i2.263
Primary glomerular diseases in the elderly
Abdullah Sumnu, Meltem Gursu, Savas Ozturk
Abdullah Sumnu, Okmeydani Training and Research Hospital, 34390 Istanbul, Turkey
Meltem Gursu, Savas Ozturk, Nephrology Clinic, Haseki Training and Research Hospital, 34390 Istanbul, Turkey
Savas Ozturk, Nefroloji Klinigi, Haseki Egitim ve Arastirma Hastanesi, 34390 Istanbul, Turkey
Author contributions: Sumnu A, Gursu M and Ozturk S contributed equally to this work; Ozturk S planned the paper; Sumnu A collected literature related with the article; Sumnu A, Gursu M and Ozturk S wrote the paper.
Conflict-of-interest: None of the authors has conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Savas Ozturk, MD, Associate Professor, Nefroloji Klinigi, Haseki Egitim ve Arastirma Hastanesi, Aksaray, 34390 Istanbul, Turkey. savasozturkdr@yahoo.com
Telephone: +90-212-3430997 Fax: +90-212-3431000
Received: November 28, 2014
Peer-review started: November 29, 2014
First decision: December 12, 2014
Revised: December 22, 2014
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 6, 2015
Processing time: 160 Days and 22.7 Hours
Abstract

Primary glomerular diseases in the elderly population are a frustrating topic due to difficulties in both the diagnosis and decision making about treatment. The most frequent type of primary glomerular disease in elderly is membranous nephropathy; while its counterpart in younger population is IgA nephropathy. The most frequent cause of nephrotic syndrome in the elderly is also membranous nephropathy. Pauci-immune crescentic glomerulonephritis (GN) rate increases both in elderly and very elderly population. Pauci-immune crescentic GNs should be regarded as urgencies in elderly patients as in their younger counterparts due to potential for causing end-stage renal disease in case of delayed diagnosis and treatment, and also causing mortality due to alveolar hemorrhage in patients with pulmonary involvement. Renal biopsy is the inevitable diagnostic method in the elderly as in all other age groups. Renal biopsy prevents unnecessary treatments and provides prognostic data. So advanced age should not be the sole contraindication for renal biopsy. The course of primary glomerular diseases may differ in the elderly population. Acute kidney injury is more frequent in the course and renal functions may be worse at presentation. These patients are more prone to be hypertensive. The decision about adding immune suppressive therapies to conservative methods should be made considering many factors like co-morbidities, drug side effects and potential drug interactions, risk of infection, patient preference, life expectancy and renal functions at the time of diagnosis.

Keywords: Elderly; Membranous nephropathy; Renal biopsy; Pauci-immune crescentic glomerulonephritis; Primary glomerular disease

Core tip: Primary glomerular diseases in the elderly population are a frustrating topic due to difficulties in both diagnosis and treatment. The most frequent type of primary glomerular disease and the most frequent cause of nephrotic syndrome is membranous nephropathy. The frequency of pauci-immune glomerulonephritides increases considerably in the very elderly population. Renal biopsy is the inevitable diagnostic method in the elderly as in all other age groups. The decision about adding immune suppressive therapies to conservative methods should be made considering many factors like co-morbidities, drug side effects, patient preference, life expectancy and renal functions at the time of diagnosis.