Preston R A, Stemmer C L, Materson B J, Perez-Stable E, Pardo V
Medical Service, Miami Veterans Administration Medical Center, Florida.
J Am Geriatr Soc. 1990 Jun;38(6):669-74. doi: 10.1111/j.1532-5415.1990.tb01427.x.
We studied the clinical and pathological data for 334 patients age 65 or more who underwent renal biopsy for acute renal failure (ARF, n = 55), subacute renal failure (SRF, n = 72), chronic renal failure (CRF, n = 57), proteinuria (n = 137), and hematuria (n = 13). Tissue diagnoses were glomerulopathy (n = 252, 75.4%), acute tubular lesions (n = 18), interstitial nephritis (n = 23), vascular diseases (n = 36, including 14 with cholesterol emboli), and five miscellaneous diagnoses. Of the 55 patients with ARF, 23 had a glomerular lesion, 15 had acute tubular necrosis, and 8 had acute interstitial nephritis. Of 72 patients with SRF, 49 had a glomerulopathy, 12 had a vascular disorder, and six had acute interstitial nephritis. Hence, patients with ARF or SRF exhibited a high potential for reversible lesions. Only 11.3% of patients with CRF had potentially reversible causes. The most common causes of proteinuria were membranous glomerulopathy (34.3%), minimal change disease (14.6%), focal segmental sclerosis (11.7%), and amyloidosis (8.8%). Of the 25 patients with advanced nephrosclerosis, 24 had renal failure, 20 were hypertensive, and 13 had cholesterol emboli. Of 33 patients with diabetes mellitus, 66.7% were found to have lesions not related to diabetes. We conclude that renal biopsy is most useful in older patients with ARF or SRF because of potentially reversible renal disease. Old age alone is not a contraindication to performing a renal biopsy.
我们研究了334例65岁及以上因急性肾衰竭（ARF，n = 55）、亚急性肾衰竭（SRF，n = 72）、慢性肾衰竭（CRF，n = 57）、蛋白尿（n = 137）和血尿（n = 13）接受肾活检的患者的临床和病理数据。组织诊断为肾小球病（n = 252，75.4%）、急性肾小管病变（n = 18）、间质性肾炎（n = 23）、血管疾病（n = 36，包括14例胆固醇栓塞）以及其他5种诊断。在55例ARF患者中，23例有肾小球病变，15例有急性肾小管坏死，8例有急性间质性肾炎。在72例SRF患者中，49例有肾小球病，12例有血管疾病，6例有急性间质性肾炎。因此，ARF或SRF患者的病变具有较高的可逆性。CRF患者中只有11.3%有潜在可逆病因。蛋白尿最常见的病因是膜性肾小球病（34.3%）、微小病变病（14.6%）、局灶节段性硬化（11.7%）和淀粉样变性（8.8%）。在25例晚期肾硬化患者中，24例有肾衰竭，20例有高血压，13例有胆固醇栓塞。在33例糖尿病患者中，66.7%发现有与糖尿病无关的病变。我们得出结论，肾活检对患有ARF或SRF的老年患者最为有用，因为可能存在可逆性肾病。高龄本身并非进行肾活检的禁忌证。
