Donadio J V
Division of Nephrology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Am J Kidney Dis. 1990 Oct;16(4):307-11. doi: 10.1016/s0272-6386(12)80007-2.
Glomerular disease was assessed in persons who had renal biopsies and who were age 60 years and older in retrospective reviews of referral-based cohorts in Europe, the United States, and Japan. From a cumulative total of 514 patients reported from five centers, 337 (66%) patients had primary glomerular diseases and 177 (34%) had various secondary renal diseases. Amyloidosis was the largest histopathologic group among the secondary disorders. Idiopathic membranous nephropathy was the most common primary glomerulopathy (107/337 [32%] patients) and also comprised 46% of nephrotic patients. In our experience covering two consecutive 13-year periods from 1959 to 1984, there was an increase both in total number of patients, and in percentage more than 60 years old, with membranous nephropathy in the more recent study period compared with the earlier period reflecting a trend to more biopsy procedures that included older patients. Non-immune-mediated rapidly progressive glomerulonephritis (RPGN), thought by some to be more common in older adults, has been shown to represent a crescentic glomerulonephritis associated with systemic necrotizing vasculitis. Treatment with corticosteroids had a short-term favorable effect on renal function in this disorder over that achieved in antiglomerular basement membrane-associated or idiopathic RPGN. However, the 5-year patient survival was remarkably lower in older patients irrespective of the disease entity. On the other hand, age was not associated with progressive renal failure in patients with membranous nephropathy. Finally, minimal change glomerulopathy accounted for 35 of 204 (17%) nephrotic subjects, and complete remissions occurred after corticosteroid treatment at the same frequency (80% to 90%) observed in younger patients.
在欧洲、美国和日本基于转诊队列的回顾性研究中，对接受肾活检且年龄在60岁及以上的人群进行了肾小球疾病评估。在五个中心报告的总计514例患者中，337例（66%）患有原发性肾小球疾病，177例（34%）患有各种继发性肾脏疾病。淀粉样变性是继发性疾病中最大的组织病理学类型。特发性膜性肾病是最常见的原发性肾小球病（107/337 [32%] 例患者），且占肾病患者的46%。根据我们1959年至1984年连续两个13年期间的经验，与早期相比，在最近的研究期间，膜性肾病患者的总数以及60岁以上患者的百分比均有所增加，这反映了包括老年患者在内的活检程序增多的趋势。非免疫介导的快速进展性肾小球肾炎（RPGN），一些人认为在老年人中更为常见，已被证明是一种与系统性坏死性血管炎相关的新月体性肾小球肾炎。与抗肾小球基底膜相关或特发性RPGN相比，在这种疾病中使用皮质类固醇治疗对肾功能有短期有利影响。然而，无论疾病类型如何，老年患者的5年生存率显著较低。另一方面，年龄与膜性肾病患者的进行性肾衰竭无关。最后，微小病变性肾小球病占204例肾病患者中的35例（17%），皮质类固醇治疗后完全缓解的发生率与年轻患者观察到的频率相同（80%至90%）。
