Glomerular diseases in the elderly in India

Three hundred fifteen (315) elderly(≥60 years) patients with clinical renaldiseases were evaluated for the evidence ofglomerular diseases between November 1998 toJune 2002. Glomerular diseases (GN) wereobserved in 20.6% (65/315) of the elderlypatients. The age of the patients (male 56;female 9) ranged between 60–90 (mean64.17 ± 3.83) years. The clinicalpresentation of GN included: nephrotic syndrome40 (61.5%), acute nephritic syndrome19 (29.2%), rapidly progressive GN 4 (6.15%)and asymptomatic urinary abnormality 2 (3.0%).Overall, primary and secondary glomerulardisease were seen in 47 (72.3%) and 18 (27.6%)elderly patients respectively. Idiopathicmembranous nephropathy was the most common GNresponsible for nephrotic syndrome in11 (27.5%) of elderly patients. DiabeticNephropathy related to type 2 diabetes mellituswas the second common cause 9 (22.5%) ofnephrotic syndrome. Amyloidosis was noted in6 (15%) patients. Nephrotic syndrome wasrelated to leprosy in one patient. Amyloidosisoccurred in association with multiple myelomain 5 and carcinoma colon in 1 patient. Thus,primary and secondary GN were responsible fornephrotic syndrome in 60% and 40% of casesrespectively. Endocapillary proliferative GN ofpost infectious etiology was the most prevalent(82.6%) form of acute GN in our elderlypatients. Hypertension occurred in 78.2% ofcases and edema in 69.5%. Pulmonary congestion(52.2%) and ARF (73.9%) were the dominantpresenting feature of acute GN and 39% ofpatients required dialytic support. Glomerularcrescents were seen in 4 (17.4%) patients withacute glomerulonephritis. Pauci-immunecrescentic GN which is the commonest type ofacute GN in the elderly in western countrieswas not observed in this study. Renal biopsyrevealed mesangiocapillary GN (1) andmesangioproliferative GN (1) in two patientswith asymptomatic urinary abnormalities.Thus, overall spectrum of glomerular disease inthe Indian elderly population is similar tothat of developed countries except in two ways:(1) post infectious endocapillary proliferativeGN was the commonest type of acute GN (2)rarity or absence of pauci-immune crescenticglomerulonephritis.