Divisão de Nefrologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Divisão de Anatomia Patológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Braz J Med Biol Res. 2022 Feb 28;55:e11861. doi: 10.1590/1414-431X2022e11861. eCollection 2022.
Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (P<0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.
肾病综合征是老年患者肾小球疾病最常见的临床表现，肾活检是重要的诊断手段。本研究旨在描述巴西老年肾病综合征患者的特点，重点关注肾小管间质和血管受累情况。这是一项回顾性研究，纳入了 2012 年 1 月至 2019 年 12 月期间行肾活检的年龄≥65 岁的肾病综合征患者。在研究期间进行的 123 例肾活检中，44 例（35.8%）用于肾病综合征的检查。在这 44 例患者中，主要病因学类型为膜性肾病 13 例（29.5%）、淀粉样变性 10 例（22.7%）、非塌陷型局灶节段性肾小球硬化症（FSGS）4 例（9.1%）、塌陷型 FSGS 4 例（9.1%）。微小病变性肾病（MCD）患者的间质纤维化程度最低，与其他肾小球疾病相比，淀粉样变性患者的急性肾小管坏死（ATN）组织学表现较膜性肾病、FSGS 或 MCD 患者少见（P=0.0077）。在伴有 ATN 的患者中，MCD 患者的急性肾损伤（AKI）发生率最高（P<0.001）。所有患者均存在不同程度的血管受累，与肾小球疾病类型无关。总之，该人群中第二大常见的肾病综合征病因是淀粉样变性，MCD 患者的急性间质小管受累更明显。血管受累与患者年龄相关，且不仅是由潜在的肾小球疾病引起。
