Patient age and the prognosis of idiopathic membranous nephropathy.
Patient age and the prognosis of idiopathic membranous nephropathy.
复制标题
DOI：
10.1371/journal.pone.0110376
复制
发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Maruyama S
中科院分区：
文献类型：
--
作者：
Yamaguchi M;Ando M;Yamamoto R;Akiyama S;Kato S;Katsuno T;Kosugi T;Sato W;Tsuboi N;Yasuda Y;Mizuno M;Ito Y;Matsuo S;Maruyama S
特发性膜性肾病（IMN）越来越多地见于老年患者。然而，老年和年轻IMN患者之间的疾病表现和结局差异仍然存在争议。我们比较了年轻和老年IMN患者的患者特征。我们招募了171名日本IMN患者，其中90名（52.6%）<65岁患者，40名（23.4%）65-70岁患者，41名（24.0%）≥71岁患者。比较年轻和老年IMN患者的临床特征和结局。在37个月的中位观察期内，103例（60.2%）患者达到完全蛋白尿缓解，这与患者年龄无显著相关性（P = 0.831）。 然而，13名（7.6%）患者因感染住院。多变量考克斯比例风险模型确定年龄较大[校正的风险比（HR）= 3.11，95%置信区间（CI）：1.45-7.49，每10年; P = 0.003]、泼尼松龙使用（校正的HR = 11.8，95% CI：1.59-242.5; P = 0.014）和环孢素与泼尼松龙联合使用（校正的HR = 10.3，95% CI：1.59-204.4; P = 0.012）是感染的重要预测因素。 免疫抑制治疗开始后1个月蛋白尿减少<25%也可预测感染（校正HR = 6.72，95%CI：1.51-37.8; P = 0.012）。 年轻和老年IMN患者的肾脏结局相似。然而，老年患者在使用免疫抑制剂时更容易发生感染。在免疫抑制治疗开始后的第一个月内反应差的患者应仔细监测感染情况，并可能需要更快的泼尼松龙减量。
Idiopathic membranous nephropathy (IMN) is increasingly seen in older patients. However, differences in disease presentation and outcomes between older and younger IMN patients remain controversial. We compared patient characteristics between younger and older IMN patients. We recruited 171 Japanese patients with IMN, including 90 (52.6%) patients <65 years old, 40 (23.4%) patients 65–70 years, and 41 (24.0%) patients ≥71 years. Clinical characteristics and outcomes were compared between younger and older IMN patients. During a median observation period of 37 months, 103 (60.2%) patients achieved complete proteinuria remission, which was not significantly associated with patient age (P = 0.831). However, 13 (7.6%) patients were hospitalized because of infection. Multivariate Cox proportional hazards models identified older age [adjusted hazard ratio (HR) = 3.11, 95% confidence interval (CI): 1.45–7.49, per 10 years; P = 0.003], prednisolone use (adjusted HR = 11.8, 95% CI: 1.59–242.5; P = 0.014), and cyclosporine used in combination with prednisolone (adjusted HR = 10.3, 95% CI: 1.59–204.4; P = 0.012) as significant predictors of infection. A <25% decrease in proteinuria at 1 month after immunosuppressive therapy initiation also predicted infection (adjusted HR = 6.72, 95% CI: 1.51–37.8; P = 0.012). Younger and older IMN patients had similar renal outcomes. However, older patients were more likely to develop infection when using immunosuppressants. Patients with a poor response in the first month following the initiation of immunosuppressive therapy should be carefully monitored for infection and may require a faster prednisolone taper.
登录
查看更多内容
影响因子：
13.2
作者：
Matsuo, Seiichi;Imai, Enyu;Hishida, Akira
通讯作者：
Hishida, Akira
影响因子：
19.6
作者：
PONTICELLI, C;ZUCCHELLI, P;BANFI, G
通讯作者：
BANFI, G
影响因子：
2.3
作者：
Yokoyama, Hitoshi;Sugiyama, Hitoshi;Yoshida, Haruyoshi
通讯作者：
Yoshida, Haruyoshi
影响因子：
19.6
作者：
Cattran, DC;Appel, GB;Kunis, CL
通讯作者：
Kunis, CL
DOI：
10.1023/a:1008332921183
发表时间：
1998-01-01
期刊：
Geriatric nephrology and urology
影响因子：
--
作者：
Glassock, R J
通讯作者：
Glassock, R J