Outcomes of primary nephrotic syndrome in elderly Japanese: retrospective analysis of the Japan Renal Biopsy Registry (J-RBR)

Hitoshi Yokoyama, Hitoshi Sugiyama, Ichiei Narita, Takao Saito, Kunihiro Yamagata, Saori Nishio, Shouichi Fujimoto, Noriko Mori, Yukio Yuzawa, Seiya Okuda, Shoichi Maruyama, Hiroshi Sato, Yoshihiko Ueda, Hirofumi Makino, Seiichi Matsuo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and objectives: There are very little data available regarding nephrotic syndrome (NS) in elderly (aged ≥65 years) Japanese. The aim of this study was to examine the causes and outcomes of NS in elderly patients who underwent renal biopsies between 2007 and 2010. Design, setting, participants, and measurements: From July 2007 to June 2010, all of the elderly (aged ≥65 years) Japanese primary NS patients who underwent native renal biopsies and were registered in the Japan renal biopsy registry (J-RBR; 438 patients including 226 males and 212 females) were identified. From this cohort, 61 patients [28 males and 33 females including 29, 19, 6, 4, and 3 patients with membranous nephropathy (MN), minimal change nephrotic syndrome (MCNS), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), and other conditions, respectively] were registered from the representative multi-centers over all districts of Japan, and analyzed retrospectively. The treatment outcome was assessed using proteinuria-based criteria; i.e., complete remission (CR) was defined as urinary protein level of <0.3 g/day or g/g Cr, and incomplete remission type I (ICR-I) was defined as urinary protein level of <1.0–0.3 g/day or g/g Cr, and renal dysfunction was defined as a serum creatinine (Cr) level of 1.5 times the baseline level. Results: In this elderly primary NS cohort, MN was the most common histological type of NS (54.8 %), followed by MCNS (19.4 %), FSGS (17.4 %), and MPGN (8.4 %). Of the patients with MN, MCNS, or FSGS, immunosuppressive therapy involving oral prednisolone was performed in 25 MN patients (86.2 %), 18 MCNS patients (94.7 %), and all 6 FSGS patients (100 %). CR was achieved in all 19 (100 %) MCNS patients. In addition, CR and ICR-I were achieved in 16 (55.2 %) and 18 (62.1 %) MN patients and 4 (66.7 %) and 5 (83.3 %) FSGS patients, respectively. There were significant differences in the median time to CR among the MCNS, FSGS, and MN patients (median: 26 vs. 271 vs. 461 days, respectively, p < 0.001), and between the elderly (65–74 years, n = 7) and very elderly (aged ≥75 years, n = 12) MCNS patients (7 vs. 22 days, p = 0.037). Relapse occurred in two (6.9 %) of the MN and nine (47.4 %) of the MCNS patients. Renal dysfunction was observed in five (7.2 %) of the MN patients. Serious complications developed in eight (14.8 %) patients, i.e., two (3.7 %) patients died, four (7.4 %, including three MCNS patients) were hospitalized due to infectious disease, and two (3.7 %) developed malignancies. The initiation of diabetic therapy was necessary in 14 of the 61 patients (23.0 %) with much higher initial steroid dosage. Conclusion: Renal biopsy is a valuable diagnostic tool for elderly Japanese NS patients. In this study, most of elderly primary NS patients respond to immunosuppressive therapy with favorable clinical outcomes. On the other hand, infectious disease is a harmful complication among elderly NS patients, especially those with MCNS. In future, modified clinical guidelines for elderly NS patients should be developed.

Original languageEnglish
Pages (from-to)496-505
Number of pages10
JournalClinical and Experimental Nephrology
Volume19
Issue number3
DOIs
Publication statusPublished - 17-06-2015

Fingerprint

Nephrotic Syndrome
Registries
Japan
Kidney
Biopsy
Lipoid Nephrosis
Membranous Glomerulonephritis
Focal Segmental Glomerulosclerosis
Membranoproliferative Glomerulonephritis
Creatinine
Immunosuppressive Agents
Communicable Diseases

All Science Journal Classification (ASJC) codes

  • Physiology
  • Nephrology
  • Physiology (medical)

