Better remission rates in elderly Japanese patients with primary membranous nephropathy in nationwide real-world practice: The Japan Nephrotic Syndrome Cohort Study (JNSCS)

被引：7

作者：

Yokoyama, Hitoshi ^{[1
]}

Yamamoto, Ryohei ^{[2
]}

Imai, Enyu ^{[3
]}

Maruyama, Shoichi ^{[4
]}

Sugiyama, Hitoshi ^{[5
]}

Nitta, Kosaku ^{[6
]}

Tsukamoto, Tatsuo ^{[7
]}

Uchida, Shunya ^{[8
]}

Takeda, Asami ^{[9
]}

Sato, Toshinobu ^{[10
]}

Wada, Takashi ^{[11
]}

Hayashi, Hiroki ^{[12
]}

Akai, Yasuhiro ^{[13
]}

Fukunaga, Megumu ^{[14
]}

Tsuruya, Kazuhiko ^{[13
,15
]}

Masutani, Kosuke ^{[16
]}

Konta, Tsuneo ^{[17
]}

Shoji, Tatsuya ^{[18
]}

Hiramatsu, Takeyuki ^{[19
]}

Goto, Shunsuke ^{[20
,21
]}

Tamai, Hirofumi ^{[22
]}

Nishio, Saori ^{[23
]}

Shirasaki, Arimasa ^{[24
]}

Nagai, Kojiro ^{[25
]}

Yamagata, Kunihiro ^{[26
]}

Hasegawa, Hajime ^{[27
]}

Yasuda, Hidemo ^{[28
]}

Ichida, Shizunori ^{[29
]}

Naruse, Tomohiko ^{[30
]}

Fukami, Kei ^{[31
]}

Nishino, Tomoya ^{[32
]}

Sobajima, Hiroshi ^{[33
]}

Tanaka, Satoshi ^{[34
]}

Akahori, Toshiyuki ^{[35
]}

Ito, Takafumi ^{[36
]}

Terada, Yoshio ^{[37
]}

Katafuchi, Ritsuko ^{[38
]}

Fujimoto, Shouichi ^{[39
]}

Okada, Hirokazu ^{[40
]}

Ishimura, Eiji ^{[41
]}

Kazama, Junichiro James ^{[42
]}

Hiromura, Keiju ^{[43
]}

Mimura, Tetsushi ^{[44
]}

Suzuki, Satashi ^{[45
]}

Saka, Yosuke ^{[46
]}

Sofue, Tadashi ^{[47
]}

Suzuki, Yusuke ^{[48
]}

Shibagaki, Yugo ^{[49
]}

Kitagawa, Kiyoki ^{[50
]}

Morozumi, Kunio ^{[51
]}

机构：

[1] Kanazawa Med Univ, Dept Nephrol, Sch Med, 1-1 Daigaku, Kahoku, Ishikawa 9200293, Japan

[2] Osaka Univ, Hlth & Counseling Ctr, 1-17 Machikaneyama Cho, Toyonaka, Osaka 5600043, Japan

[3] Nakayamadera Imai Clin, 2-8-18 Nakayamadera, Takarazuka, Hyogo 6650861, Japan

[4] Nagoya Univ, Grad Sch Med, Dept Nephrol, Showa Ku, 65 Tsurumai Cho, Nagoya, Aichi 4668550, Japan

[5] Okayama Univ, Dept Human Resource Dev Dialysis Therapy Kidney D, Grad Sch Med Dent & Pharmaceut Sci, Kita Ku, 2-5-1 Shikatacho, Okayama 7008558, Japan

[6] Tokyo Womens Med Univ, Dept Med, Kidney Ctr, Shinjuku Ku, 8-1 Kawada Cho, Tokyo 1628666, Japan

[7] Kitano Hosp, Tazuke Kofukai Med Res Inst, Div Nephrol & Dialysis, Kita Ku, 2-4-20 Ogimachi, Osaka 5308480, Japan

[8] Teikyo Univ, Sch Med, Dept Internal Med, Itabashi Ku, 2-11-1 Kaga, Tokyo 1738606, Japan

[9] Japanese Red Cross Nagoya Daini Hosp, Kidney Dis Ctr, Showa Ku, 2-9 Myokencho, Nagoya, Aichi 4668650, Japan

