Yang Fan, Li Bing, Cui Wenpeng, He Chunyan, Liu Shujun, Guo Qiaoyan, Wu Man, Miao Lining, Luo Ping
The Department of Nephropathy, The Second Hospital, Norman Bethune Medical College, Jilin University, Changchun, 130021, China.
Int Urol Nephrol. 2015 Feb;47(2):327-33. doi: 10.1007/s11255-014-0895-7. Epub 2014 Dec 25.
To investigate the clinical characteristics and histopathological features of kidney disease in elderly patients.
We retrospectively analyzed the results of 4,185 consecutive renal biopsies, and 288 patients aged >60 years at the Second Hospital of Jilin University from January 1998 to December 2013 were finally included. All patients had been clinically and histologically diagnosed with kidney disease.
Nephrotic syndrome was the main clinical indication for biopsy. Twenty-four patients (8.33 %) experienced a minor complication related to their biopsy procedure. Among patients diagnosed as primary glomerulonephritis (GN), membranous nephropathy (MN) was the most frequent subclassification (24.7 %), followed by mesangioproliferative glomerulonephritis (MsPGN, 11.1 %) and IgA nephropathy (IgAN, 8.0 %). Amyloidosis (8.7 %) was the most common secondary GN, followed by antineutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune GN (5.2 %) and diabetic nephropathy (DN, 3.8 %). Based on renal biopsies results, 143/288 patients received immunosuppressive therapy and showed an overall remission rate (complete plus partial remissions) of 74.1 %. Among 71 MN patients, 29 patients received steroids plus cyclophosphamide and showed a remission rate of 79.3 %, while 42 patients received steroids and tacrolimus and showed a remission rate of 90.5 %. Among 25 patients with amyloidosis, 22 cases received melphalan plus dexamethasone and showed a remission rate of 40.9 %, while three patients received vincristine, adriamycin, and dexamethasone and showed a remission rate of 66.7 %.
Making an accurate pathologic diagnosis by renal biopsy is crucial for selecting the proper treatment for elderly patients with kidney disease.
探讨老年肾病患者的临床特征和组织病理学特征。
我们回顾性分析了4185例连续肾活检的结果，最终纳入了1998年1月至2013年12月在吉林大学第二医院年龄>60岁的288例患者。所有患者均经临床和组织学诊断为肾病。
肾病综合征是活检的主要临床指征。24例患者（8.33%）经历了与活检操作相关的轻微并发症。在诊断为原发性肾小球肾炎（GN）的患者中，膜性肾病（MN）是最常见的亚分类（24.7%），其次是系膜增生性肾小球肾炎（MsPGN，11.1%）和IgA肾病（IgAN，8.0%）。淀粉样变性（8.7%）是最常见的继发性GN，其次是抗中性粒细胞胞浆自身抗体（ANCA）相关性寡免疫性GN（5.2%）和糖尿病肾病（DN，3.8%）。根据肾活检结果，143/288例患者接受了免疫抑制治疗，总体缓解率（完全缓解加部分缓解）为74.1%。在71例MN患者中，29例患者接受了类固醇加环磷酰胺治疗，缓解率为79.3%，而42例患者接受了类固醇和他克莫司治疗，缓解率为90.5%。在25例淀粉样变性患者中，22例接受了美法仑加地塞米松治疗，缓解率为40.9%，而3例患者接受了长春新碱、阿霉素和地塞米松治疗，缓解率为66.7%。
通过肾活检做出准确的病理诊断对于为老年肾病患者选择合适的治疗方法至关重要。
