Acute glomerulonephritis has a clear age-related presentation and prognosis. In children and young adults, acute glomerulonephritis is often associated with recent streptococcal infection, producing hematuria, heavy proteinuria, edema, hypertension, and in many cases, the development of pulmonary congestion. The prognosis is generally good in poststreptococcal disease but variable in nonnoslslreptococcal cases.
In elderly patients, Ihe nonspecific clinical features (such as nausea, malaise, arthralgias, and a striking predilection for pulmonary infiltrates initially) are thought to represent worsening of a preexisting illness, especially heart failure. Proteinuria is generally moderate. Hypertension or edema, although unusual, indicates a streptococcal cause, more often a pyoderma! streptococcal infection rather than pharyngitis; the prognosis is favorable. Otherwise, the prognosis is poor, with crcscentic glomerulonephritis associated with focal, segmental, necrotizing, or fibrosing glomerulus the most common histologic finding.
The value of treatment with corticosteroids, immunosuppressive agents, anticoagulants, and plasmapheresis remains controversial. In view of the poor prognosis of rapidly progressive glomerulonephritis in the elderly, the potential benefits of high-dose pulse corticosteroid therapy are likely to outweigh the risks.

Traditionally, age was thought to play an important role in the pathogenesis of nephrotic syndromes (eg, the likelihood of minimal-change disease decreases and that of amyloidosis increases with age). However, clinical und biopsy data from a large number of elderly nephrotic patients now indicate that, in general, age has no impact on the frequency of any pathologic glomerular change.
The most common nephrotic lesion in old age is membranous glomerulonephritis; the second most common is minimal-change disease. Membranous glomerulonephritis is often associated with carcinoma of the lung, colon, or stomach. Nonsteroidal anti-inflammatory drugs are emerging as an important preventable cause of nephrotic syndrome in
the elderly.
Elderly patients with minimal-change disease generally have an excellent response to corticosteroids and immunosuppressants. In addition, some elderly patients with membranous glomerulonephritis respond to corticosteroid or cyclophosphamide therapy. In many cases.