高龄肾病患者肾脏活检的临床病理分析
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摘要
目的分析中国高龄肾病患者肾脏活检的临床病理特征。方法收集行肾脏活检的高龄(81～91岁)肾病患者(高龄组,85例)和60～61岁患者(对照组,1542例)的相关资料,分析两组肾脏活检的疾病指征和病理诊断分布。结果高龄组患者中,肾病综合征(NS)是肾活检最常见的疾病指征,占65.9%,其次是NS合并急性肾损伤(AKI),占16.5%。与对照组相比,高龄组患者NS合并AKI作为肾活检临床指征的较为常见(16.9%vs.4.4%)(P<0.05),但以蛋白尿为肾活检的较少(6.0%vs.21.6%)(P<0.05)。高龄组肾脏病理分布:NS患者主要病理改变为膜性肾病(63%),其次是微小病变肾病(11.1%)和淀粉样肾病(9.3%)。在NS合并AKI患者,最常见的病理改变为微小病变肾病,其次为局灶性节段性肾小球硬化(FSGS)。膜性肾病和肾淀粉样变的临床表现多为NS,微小病变和FSGS的临床表现多见NS或伴AKI。高龄组和对照组患者膜性肾病都是最常见的病理诊断,其次是微小病变肾病。高龄组IgA肾病发生率低于对照组(2.4%vs.12.2%)(P<0.01)。结论高龄肾病患者肾活检的最常见疾病指征是NS,病理诊断是膜性肾病。
Objective To analyze the clinicopathological features of renal biopsy in very elderly patients with nephropathy.Methods The data of Chinese patients with nephropathy who underwent renal biopsy were collected in 85 patients aged from 80 to 91 years old(group A) and 1542 patients aged from 60 to 61 years old(group B).The disease features of renal biopsy were analyzed and compared between two groups.Results Nephrotic syndrome(NS) in group A was the most common clinical indication for renal biopsy,which accounded for 65.9%.NS combined with acute renal injury(AKI) was the second common disease indication of renal biopsy in group A,which accounded for 16.5%.Compared to group B,in group A the percentage of patients taking NS combined with AKI as disease indication for renal biopsy was more(16.9% vs.4.4%)(P<0.05) and that of albuminuria was less(6.0% vs.21.6%)(P<0.05).The renal pathological distribution in group A was in an order of membranous nephropathy(63%) >minimal lesion nephropathy(MCN)(11.1%) >amyloid nephropathy(9.3%).In the patients with NS combined with AKI in group A,the most common pathological change was MCN and focal segmental glomerulosclerosis(FSGS) was the second one.The clinical manifestation in most patients with membranous nephropathy and amyloid nephropathy was NS and that in those with MCN and FSGS was NS or NS combined with AKI.Membranous nephropathy was the most common pathologic diagnosis and MCN was the second one in both groups.The incidence of IgA nephropathy was lower in group A than that in group B(2.4% vs.12.2%)(P<0.01).Conclusion In very elderly patients with nephropathy,the most disease indication for renal biopsy is NS and most common pathological diagnosis is membranous nephropathy.
Objective To analyze the clinicopathological features of renal biopsy in very elderly patients with nephropathy.Methods The data of Chinese patients with nephropathy who underwent renal biopsy were collected in 85 patients aged from 80 to 91 years old(group A) and 1542 patients aged from 60 to 61 years old(group B).The disease features of renal biopsy were analyzed and compared between two groups.Results Nephrotic syndrome(NS) in group A was the most common clinical indication for renal biopsy,which accounded for 65.9%.NS combined with acute renal injury(AKI) was the second common disease indication of renal biopsy in group A,which accounded for 16.5%.Compared to group B,in group A the percentage of patients taking NS combined with AKI as disease indication for renal biopsy was more(16.9% vs.4.4%)(P<0.05) and that of albuminuria was less(6.0% vs.21.6%)(P<0.05).The renal pathological distribution in group A was in an order of membranous nephropathy(63%) >minimal lesion nephropathy(MCN)(11.1%) >amyloid nephropathy(9.3%).In the patients with NS combined with AKI in group A,the most common pathological change was MCN and focal segmental glomerulosclerosis(FSGS) was the second one.The clinical manifestation in most patients with membranous nephropathy and amyloid nephropathy was NS and that in those with MCN and FSGS was NS or NS combined with AKI.Membranous nephropathy was the most common pathologic diagnosis and MCN was the second one in both groups.The incidence of IgA nephropathy was lower in group A than that in group B(2.4% vs.12.2%)(P<0.01).Conclusion In very elderly patients with nephropathy,the most disease indication for renal biopsy is NS and most common pathological diagnosis is membranous nephropathy.
引文
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[4] Ribstein J,Du Cailar G,Mimran A.Glucose tolerance and age-associated decline in renal function of hypertensive patients[J].J Hypertens,2001,19(12):2257-2264.
[5] Baggio B,Budakovic A,Perissinotto E,et al.Atherosclerotic risk factors and renal function in the elderly:the role of hyperfibrinogenaemia and smoking.Results from the Italian Longitudinal Study on Ageing(ILSA)[J].Nephrol Dial Transplant,2005,20(1):114-123.
[6] Stevens LA,Li SY,Wang CC,et al.Prevalence of CKD and comorbid illness in elderly patients in the United States:Results From the Kidney Early Evaluation Program (KEEP)[J].Am J Kidney Dis,2010,55(3):S23-S33.
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[8] Komatsuda A,Nakamoto Y,Imai H,et al.Kidney diseases among the elderly-a clinicopathological analysis of 247 elderly patients[J].Intern Med,1993,32(5):377-381.