[10] JCHO Sendai Hosp, Dept Nephrol, Aoba Ku, 3-16-1 Tsutsumi Machi, Sendai, Miyagi 9818501, Japan

[11] Kanazawa Univ, Dept Nephrol & Lab Med, 13-1 Takara Machi, Kanazawa, Ishikawa 9208641, Japan

[12] Fujita Hlth Univ, Sch Med, Dept Nephrol, 1-98 Dengakugakubo, Toyoake, Aichi 4701192, Japan

[13] Nara Med Univ, Dept Internal Med 1, 840 Shijocho, Kashihara, Nara 6348522, Japan

[14] Toyonaka City Hosp, Div Nephrol, Dept Internal Med, 4-14-1 Shibaharacho, Toyonaka, Osaka 5608565, Japan

[15] Kyushu Univ, Grad Sch Med Sci, Dept Integrated Therapy Chron Kidney Dis, Higashi Ku, 3-1-1 Maidashi, Fukuoka, Fukuoka 8128582, Japan

[16] Fukuoka Univ, Div Nephrol & Rheumatol, Dept Internal Med, Fac Med,Jonan Ku, 7-45-1 Nanakuma, Fukuoka, Fukuoka 8140180, Japan

[17] Yamagata Univ, Sch Med, Dept Cardiol Pulmonol & Nephrol, 2-2 Iida Nishi, Yamagata 9909585, Japan

[18] Osaka Gen Med Ctr, Dept Kidney Dis & Hypertens, Sumiyoshi Ku, 3-1-56 Bandaihigashi, Osaka 5588558, Japan

[19] Konan Kosei Hosp, Dept Nephrol, 137 Omatsubara, Konan, Aichi 4838704, Japan

[20] Kobe Univ, Grad Sch Med, Div Nephrol, Cuho Ku, 7-5-1 Kusunokicho, Kobe, Hyogo 6500017, Japan

[21] Kobe Univ, Grad Sch Med, Kidney Ctr, Cuho Ku, 7-5-1 Kusunokicho, Kobe, Hyogo 6500017, Japan

[22] Anjo Kosei Hosp, Dept Nephrol, 28 Higashihirokute, Anjo, Aichi 4468602, Japan

[23] Hokkaido Univ, Grad Sch Med, Div Rheumatol Endocrinol & Nephrol, Kita Ku, Kita 15,Nishi 7, Sapporo, Hokkaido 0608638, Japan

[24] Ichinomiya Municipal Hosp, Dept Nephrol, 2-2-22 Bunkyo, Ichinomiya, Aichi 4918558, Japan

[25] Tokushima Univ, Inst Biomed Sci, Dept Nephrol, Grad Sch, 3-18-15 Kuramoto Cho, Tokushima 7708503, Japan

[26] Univ Tsukuba, Fac Med, Dept Nephrol, 1-1-1 Tennodai, Tsukuba, Ibaraki 3058575, Japan

[27] Saitama Med Univ, Saitama Med Ctr, Dept Hypertens & Nephrol, 1981 Kamoda, Kawagoe, Saitama 350850, Japan

[28] Hamamatsu Univ Sch Med, Internal Med 1, Higashi Ku, 1-20-1 Handayama, Hamamatsu, Shizuoka 4313192, Japan

[29] Japanese Red Cross Nagoya Daiichi Hosp, Dept Nephrol, Nakamura Ku, 3-35 Michishitacho, Nagoya, Aichi, Japan

[30] Kasugai Municipal Hosp, Dept Nephrol, 1-1-1 Takakicho, Kasugai, Aichi 4868510, Japan

[31] Kurume Univ, Div Nephrol, Dept Med, Sch Med, 67 Asahimachi, Kurume, Fukuoka 8300011, Japan

[32] Nagasaki Univ Hosp, Dept Nephrol, 1-7-1 Sakamoto, Nagasaki 8528501, Japan

[33] Ogaki Municipal Hosp, Dept Diabetol & Nephrol, 4-86 Minaminokawacho, Ogaki, Gifu 5038502, Japan

[34] Shizuoka Prefectural Gen Hosp, Dept Nephrol, Aoi Ku, 4-27-1 Kitaando, Shizuoka 4208527, Japan

[35] Chutoen Gen Med Ctr, Dept Nephrol, 1-1 Shobugaike, Kakegawa, Shizuoka 4368555, Japan

