Abstract
Background and Aims
With increasing longevity, the numbers of elderly patients presenting with renal diseases including glomerular disease are increasing. Nephrotic syndrome (NS) is a common presentation of glomerular disease in the elderly. We performed this study to assess predictors of renal survival in this population.
Method
A retrospective study including one hundred and six patients aged 65 years or more hospitalized for NS in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016.
A multivariate study was carried out, the dependent variable being the evolution towards end-stage renal disease (ESRD).
Results
We studied 106 patients with an average age of 70 ± 4.5years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.6 [3-19.5 g/l], the mean albumin level was 20 ± 5.6g/l and the mean protidemia was 50 ± 6.9 g/l. Nephrotic syndrome was impure in 89.6 % of patients with high blood pressure in 70.5 % of cases, hematuria ≥2 + in 34.7% of cases and renal failure in 88.4 % of cases. The renal biopsy was performed in 41 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (27 %). NS was secondary in 63.2 % of cases mainly to amyloidosis (35.8 %) and diabetes (19.8 %). Idiopathic nephropaty was dominated by membranous nephropathy (11.3 %) and primitive membranoproliferative glomerulonephritis (MPGN) (6.6 %). At the end of follow-up, 35 % of patients achieved complete or partial remission and 58.5 % progressed to ESRD. The multivariate study found as independent risk factors of progression to ESRD uremia ≥ 17 mmol/l (ORa =33.2 [1.3 - 837.7]; p<0.05), phosphoremia ≥ 1.6 mmol/l (ORa=22.1 [1.8-266.5]; p<0.05), potassium concentration ≥ 4.3mmol/l (ORa=24.7 [2.4,251.5]; p<0.01), extra-renal signs (ORa=38,9 [2.4 - 634.3]; p: 0.01), secondary nephropathy (ORa=74 [3.1 - 1788.2]; p<0.01) and MPGN (ORa=48[1.4 - 1675.5]; p<0.05). The protective factors were hemoglobinemia ≥ 9.3g/dl (ORa=0.007 [0 - 0.2]; p<0.01), kidneys well differentiated on ultrasound (ORa=0.032 [0.003 - 0.4]; p<0.01) and treatment with two diuretics (ORa=0.03 [0.003 - 0.4]; p<0.01).
Conclusion
Elderly NS was characterized by a poor prognosis, in particular secondary to delayed and non-uniform treatment strategies, hence the need for rising physician awarness about this decease and consultation on a standardized treatment strategies.
POS-451 PROTEINURIA ≥ 10G/DAY AS A PROGNOSTIC FACTOR FOR GENERAL AND RENAL SURVIVAL IN PATIENTS WITH NEPHROTIC SYNDROME IN A PERUVIAN HOSPITAL
