Renal Failure

Glomerular Diseases in Older Adults: From Kidney Biopsy to Tailored Immunosuppression

Adults aged 65 years and older represent a rapidly growing proportion of patients with biopsy-proven glomerular disease, yet they remain largely excluded from the clinical trials that shape current guidelines. In this population, disease-specific immune injury overlaps with age-related nephrosclerosis, frailty, multimorbidity and a heightened susceptibility to infection, so that the same histological diagnosis can carry a different prognosis and a different balance of treatment risks than in younger patients. Much of what is recommended for older adults is therefore extrapolated from younger cohorts rather than derived from studies designed around them.

The consequences are practical and immediate. Clinicians face recurring uncertainty about when to perform a kidney biopsy, how to interpret chronic lesions, and how to weigh the efficacy of glucocorticoids, rituximab, cyclophosphamide and newer targeted agents against their toxicity. Acute kidney injury is a frequent mode of presentation, and the chance of kidney recovery must be balanced against the risks of treatment, particularly infection, a major cause of early death in older patients receiving immunosuppression. Building age-specific evidence is essential to avoid both undertreatment and avoidable harm.

This Article Collection invites articles on immune-mediated glomerular diseases in older adults, including ANCA-associated vasculitis and rapidly progressive glomerulonephritis, membranous nephropathy, minimal change disease and other podocytopathies, IgA nephropathy presenting with acute kidney injury, anti-GBM disease, monoclonal gammopathy of renal significance and paraneoplastic glomerulopathies. We particularly welcome studies on the safety and diagnostic yield of kidney biopsy in the very elderly, frailty and geriatric assessment as tools for treatment selection, dose-adapted and steroid-sparing regimens, infection prophylaxis, kidney recovery after acute kidney injury, and patient-centered outcomes. The aim is to build the evidence base needed for age-specific, individualized care.

Article Collection key terms:

• Glomerulonephritis
• Older adults
• Kidney biopsy
• Immunosuppression
• Frailty

Article Collection Guest Advisors:

Dr Andrea Angioi, MD, FASN, is a consultant nephrologist at the Division of Nephrology, Dialysis and Transplantation, ARNAS G. Brotzu, Cagliari, Italy, where he coordinates the inpatient ward. Between 2015 and 2021 he held research positions at the Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, under Prof. Fernando C. Fervenza. His research focuses on glomerular and complement-mediated kidney diseases, monoclonal gammopathy of renal significance and artificial intelligence in nephrology. He is a Fellow of the American Society of Nephrology and a member of the Renal Pathology Society, and serves as Senior Associate Editor of Renal Failure and Associate Editor of Frontiers in Nephrology. His 2024 Renal Failure review on the management of immune-mediated glomerular diseases in the elderly is the starting point of this Collection.

­­All manuscripts submitted to this Article Collection will undergo a full peer-review; the Guest Advisors for this Collection will not be handling the manuscripts (unless they are an Editorial Board member).

Please review the journal scope and author submission instructions prior to submitting a manuscript.

The deadline for submitting manuscripts is 26th July 2027.

Please contact Rebecca Kearns at Rebecca.Kearns@tandf.co.uk with any queries and discount codes regarding this Article Collection.

Please be sure to select the appropriate Article Collection from the drop-down menu in the submission system.

The Guest Advisors for this Article Collection have declared no conflict of interests