1 %) cases showed a daily proteinuria of 3.5 g or higher [15]. The renal survival rate was 60 % at 20 years after diagnosis in patients with primary MN, and the renal survival rate in patients on steroid therapy was significantly higher in patients on supportive therapy alone in Japan [16], while spontaneous remission was reported to be common (32 %) in patients with primary MN with nephrotic syndrome in Spain [17], even in patients exhibiting chronic renal

impairment [18]. Whether treatment with renin–angiotensin Acalabrutinib blockers or immunoglobulins other than steroids has a favorable effect on the renal prognosis of primary MN should be elucidated in future clinical studies. The minor glomerular abnormalities in primary nephrotic syndrome, which correspond to MCNS, was the most common histopathology reported in 2008 (44.1 %) and 2010 (50.0 %) in the J-RBR. Since MCNS develops in patients at younger ages [5, 15] while primary MN develops in a relatively elderly population [15, 16], the frequency of these diseases may depend on the distribution of the age ranges of patients registered in each year. Indeed, the rate of native biopsies of subjects younger than 20 years of age slightly increased from 11.4 % in 2009 to 12.7 % in 2010 (Table 3) and the mean age of patients with nephrotic learn more syndrome

slightly decreased from 53.5 years in 2009 to 50.1 years in 2010 (Table 5) in the J-RBR. The average age of rapidly progressive nephritic syndrome Amino acid was the highest (64.4 years) in the age distribution in the classification of clinical diagnosis in the J-RBR (Table 5). Elderly subjects (65 years and over) comprised nearly 25 % of cases, and very elderly subjects (80 years and over) comprised 2.5 %

of the cases in the combined data for 2009 and 2010 in the J-RBR. It has been reported that there were statistically significant differences in the renal disease spectrum between elderly and younger subjects [19, 20]. The frequency of rapidly progressive nephritic syndrome in the clinical diagnosis dramatically increased from 4.0 % in the younger group (20–64 years) to 19.6 % in the very elderly in the combined data from 2007 to November 2011 in the J-RBR [20]. A nationwide survey of rapidly progressive glomerulonephritis (RPGN) was conducted between 1989 and 2007 in Japan, and showed that 64.0 % of patients had pauci-immune-type RPGN, including 42.0 % renal-limited vasculitis, 19.4 % microscopic polyangiitis, and 2.6 % Wegener’s granulomatosis (currently granulomatosis with polyangiitis) [21]. Since the frequency of myeloperoxidase–anti-neutrophil cytoplasmic antibody (MPO-ANCA)-positive nephritis has increased recently [22], a further subanalysis of rapidly progressive nephritic syndrome in the J-RBR should be performed to validate the recently published Japanese guidelines for RPGN [23].