1
|
Ben ayed T, Gorsane I, Trabelsi R, Ounissi M, Ben Abdallah T. P0435PREDICTORS OF RENAL SURVIVAL IN ELDERLY NEPHROTIC SYNDROME. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Tasnim Ben ayed
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Charles Nicolle Hospital, Department of Medicine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| |
Collapse
|
2
|
Ben ayed T, Gorsane I, Trabelsi R, Ounissi M, Ben Abdallah T. P0465NEPHROTIC SYNDROME IN ELDERLY PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Nephrotic syndrome (NS) is one of the manifestations of acute or chronic glomerular nephropathy in the elderly. Our study objective was to determine the particularities of NS in the elderly.
Method
This is a retrospective study, carried out in the Internal Medicine department A of Charles Nicolle hospital at Tunis, between January the 1st, 1975 and December the 31st, 2016. This study included subjects aged 65 years old or over hospitalized for NS.
Results
We studied 115 patients with an average age of 71 ± 5 years [65-83 years] with a sex ratio (M/F) of 1.7. Twenty-three percent of patients were diabetic. The median proteinuria was 4.7 g/l [3-19.5 g/l], the mean albumin level was 20 ± 6g/l and the mean protidemia was 50.6 ± 6.9 g/l. Nephrotic syndrome was impure in 89.5 % of patients with high blood pressure in 54 % of cases, hematuria ≥2 + in 30% of cases and renal failure in 82.7 % of cases. Renal biopsy was performed in 45 patients. The most common glomerular lesions were Membranous nephropathy (29 %) followed by amyloidosis (24.5 %). NS was secondary in 65.2 % of cases mainly to amyloidosis (35.6 %) and diabetes (19 %). Idiopathic nephropaty was dominated by membranous nephropathy (9.5 %) and primitive primitive (MPGN) (4.3 %). The treatment was symptomatic for 84.4% of patients. Corticosteroids and/or immunosuppressive treatment have been used for 15.6% of patients. At the end of follow-up, 35.3 % of patients achieved complete or partial remission and 56.6 % progressed to ESRD.
Conclusion
Elderly NS was characterized by a poor prognosis due to delayed cosultation and non-uniform treatment strategies. Multicentric study in order to identify different action axes could improve the prognosis of this disease. Multicentric study in order to identify different action axes could improve the prognosis of this disease.
Collapse
Affiliation(s)
- Tasnim Ben ayed
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Imen Gorsane
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| | - Raja Trabelsi
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Mondher Ounissi
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Charles Nicolle Hospital, Medecine A, Tunis, Tunisia
- Faculty of Medecine, El manar university, Tunis, Tunisia
- Charles Nicolle Hospital, Laboratory of Research in Immunology of Renal Transplantation and Immunopathology (LR03SP01), Tunis, Tunisia
| |
Collapse
|