PROLIFERATIVE GLOMERULONEPHRITIS IN THE ELDERLY: AN OBSERVATIONAL STUDY FROM NORTHERN INDIAN

Introduction:

The increase in life expectancy is associated with an increasing prevalence of kidney disease, including proliferative glomerulonephritis (GN). In the elderly, the clinical course and morphological manifestation may be influenced by age-related GFR reductions, preexisting hypertension, or diabetes. Kidney biopsy is the inevitable diagnostic method in the elderly, as in all other age groups, in identifying treatable, reversible lesions and defining both the activity and chronicity of kidney injury. Thus, advanced age should not be the sole contraindication for biopsy.

Methods:

This is a 12-year retrospective observational study from Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, a tertiary care hospital in northern India. The biopsy and clinical data of 101 patients aged ≥60 years were retrospectively identified and analyzed. All kidney biopsies studied were performed from January 2011 to August 2023.

Results:

The mean age of patients was 66.02 ± 5.15 years, and 48.5% (n=49) of patients were female. At presentation, 39 (38.6%) patients were hypertensive, 18 (17.8%) both diabetic and hypertensive and 1 (1.0%) only diabetic. The baseline median eGFR was 17 (IQR 9-34) mg/dl, mean serum albumin 3.13 ± 0.56 g/dl, and median 24-hour urine protein to creatinine ratio was 4.80 (IQR 2.89-6.24) mg/mg. In elderly patients, the leading indication for biopsy was rapidly progressive renal failure (52.5%, n=53), and the most prevalent pathologic diagnoses were immune complex-mediated GN (49.5%, n=50), pauci-immune GN (26.7%, n=27), C3 glomerulopathy (17.8%, n=18), anti-GBM GN (2.0%, n=2), and monoclonal Ig–mediated GN (2.0%, n=2) (Table 1). Table 2 shows the clinical features of patients according to histopathologic diagnoses.

Excluding two unclassified cases, 90 out of 99 (90.9%) patients received steroids, including 38 (38.4%) treated with IV methylprednisolone. 47 (47.5%) patients required additional immunosuppression; seven (7.1%) were not treated with immunosuppression. The rates of complete remission (CR) and partial remission (PR) at 6 months and 12 months, respectively, were 25% and 44.8%, and 40.6% and 40.6% (Table 3). Severe kidney failure necessitating dialysis at presentation (p <0.001) was significantly associated with advanced CKD, ESKD, or death. The adverse outcomes included infections (28.3), hyperglycemia (23.2%), and avascular necrosis (3.0%) (Table 4).

Conclusions:

The most prevalent proliferative glomerulonephritis in the elderly is immune complex-mediated GN, followed by pauci-immune GN. The most common clinical presentation is rapidly progressive renal failure. Even with immunosuppression, more than half of patients failed to achieve complete or partial remission. Dialysis-dependent kidney failure at presentation is significantly associated with worse renal outcomes.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.