Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger Treatment and clinical outcomes of elderly idiopathic membranous nephropathy: A multicenter cohort study in Korea Eunjin Bae a , Sung Woo Lee b , Seokwoo Park c , Dong Ki Kim c , Hajeong Lee c , Hyuk Huh c , Ho Jun Chin d , Shina Lee e , Dong-Ryeol Ryu e , Ji In Park f , Sejoong Kim d , Dong Jun Park a , Shin-Wook Kang g , Yon Su Kim c , Yun Kuy Oh h , Yong Chul Kim h , Chun Soo Lim h , Jung Tak Park g, ⁎⁎ ,1 , Jung Pyo Lee c,h, ⁎ ,1 a Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea b Department of Internal Medicine, Eulji General Hospital, Seoul, Republic of Korea c Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea d Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea e Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea f Department of Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea g Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea h Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea ARTICLE INFO Keywords: Elderly Membranous nephropathy Angiotensin II receptor blocker or angiotensin- converting enzyme inhibitor ABSTRACT Idiopathic membranous nephropathy (MN) is the most common glomerulonephritis in elderly patients showing nephrotic syndrome. However, little is known about its treatment options and outcomes in elderly MN patients at long term follow-up. We retrospectively enrolled patients with biopsy-proven MN between April 1990 and December 2015 from eight tertiary hospitals in Korea. Among them, we excluded patients who had secondary causes of MN and subnephrotic-range proteinuria. We evaluated the presenting features and clinical outcomes and analyzed the all-cause mortality, renal outcomes, infection, and remission with respect to age. During the median follow-up at 77.2 months, 198 younger patients (< 65 years) and 133 elderly patients (≥65 years) were enrolled. Age was an independent risk factor for all-cause mortality, renal outcome, and infection (for all P< 0.05) except remission. In elderly patients, there was no significant factor associated with mortality rate. The use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) was sig- nificantly associated with renal outcome and infection (renal outcome, hazard ration [HR] 0.06, 95% confidence intervals [CI] 0.01–0.36, P = 0.003; infection, HR 0.20, 95% CI 0.04–0.94, P = 0.041). Immunosuppressant therapy significantly increased renal outcome (P = 0.045) and infection (P = 0.029) compared with con- servative therapy. In conclusion, old age is one of the clinically important predictors for MN patients. Among the treatment of elderly MN patients, only ACEI or ARB was associated with beneficial effects on renal outcome and infection. Elderly MN patients need a more tailored regimen considering their comorbidities and condition. 1. Introduction The world population continues to rapidly grow older and life ex- pectancies have increased (Tonelli & Riella, 2014). Hence, the aging kidney has become a topic of great interest in geriatric medicine and clinical nephrology. With advancing age, various structural changes occur, including micro-anatomic changes, such as nephrosclerosis and a decline in nephron number, and macro-anatomic changes, such as de- creased kidney cortical volume and the development of renal cysts (Glassock & Rule, 2012). Moreover, glomerular filtration rate (GFR) declines with age, which is correlated with structural changes (Weinstein & Anderson, 2010) and vascular processes (Cattran, 2005). Although elderly patients have the same GFR and amount of proteinuria compared with younger patients, their prognosis may be different. https://doi.org/10.1016/j.archger.2018.03.002 Received 15 December 2017; Received in revised form 25 February 2018; Accepted 1 March 2018 ⁎ Corresponding author at: Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Boramae Medical Center, 20, Boramae-ro 5- gil, Dongjak-gu, Seoul, 07061, Republic of Korea. ⁎⁎ Corresponding author at: Department of Internal Medicine, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. 1 The two corresponding authors contributed equally to this research. E-mail addresses: jtpark@yuhs.ac (J.T. Park), nephrolee@gmail.com (J.P. Lee). Archives of Gerontology and Geriatrics 76 (2018) 175–181 Available online 03 March 2018 0167-4943/ © 2018 Published by Elsevier B.V. T