Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR)
Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR)
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DOI：
10.1007/s10157-012-0673-8
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发表时间：
2012-12-01
影响因子：
2.3
通讯作者：
Yoshida, Haruyoshi
中科院分区：
文献类型：
--
作者：
Yokoyama, Hitoshi;Sugiyama, Hitoshi;Yoshida, Haruyoshi
日本老年人（65岁时千分之一的年龄）和高龄老人（80岁时千分之一的年龄）肾病的数据极为有限。本研究的目的是探讨肾脏疾病的原因和他们的临床表现在老年患者接受肾活检。从2007年7月至2011年11月，所有在日本肾活检登记处（J-RBR； 2802例，其中男性1596例，女性1206例）登记的老年本地肾活检患者被确定。他们的数据与同期在J-RBR上登记的7416名年龄在20岁至64岁之间的对照组患者进行了比较。此外，对276例高龄患者的临床及病理分类进行了分析。活检指征为肾病综合征（NS）（36.2%）、慢性肾病综合征（31.8%）、急性肾损伤（18.6%）和急性进行性肾小球肾炎（22.5%），分别占50.7%和36.2%。原发性肾小球疾病是最常见的诊断，其次是mpo - anca阳性肾炎、IgA肾病（IgAN）和糖尿病肾病。包括IgAN在内的原发性GN中，膜性肾病（MN）是最常见的组织学类型，其次是IgAN和轻微的肾小球异常。与对照组比较，MN、mpo - anca阳性肾炎和淀粉样蛋白肾病在老年人中较常见（P < 0.001）， IgAN较少见（P < 0.001）。在老年肾病综合征中，MN是最常见的组织学类型，其次是微小变化NS、糖尿病肾病、淀粉样蛋白肾病和局灶节段性肾小球硬化。70岁后尿蛋白/肌酐比值和每日蛋白尿存在显著差异。肾活检是一种有价值的诊断工具，即使在老年人和高龄日本患者。在未来，修订临床指南的老年肾脏疾病应制定。
Data regarding renal disease in the elderly (age a parts per thousand yen65 years old) and very elderly (age a parts per thousand yen80 years old) Japanese are extremely limited. The aim of this study was to examine the causes of renal disease and their clinical presentations in elderly patients who underwent renal biopsy.From July 2007 to November 2011, all of the elderly native renal biopsy patients who had been registered in the Japan Renal Biopsy Registry (J-RBR; 2802 including 1596 males and 1206 females) were identified. Their data were compared with a control group of 7416 patients who ranged in age from 20 to 64 years old and were registered on the J-RBR over the same period. In addition, the clinical and pathological classifications of 276 very elderly patients were also analyzed.The indications for biopsy were nephrotic syndrome (NS) in 36.2 and 50.7 % of the elderly and the very elderly patients, chronic nephritic syndrome in 31.8 and 17.4 %, and acute kidney injury including rapidly progressive glomerulonephritis in 18.6 and 22.5 %, respectively. Primary glomerular disease was the most frequent diagnosis, followed by MPO-ANCA-positive nephritis, IgA nephropathy (IgAN), and diabetic nephropathy. In primary GN including IgAN, membranous nephropathy (MN) was the most frequent histological type, followed by IgAN and minor glomerular abnormalities. A comparison with the control group showed that MN, MPO-ANCA-positive nephritis, and amyloid nephropathy were more common in the elderly (P < 0.001), and IgAN was less common (P < 0.001). As for nephrotic syndrome in the elderly, MN was the most common histological type, followed by minimal change NS, diabetic nephropathy, amyloid nephropathy, and focal segmental glomerulosclerosis. There was a significant discrepancy between the urinary protein/creatinine ratio and daily proteinuria after the 7th decade of life.Renal biopsy is a valuable diagnostic tool, even in elderly and very elderly Japanese patients. In the future, modified clinical guidelines for elderly renal disease should be developed.