P0246MEMBRANOUS NEPHROPATHY IN THE ELDERLY : EPIDEMIOLOGY, DIAGNOSIS AND MANAGEMENT

Abstract Background and Aims The aging of the population and the increase in life expectancy have led to increasing numbers of elderly patients so greater numbers of elderly patients with chronic kidney diseases are surviving longer. Membranous nephropathy (MN) is the most important cause of glomerular disease in older patients (≥65 years). The aim of this study is to describe the epidemiological and clinical profile of elderly patients with MN and to analyze the diagnostic and management approach. Method We conducted a retrospective descriptive study in the nephrology department at Charles Nicolle hospital over a period of 44 years. All older patients (≥65 years) with histologically proven MN were included in this study. Results Thirty patients were collected. The mean age was 69.43 years (65-78 years) with a male predominance (sex ratio: 2.3) and low socio-economic level in 83.3% of cases. Sixteen patients were smokers (55.3%), 5 ethyl patients (16.7%), diabetes was present in 3 patients (10%) and hypertension in 11 patients (36.7%). Two cases of neoplasm were present, namely one case of prostatic adenocarcinoma and one case of gallbladder adenocarcinoma, all were diagnosed and treated along one year and ten years respectively, before the diagnosis of MN. The circumstances of discovery was dominated by oedema in 27 cases (86.27%), hypertension in 11 cases (36.7%) and elevated creatinine level in 9 cases (30%). Deep venous thrombosis was the circumstance of discovery in one case. At the time of diagnosis, the clinico-biological picture was dominated by high systolic blood pressure in 21 cases (67.6%), anasarca in 7 cases (23.3%), proteinuria in all cases and hematuria in 20 cases (66.6%). Biology revealed nephrotic syndrome (NS) in 28 cases (87.11%), hypercholesterolemia in 23 cases (76.6%), high serum creatinine in 14 cases (46.6%) with an average creatinine level of 123,85 µmol/l, anemia in 17 cases (56.6%) and anti-neutrophil cytoplasmic antibodies were positive in one case. MN was confirmed by a kidney biopsy in all cases. Twenty-two patients had idiopathic MN (IMN) and 2 patients had secondary MN. In fact, MN was associated with multiple myeloma in one case and secondary to hepatitis B in other case. Symptomatic treatment was indicated in all patients. Patients with secondary MN received etiopathogenic treatment. For the IMN, immunosuppressive therapy started early for 12 patients (40%) because of the severe NS and the deterioration of renal function. Eight patients (26.6%) received corticosteroids alone, three patients received corticosteroid with mycofenolate mofetil and one patient received corticosteroid with ciclosporin. We noted complete remission in 6 patients and end renal stage disease in 5 patients. Conclusion In studies of glomerular disease in the elderly, MN was the most common cause of NS. The clinical presentation is similar in older and younger patients, but older patients more often present with kidney failure and severe NS.