Cite this

Yokoyama, Hitoshi ; Sugiyama, Hitoshi ; Narita, Ichiei ; Saito, Takao ; Yamagata, Kunihiro ; Nishio, Saori ; Fujimoto, Shouichi ; Mori, Noriko ; Yuzawa, Yukio ; Okuda, Seiya ; Maruyama, Shoichi ; Sato, Hiroshi ; Ueda, Yoshihiko ; Makino, Hirofumi ; Matsuo, Seiichi. / Outcomes of primary nephrotic syndrome in elderly Japanese : retrospective analysis of the Japan Renal Biopsy Registry (J-RBR). In: Clinical and Experimental Nephrology. 2015 ; Vol. 19, No. 3. pp. 496-505.
@article{76fac2b88e4f454eb1470ad322ecbdf7,
title = "Outcomes of primary nephrotic syndrome in elderly Japanese: retrospective analysis of the Japan Renal Biopsy Registry (J-RBR)",
abstract = "Background and objectives: There are very little data available regarding nephrotic syndrome (NS) in elderly (aged ≥65 years) Japanese. The aim of this study was to examine the causes and outcomes of NS in elderly patients who underwent renal biopsies between 2007 and 2010. Design, setting, participants, and measurements: From July 2007 to June 2010, all of the elderly (aged ≥65 years) Japanese primary NS patients who underwent native renal biopsies and were registered in the Japan renal biopsy registry (J-RBR; 438 patients including 226 males and 212 females) were identified. From this cohort, 61 patients [28 males and 33 females including 29, 19, 6, 4, and 3 patients with membranous nephropathy (MN), minimal change nephrotic syndrome (MCNS), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), and other conditions, respectively] were registered from the representative multi-centers over all districts of Japan, and analyzed retrospectively. The treatment outcome was assessed using proteinuria-based criteria; i.e., complete remission (CR) was defined as urinary protein level of <0.3 g/day or g/g Cr, and incomplete remission type I (ICR-I) was defined as urinary protein level of <1.0–0.3 g/day or g/g Cr, and renal dysfunction was defined as a serum creatinine (Cr) level of 1.5 times the baseline level. Results: In this elderly primary NS cohort, MN was the most common histological type of NS (54.8 {\%}), followed by MCNS (19.4 {\%}), FSGS (17.4 {\%}), and MPGN (8.4 {\%}). Of the patients with MN, MCNS, or FSGS, immunosuppressive therapy involving oral prednisolone was performed in 25 MN patients (86.2 {\%}), 18 MCNS patients (94.7 {\%}), and all 6 FSGS patients (100 {\%}). CR was achieved in all 19 (100 {\%}) MCNS patients. In addition, CR and ICR-I were achieved in 16 (55.2 {\%}) and 18 (62.1 {\%}) MN patients and 4 (66.7 {\%}) and 5 (83.3 {\%}) FSGS patients, respectively. There were significant differences in the median time to CR among the MCNS, FSGS, and MN patients (median: 26 vs. 271 vs. 461 days, respectively, p < 0.001), and between the elderly (65–74 years, n = 7) and very elderly (aged ≥75 years, n = 12) MCNS patients (7 vs. 22 days, p = 0.037). Relapse occurred in two (6.9 {\%}) of the MN and nine (47.4 {\%}) of the MCNS patients. Renal dysfunction was observed in five (7.2 {\%}) of the MN patients. Serious complications developed in eight (14.8 {\%}) patients, i.e., two (3.7 {\%}) patients died, four (7.4 {\%}, including three MCNS patients) were hospitalized due to infectious disease, and two (3.7 {\%}) developed malignancies. The initiation of diabetic therapy was necessary in 14 of the 61 patients (23.0 {\%}) with much higher initial steroid dosage. Conclusion: Renal biopsy is a valuable diagnostic tool for elderly Japanese NS patients. In this study, most of elderly primary NS patients respond to immunosuppressive therapy with favorable clinical outcomes. On the other hand, infectious disease is a harmful complication among elderly NS patients, especially those with MCNS. In future, modified clinical guidelines for elderly NS patients should be developed.",
author = "Hitoshi Yokoyama and Hitoshi Sugiyama and Ichiei Narita and Takao Saito and Kunihiro Yamagata and Saori Nishio and Shouichi Fujimoto and Noriko Mori and Yukio Yuzawa and Seiya Okuda and Shoichi Maruyama and Hiroshi Sato and Yoshihiko Ueda and Hirofumi Makino and Seiichi Matsuo",
year = "2015",
month = "6",
day = "17",
doi = "10.1007/s10157-014-1022-x",
language = "English",
volume = "19",
pages = "496--505",
journal = "Clinical and Experimental Nephrology",
issn = "1342-1751",
publisher = "Springer Japan",
number = "3",

