Treatment with cyclophosphamide in elderly-onset nephrotic syndrome.
BACKGROUND
The best treatment of elderly-onset nephrotic syndrome has not been well defined. The use of corticosteroids or combination immunosuppressants may be associated with a significant incidence of side effects in the elderly. There is little data on the use of cyclophosphamide alone.


METHODS
We retrospectively reviewed 30 patients with idiopathic elderly-onset nephrotic syndrome treated with cyclophosphamide.


RESULTS
Male to female ratio was 2:1, mean age at diagnosis was 72.7 +/- 5.9 years and average length of follow-up was 41.4 +/- 21.3 months. Significant co-morbidities, including hypertension, were present in 57%. A raised serum creatinine level was found in 57%. Biopsy revealed 15 membranous nephropathy, 4 mesangial proliferative Gn, 5 IgA nephropathy, 3 minimal change nephropathy, 2 focal segmental glomerulosclerosis and 1 C1q nephropathy. Cyclophosphamide was given for 32.0 +/- 16.2 weeks with an averaged cumulative dose per patient 177 +/- 84 mg/kg BW. Remission (complete or partial) was attained by 40, 63, 80 and 87% of patients within 12, 24, 36 and 48 weeks of treatment, respectively. Eighteen patients attained complete remission and 9 partial remission after treatment. The mean interval to attain first remission (complete or partial) was 18.9 +/- 14.6 weeks. This was not affected by age (p = NS) or initial albumin level (p = NS). At the time of last follow-up, all but 2 patients were in complete or partial remission with raised serum creatinine levels in 40%.


CONCLUSIONS
Cyclophosphamide was effective and well tolerated in the treatment of elderly-onset nephrotic syndrome, with sustained remission and preserved renal function.
Mak
Siu-Ka
SK
Department of Medicine and Geriatrics, Kwong Wah Hospital, Kowloon, Hong Kong, China. maksk@ha.org.hk
Lo
Kin-Yee
KY
Wong
Calvin Y
CY
Tong
Gensy M W
GM
Wong
Ping-nam
PN
Wong
Andrew K M
AK
D000368:Aged; D000369:Aged, 80 and over; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies
D003520:Cyclophosphamide