de Oliveira Claudine Maria Jorge, Costa Roberto Silva, Vieira Neto Osvaldo Merege, Dantas Rosana Aparecida Spadoti, Moysés Neto Miguel, Romão Elen Almeida, Barros-Silva Gyl Eanes, Coelho Eduardo Barbosa, Dantas Márcio
Serviços Médicos de Anestesia.
J Bras Nefrol. 2010 Dec;32(4):379-85.
The elderly population is growing and aging in better clinical conditions than in the past. However, the distribution and course of kidney diseases in elderly patients are not well known partially due to reluctance to indicate renal biopsies in those patients.
To evaluate the distribution, clinical features, and outcomes of nephropathies diagnosed by biopsy in the elderly.
Seventy-one patients (47 males, 24 females) aged 60 years or older (67.3 ± 6.5 years), undergoing biopsy from January 1990 to December 2006, were evaluated. They were grouped according to their clinical syndromes.
Nephrotic syndrome was observed in 35 patients (49.3%), mainly associated with membranous nephropathy (17 patients), followed by amyloidosis and focal segmental glomerulosclerosis (seven patients each). Acute kidney injury (AKI) was diagnosed in 19 patients, and the main histopathological diagnoses were acute tubular necrosis (six patients) and cast nephropathy (three patients). Of those 19 patients, only two had a favorable course, while the others died early or progressed toward advanced chronic kidney disease. Twelve patients undergoing biopsy because of asymptomatic hematuria or proteinuria had different diagnoses, but most of them already had significant chronic nephropathy. In five patients with nephritic syndrome, the biopsies also showed several diagnoses.
Nephrotic syndrome was the major indication for renal biopsy, and membranous nephropathy was the most frequent diagnosis. Among patients with AKI and asymptomatic hematuria or proteinuria, different diagnoses were found with high levels of advanced chronic nephropathy.
老年人口数量不断增加，且与过去相比，其临床状况更佳。然而，老年患者肾脏疾病的分布及病程尚不明确，部分原因是不愿对这些患者进行肾活检。
评估老年患者经活检诊断的肾病的分布、临床特征及预后。
对1990年1月至2006年12月期间接受活检的71例60岁及以上（67.3±6.5岁）患者（47例男性，24例女性）进行评估。根据临床综合征对他们进行分组。
35例患者（49.3%）出现肾病综合征，主要与膜性肾病相关（17例患者），其次是淀粉样变性和局灶节段性肾小球硬化（各7例患者）。19例患者被诊断为急性肾损伤（AKI），主要组织病理学诊断为急性肾小管坏死（6例患者）和管型肾病（3例患者）。在这19例患者中，只有2例病程良好，其他患者早期死亡或进展为晚期慢性肾病。12例因无症状血尿或蛋白尿接受活检的患者有不同诊断，但他们大多数已有明显的慢性肾病。5例肾病综合征患者的活检也显示了多种诊断。
肾病综合征是肾活检的主要指征，膜性肾病是最常见的诊断。在急性肾损伤以及无症状血尿或蛋白尿患者中，发现了不同诊断，且晚期慢性肾病发生率较高。