}

Yokoyama, H, Sugiyama, H, Narita, I, Saito, T, Yamagata, K, Nishio, S, Fujimoto, S, Mori, N, Yuzawa, Y, Okuda, S, Maruyama, S, Sato, H, Ueda, Y, Makino, H & Matsuo, S 2015, 'Outcomes of primary nephrotic syndrome in elderly Japanese: retrospective analysis of the Japan Renal Biopsy Registry (J-RBR)', Clinical and Experimental Nephrology, vol. 19, no. 3, pp. 496-505. https://doi.org/10.1007/s10157-014-1022-x

Outcomes of primary nephrotic syndrome in elderly Japanese : retrospective analysis of the Japan Renal Biopsy Registry (J-RBR). / Yokoyama, Hitoshi; Sugiyama, Hitoshi; Narita, Ichiei; Saito, Takao; Yamagata, Kunihiro; Nishio, Saori; Fujimoto, Shouichi; Mori, Noriko; Yuzawa, Yukio; Okuda, Seiya; Maruyama, Shoichi; Sato, Hiroshi; Ueda, Yoshihiko; Makino, Hirofumi; Matsuo, Seiichi.

In: Clinical and Experimental Nephrology, Vol. 19, No. 3, 17.06.2015, p. 496-505.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of primary nephrotic syndrome in elderly Japanese

T2 - retrospective analysis of the Japan Renal Biopsy Registry (J-RBR)

AU - Yokoyama, Hitoshi

AU - Sugiyama, Hitoshi

AU - Narita, Ichiei

AU - Saito, Takao

AU - Yamagata, Kunihiro

AU - Nishio, Saori

AU - Fujimoto, Shouichi

AU - Mori, Noriko

AU - Yuzawa, Yukio

AU - Okuda, Seiya

AU - Maruyama, Shoichi

AU - Sato, Hiroshi

AU - Ueda, Yoshihiko

AU - Makino, Hirofumi

AU - Matsuo, Seiichi

PY - 2015/6/17

Y1 - 2015/6/17

N2 - Background and objectives: There are very little data available regarding nephrotic syndrome (NS) in elderly (aged ≥65 years) Japanese. The aim of this study was to examine the causes and outcomes of NS in elderly patients who underwent renal biopsies between 2007 and 2010. Design, setting, participants, and measurements: From July 2007 to June 2010, all of the elderly (aged ≥65 years) Japanese primary NS patients who underwent native renal biopsies and were registered in the Japan renal biopsy registry (J-RBR; 438 patients including 226 males and 212 females) were identified. From this cohort, 61 patients [28 males and 33 females including 29, 19, 6, 4, and 3 patients with membranous nephropathy (MN), minimal change nephrotic syndrome (MCNS), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), and other conditions, respectively] were registered from the representative multi-centers over all districts of Japan, and analyzed retrospectively. The treatment outcome was assessed using proteinuria-based criteria; i.e., complete remission (CR) was defined as urinary protein level of <0.3 g/day or g/g Cr, and incomplete remission type I (ICR-I) was defined as urinary protein level of <1.0–0.3 g/day or g/g Cr, and renal dysfunction was defined as a serum creatinine (Cr) level of 1.5 times the baseline level. Results: In this elderly primary NS cohort, MN was the most common histological type of NS (54.8 %), followed by MCNS (19.4 %), FSGS (17.4 %), and MPGN (8.4 %). Of the patients with MN, MCNS, or FSGS, immunosuppressive therapy involving oral prednisolone was performed in 25 MN patients (86.2 %), 18 MCNS patients (94.7 %), and all 6 FSGS patients (100 %). CR was achieved in all 19 (100 %) MCNS patients. In addition, CR and ICR-I were achieved in 16 (55.2 %) and 18 (62.1 %) MN patients and 4 (66.7 %) and 5 (83.3 %) FSGS patients, respectively. There were significant differences in the median time to CR among the MCNS, FSGS, and MN patients (median: 26 vs. 271 vs. 461 days, respectively, p < 0.001), and between the elderly (65–74 years, n = 7) and very elderly (aged ≥75 years, n = 12) MCNS patients (7 vs. 22 days, p = 0.037). Relapse occurred in two (6.9 %) of the MN and nine (47.4 %) of the MCNS patients. Renal dysfunction was observed in five (7.2 %) of the MN patients. Serious complications developed in eight (14.8 %) patients, i.e., two (3.7 %) patients died, four (7.4 %, including three MCNS patients) were hospitalized due to infectious disease, and two (3.7 %) developed malignancies. The initiation of diabetic therapy was necessary in 14 of the 61 patients (23.0 %) with much higher initial steroid dosage. Conclusion: Renal biopsy is a valuable diagnostic tool for elderly Japanese NS patients. In this study, most of elderly primary NS patients respond to immunosuppressive therapy with favorable clinical outcomes. On the other hand, infectious disease is a harmful complication among elderly NS patients, especially those with MCNS. In future, modified clinical guidelines for elderly NS patients should be developed.

