Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
Adv Chronic Kidney Dis. 2012 Mar;19(2):61-7. doi: 10.1053/j.ackd.2011.09.003.
Longer life expectancy has led to a growing epidemic of kidney disease in the elderly (aged ≥ 65 years) and very elderly (aged ≥ 80 years). While much of the rising burden of kidney disease in these age-groups can be attributed to age-associated decline and a high prevalence of comorbidities such as hypertension and diabetes mellitus, a significant proportion of kidney disease is due to potentially reversible causes of injury in the glomerular, tubulointerstitial, and vascular compartments. A renal biopsy is crucial not only to diagnose such potentially reversible lesions but also to provide prognostic information and guide therapeutic decisions. In this review, we survey the literature on renal biopsy in the elderly and very elderly, focusing on the utility and safety of this procedure. We report the most common histopathologic findings in these age-groups and demonstrate that many of these lesions are associated with diseases that respond to appropriate therapies, regardless of age. We conclude that, in a variety of commonly encountered clinical situations, a renal biopsy is crucial for appropriate management of elderly and very elderly patients with kidney disease.
预期寿命的延长导致老年（年龄≥65 岁）和非常老年（年龄≥80 岁）人群中肾脏疾病的发病率不断上升。虽然这些年龄段中肾脏疾病负担的增加在很大程度上归因于与年龄相关的下降以及高血压和糖尿病等合并症的高发，但相当一部分肾脏疾病是由于肾小球、肾小管间质和血管腔中潜在可逆转的损伤原因所致。肾脏活检不仅对于诊断这些潜在可逆转的病变至关重要，而且还可以提供预后信息并指导治疗决策。在这篇综述中，我们调查了老年和非常老年人群中肾脏活检的文献，重点关注该操作的实用性和安全性。我们报告了这些年龄段中最常见的组织病理学发现，并证明许多这些病变与可通过适当治疗来缓解的疾病相关，而与年龄无关。我们得出结论，在各种常见的临床情况下，对于患有肾脏疾病的老年和非常老年患者，肾脏活检对于适当的治疗至关重要。