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[11] Bomback AS,Herlitz LC,Markowitz GS.Renal biopsy in the elderly and very elderly:useful or not[J]?Adv Chronic Kidney Dis,2012,19(2):61-67.
[12] Nair R,Bell JM,Walker PD.Renal biopsy in patients aged 80 years and older[J].Am J Kidney Dis,2004,44(4):618-626.
[13] Moutzouris DA,Herlitz L,Appel GB,et al.Renal biopsy in the very elderly[J].Clin J Am Soc Nephrol,2009,4(6):1073-1082.
[14] Verde E,Quiroga B,Rivera F,et al.Renal biopsy in very elderly patients:data from the Spanish Registry of Glomerulonephritis[J].Am J Nephrol,2012,35(3):230-237.
[15] Yokoyama H,Sugiyama H,Sato H,et al.Renal disease in the elderly and the very elderly Japanese:analysis of the Japan Renal Biopsy Registry (J-RBR)[J].Clin Exp Nephrol,2012,16(6):903-920.
[16] Biteker M,Dayan A,Tekkesin AI,et al.Incidence,risk factors,and outcomes of perioperative acute kidney injury in noncardiac and nonvascular surgery[J].Am J Surg,2014,207(1):53-59.
[17] Kim M,Brady JE,LI G.Variations in the risk of acute kidney injury across intraabdominal surgery procedures[J].Anesth Analg,2014,119(5):1121-1132.
[18] Macias-Nunez JF,Lopez-Novoa JM,Martinez-Maldonado M.Acute renal failure in the aged[J].Semin Nephrol,1996,16(4):330-338.
[19] Liaňo F,Pascual J.Epidemiology of acute renal failure:a prospective,multicenter,community-based study.Madrid Acute Renal Failure Study Group[J].Kidney Int,1996,50(3):811-818.
[20] Dondaio JV,Grande JP.IgA Nephropathy[J].N Engl J Med,2002,347(10):738-748.
[2] Davison AM.Renal disease in the elderly[J].Nephron,1998,80(1):6-16.
[3] Fliser D,Franek E,Joest M,et al.Renal function in the elderly:impact of hypertension and cardiac function[J].Kidney Int,1997,51(4):1196-1204.
[4] Ribstein J,Du Cailar G,Mimran A.Glucose tolerance and age-associated decline in renal function of hypertensive patients[J].J Hypertens,2001,19(12):2257-2264.
[5] Baggio B,Budakovic A,Perissinotto E,et al.Atherosclerotic risk factors and renal function in the elderly:the role of hyperfibrinogenaemia and smoking.Results from the Italian Longitudinal Study on Ageing(ILSA)[J].Nephrol Dial Transplant,2005,20(1):114-123.
[6] Stevens LA,Li SY,Wang CC,et al.Prevalence of CKD and comorbid illness in elderly patients in the United States:Results From the Kidney Early Evaluation Program (KEEP)[J].Am J Kidney Dis,2010,55(3):S23-S33.
[7] Uezono S,Hara S,Sato Y,et al.Renal biopsy in elderly patients:a clinicopathological analysis[J].Ren Fail,2006,28(7):549-555.
[8] Komatsuda A,Nakamoto Y,Imai H,et al.Kidney diseases among the elderly-a clinicopathological analysis of 247 elderly patients[J].Intern Med,1993,32(5):377-381.
[9] Ozono Y,Harada T,Yamaguchi K,et al.Nephrotic syndrome in the elderly--clinicopathological study[J].Nihon Jinzo Gakkai Shi,1994,36(1):44-50.
[10] Ishimoto F,Shibasaki T,Nakano M,et al.Nephrotic syndrome in the elderly-a clinicopathological study(author's transl)[J].Nihon Jinzo Gakkai Shi,1981,23(10):1251-1261.
[11] Bomback AS,Herlitz LC,Markowitz GS.Renal biopsy in the elderly and very elderly:useful or not[J]?Adv Chronic Kidney Dis,2012,19(2):61-67.
[12] Nair R,Bell JM,Walker PD.Renal biopsy in patients aged 80 years and older[J].Am J Kidney Dis,2004,44(4):618-626.
[13] Moutzouris DA,Herlitz L,Appel GB,et al.Renal biopsy in the very elderly[J].Clin J Am Soc Nephrol,2009,4(6):1073-1082.
[14] Verde E,Quiroga B,Rivera F,et al.Renal biopsy in very elderly patients:data from the Spanish Registry of Glomerulonephritis[J].Am J Nephrol,2012,35(3):230-237.
[15] Yokoyama H,Sugiyama H,Sato H,et al.Renal disease in the elderly and the very elderly Japanese:analysis of the Japan Renal Biopsy Registry (J-RBR)[J].Clin Exp Nephrol,2012,16(6):903-920.
[16] Biteker M,Dayan A,Tekkesin AI,et al.Incidence,risk factors,and outcomes of perioperative acute kidney injury in noncardiac and nonvascular surgery[J].Am J Surg,2014,207(1):53-59.
[17] Kim M,Brady JE,LI G.Variations in the risk of acute kidney injury across intraabdominal surgery procedures[J].Anesth Analg,2014,119(5):1121-1132.
[18] Macias-Nunez JF,Lopez-Novoa JM,Martinez-Maldonado M.Acute renal failure in the aged[J].Semin Nephrol,1996,16(4):330-338.
[19] Liaňo F,Pascual J.Epidemiology of acute renal failure:a prospective,multicenter,community-based study.Madrid Acute Renal Failure Study Group[J].Kidney Int,1996,50(3):811-818.
[20] Dondaio JV,Grande JP.IgA Nephropathy[J].N Engl J Med,2002,347(10):738-748.