Moran D, Korzets Z, Bernheim J, Bernheim J, Yaretzky A
Department of Geriatrics, Meir General Hospital, Kfar Saba, Israel.
Gerontology. 1993;39(1):49-54. doi: 10.1159/000213514.
During the past decade, controversy has raged about the necessity of renal biopsy for the management of the idiopathic nephrotic syndrome. The debate has centered on whether a precise diagnosis is imperative for steroid treatment or whether such therapy can be given blindly. The above question has not been addressed in the elderly. In this retrospective study 30 patients aged > 60 years, all of whom underwent a renal biopsy for an unexplained nephrotic syndrome, were categorized according to histological findings and clinical evolution of their disease. The spectrum of histology was diverse, the most common renal lesion diagnosed being membranous glomerulopathy (MGN) (23%). At variance with other works is the relatively high incidence of membranoproliferative glomerulonephritis (MPGN) (20%) found by us. Minimal change disease (MCD) and amyloidosis were encountered in 5 (17%) and 4 patients (13%), respectively. Specific therapy (steroids) was administered in 11 patients. No benefit of steroid treatment was shown in patients with either MGN or MPGN. The only lesion which responded to steroids was MCD (3 complete remissions, 1 partial). Only one biopsy was complicated by a clinically significant perirenal hematoma requiring blood transfusion. No surgical intervention was necessary. Our findings tend to favor a positive approach to the performance of a renal biopsy in the management of the nephrotic syndrome in the elderly.
在过去十年中，关于肾活检在特发性肾病综合征治疗中的必要性一直存在激烈争论。争论的焦点在于类固醇治疗是否必须有精确诊断，还是可以盲目给予这种治疗。上述问题在老年人中尚未得到解决。在这项回顾性研究中，30名年龄>60岁的患者，均因不明原因的肾病综合征接受了肾活检，根据组织学检查结果和疾病的临床进展进行了分类。组织学谱多样，诊断出的最常见肾脏病变是膜性肾小球病（MGN）（23%）。与其他研究不同的是，我们发现膜增生性肾小球肾炎（MPGN）的发病率相对较高（20%）。微小病变病（MCD）和淀粉样变性分别在5例（17%）和4例患者（13%）中出现。11例患者接受了特异性治疗（类固醇）。在MGN或MPGN患者中未显示出类固醇治疗的益处。唯一对类固醇有反应的病变是MCD（3例完全缓解，1例部分缓解）。仅1例活检并发临床上有意义的肾周血肿，需要输血。无需手术干预。我们的研究结果倾向于支持在老年肾病综合征的治疗中积极进行肾活检。