[36] Shimane Univ Hosp, Div Nephrol, 89-1 Enyacho, Izumo, Shimane 6938501, Japan

[37] Kochi Univ, Kochi Med Sch, Dept Endocrinol Metab & Nephrol, Nanko Ku, Kochi 7838505, Japan

[38] Natl Fukuoka Higashi Med Ctr, Kidney Unit, 1-1-1 Chidori, Koga, Fukuoka 8113195, Japan

[39] Univ Miyazaki, Fac Med, Dept Hemovasc Med & Artificial Organs, 5200 Kihara, Miyazaki 8891692, Japan

[40] Saitama Med Univ, Dept Nephrol, 38 Morohongo, Iruma, Saitama 3500495, Japan

[41] Osaka City Univ Grad, Dept Nephrol, Sch Med, Abeno Ku, 1-4-3 Asahimachi, Osaka 5458585, Japan

[42] Fukushima Med Univ, Dept Hypertens & Nephrol, Sch Med, 1 Hikariga Oka, Fukushima 9601295, Japan

[43] Gunma Univ, Grad Sch Med, Dept Nephrol & Rheumatol, 3-39-22 Showa Matchi, Maebashi, Gumma 3718511, Japan

[44] Gifu Prefectural Tajimi Hosp, Dept Nephrol, 5-161 Maebatacho, Tajimi, Gifu 5078522, Japan

[45] Kainan Hosp, Dept Nephrol, 396 Minamihonden, Yatomi, Aichi 4988502, Japan

[46] Yokkaichi Municipal Hosp, Dept Nephrol, 2-2-37 Shibata, Yokaichi, Mie 5108567, Japan

[47] Kagawa Univ, Dept Cardiorenal & Cerebrovasc Med, 1750-1 Ikenobe, Miki, Kagawa 7610793, Japan

[48] Juntendo Univ, Fac Med, Dept Internal Med, Div Nephrol,Bunkyo Ku, 2-1-1 Hongo, Tokyo 1138421, Japan

[49] St Marianna Univ, Div Nephrol & Hypertens, Dept Internal Med, Sch Med,Miyamae Ku, 2-16-1 Sugao, Kawasaki, Kanagawa 216000, Japan

[50] Natl Hosp Org Kanazawa Med Ctr, Div Internal Med, 1-1 Shimoishibikimachi, Kanazawa, Ishikawa 9208650, Japan

来源：

CLINICAL AND EXPERIMENTAL NEPHROLOGY | 2020年 / 24卷 / 10期

关键词：

Membranous nephropathy; Elderly; Immunosuppressants; Corticosteroids; CLINICAL-PRACTICE; RISK; PROGNOSIS; OUTCOMES; DISEASE; GUIDELINES;

D O I：

10.1007/s10157-020-01913-9

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background The aim of the present study was to clarify the prevalence of immunosuppressive drug use and outcomes in elderly and non-elderly patients with primary membranous nephropathy (MN) in nationwide real-world practice in Japan. Patients and methods Between 2009 and 2010, 374 patients with primary nephrotic syndrome were enrolled in the cohort study (The Japan Nephrotic Syndrome Cohort Study, JNSCS), including 126 adult patients with MN. Their clinical characteristics were compared with those of nephrotic patients with primary MN registered in a large nationwide registry (The Japan Renal Biopsy Registry, J-RBR). Outcomes and predictors in the elderly (>= 65 years) and non-elderly groups were identified. Results Similar clinical characteristics were observed in JNSCS patients and J-RBR patients (n = 1808). At the early stage of 1 month, 84.1% of patients were treated with immunosuppressive therapies. No significant differences were observed in therapies between age groups. However, elderly patients achieved complete remission (CR) more frequently than non-elderly patients, particularly those treated with therapies that included corticosteroids. No significant differences were noted in serum creatinine (sCr) elevations at 50 or 100%, end-stage kidney disease, or all-cause mortality between age groups. Corticosteroids were identified as an independent predictor of CR (HR 2.749, 95%CI 1.593-4.745,p = 0.000) in the multivariate Cox's model. sCr levels, hemoglobin levels, immunosuppressants, clinical remission, and relapse after CR were independent predictors of sCr x 1.5 or x 2.0. Conclusion Early immunosuppressive therapy including corticosteroids for primary MN showed better remission rates in elderly patients in a nationwide cohort study.

引用

页码：893 / 909

页数：17

共 29 条

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