AB - Background and objectives: There are very little data available regarding nephrotic syndrome (NS) in elderly (aged ≥65 years) Japanese. The aim of this study was to examine the causes and outcomes of NS in elderly patients who underwent renal biopsies between 2007 and 2010. Design, setting, participants, and measurements: From July 2007 to June 2010, all of the elderly (aged ≥65 years) Japanese primary NS patients who underwent native renal biopsies and were registered in the Japan renal biopsy registry (J-RBR; 438 patients including 226 males and 212 females) were identified. From this cohort, 61 patients [28 males and 33 females including 29, 19, 6, 4, and 3 patients with membranous nephropathy (MN), minimal change nephrotic syndrome (MCNS), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), and other conditions, respectively] were registered from the representative multi-centers over all districts of Japan, and analyzed retrospectively. The treatment outcome was assessed using proteinuria-based criteria; i.e., complete remission (CR) was defined as urinary protein level of <0.3 g/day or g/g Cr, and incomplete remission type I (ICR-I) was defined as urinary protein level of <1.0–0.3 g/day or g/g Cr, and renal dysfunction was defined as a serum creatinine (Cr) level of 1.5 times the baseline level. Results: In this elderly primary NS cohort, MN was the most common histological type of NS (54.8 %), followed by MCNS (19.4 %), FSGS (17.4 %), and MPGN (8.4 %). Of the patients with MN, MCNS, or FSGS, immunosuppressive therapy involving oral prednisolone was performed in 25 MN patients (86.2 %), 18 MCNS patients (94.7 %), and all 6 FSGS patients (100 %). CR was achieved in all 19 (100 %) MCNS patients. In addition, CR and ICR-I were achieved in 16 (55.2 %) and 18 (62.1 %) MN patients and 4 (66.7 %) and 5 (83.3 %) FSGS patients, respectively. There were significant differences in the median time to CR among the MCNS, FSGS, and MN patients (median: 26 vs. 271 vs. 461 days, respectively, p < 0.001), and between the elderly (65–74 years, n = 7) and very elderly (aged ≥75 years, n = 12) MCNS patients (7 vs. 22 days, p = 0.037). Relapse occurred in two (6.9 %) of the MN and nine (47.4 %) of the MCNS patients. Renal dysfunction was observed in five (7.2 %) of the MN patients. Serious complications developed in eight (14.8 %) patients, i.e., two (3.7 %) patients died, four (7.4 %, including three MCNS patients) were hospitalized due to infectious disease, and two (3.7 %) developed malignancies. The initiation of diabetic therapy was necessary in 14 of the 61 patients (23.0 %) with much higher initial steroid dosage. Conclusion: Renal biopsy is a valuable diagnostic tool for elderly Japanese NS patients. In this study, most of elderly primary NS patients respond to immunosuppressive therapy with favorable clinical outcomes. On the other hand, infectious disease is a harmful complication among elderly NS patients, especially those with MCNS. In future, modified clinical guidelines for elderly NS patients should be developed.

UR - http://www.scopus.com/inward/record.url?scp=84931264694&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84931264694&partnerID=8YFLogxK

U2 - 10.1007/s10157-014-1022-x

DO - 10.1007/s10157-014-1022-x

M3 - Article

C2 - 25230687

AN - SCOPUS:84931264694

VL - 19

SP - 496

EP - 505

JO - Clinical and Experimental Nephrology

JF - Clinical and Experimental Nephrology

SN - 1342-1751

IS - 3

ER -