![]() Until the identification of anti-PLA2R antibodies, membranous nephropathy was included in the INS but is now considered as a different entity. FSGS scarring lesions can be identified at the onset or in advanced disease. In a subset of patients, focal and segmental glomerulosclerosis (FSGS) develops, sometimes accompanied by mild to moderate deposition of IgM and C3 complement component within the mesangium. Renal pathology shows a normal appearance of glomeruli by light microscopy (minimal changes disease (MCD)), negative immunofluorescence and foot-process fusion by electron microscopy. Idiopathic nephrotic syndrome (INS) is a rare renal disease characterized by a massive urinary loss of albumin culminating in nephrotic syndrome. Alternative immunosuppressive regimens, including B-cells depleting agents as frontline therapy, should be tested in this subset of patients to improve the mid- to long-term outcomes. Thus, in older patients with INS and receiving steroids, renal response is delayed and relapse is the rule. Complications were highly prevalent: diabetes mellitus (23.3%), hypertension (24.1%), infection requiring hospitalization (21.6%) and acute kidney injury (9.5%). After a median follow-up of 34 months (IQR (12 57)), 7 patients had died (6%) and 5 reached end-stage renal disease. Cumulative incidence of relapse was 90% at 7 years, with relapse occurring continuously over time. In a large multicentric retrospective study that included 116 patients with INS and onset ≥ 60 years of age, we showed that cumulative incidence of renal response was 95% after frontline therapy, with an age-dependent median time-to-response (60 days before 70 years of age at the onset vs. ![]() Whether immunosuppressive regimens formerly designed in children and young adults are safe and efficient in elderly remains elusive. Because of its rarity, renal presentation and outcomes of idiopathic nephrotic syndrome (INS minimal changes disease or focal and segmental glomerulosclerosis) has poorly been described in elderly patients, precluding an individualized therapy procedure. ![]()
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