The global increase in life expectancy has translated to more elderly patients affected from renal disease. Several studies have analyzed renal biopsies in elderly patients (Moorthy AV - 1980 [1], Kingswood JC - 1984 [2], Ferro G - 2006 [3], Preston RA - 1990) [4], estabilishing 65 years or even 60 years as a cut-off. However the concept of old age has been changing in developed countries. To better define the histological presentation and to assess the real clinical utility of the histopathological evaluation in very elderly patients, the present study examines renal biopsies of a subgroup of older patients, namely those aged 70 years and over.
This is a retrospective study of all consecutive very elderly patients (age ≥ 70 years) biopsied at our Unit between 1st January 2000 and 31th December 2012. Data are extracted from renal biopsies database. No re-biopsies were included in our study.
Until 2004, no renal biopsy has been performed in elderly patients in our Unit. Between January 2005 and December 2012, a total of 106 native renal biopsies have been performed (Figure 1). Fifty-nine were men and forthy-seven were women (male-to-female ratio of 1.3). Mean age was 76 ± 4 years without significant difference gender-related. In 8/106 (7.5%) renal biopsy was not diagnostic. Primary glomerulonephritis were seen in 39/98 (39.8%) patients and secondary glomerulonephritis in 25/98 (25.5%). Membranous glomerulonephritis was the most common (21/98, 21%) and was significantly more frequent in males (M17: F4, p<0.05). Other common diagnoses included cast nephropathy (11/98, 11%) and amyloidosis (11/98, 11%) (Figure 2). Nephrotic syndrome was the most common clinical presentation (43%) followed by acute renal failure (30%). After biopsy, 48% received immunosuppressive therapy.
Renal biopsy, even in very elderly patients, provides us with useful information for an accurate histological diagnosis and, interestingly, end stage renal disease is not very common. In our experience, nephrotic syndrome is the main indication for renal biopsy, and membranous glomerulonephritis followed by mieloma-related kidney diseases are the most frequent histological patterns in patients aged over 70 years. Therefore, in elderly patients renal biopsy is still a useful tool and should be performed on an individual basis in order to improve prognosis by providing an accurate diagnosis and enabling specific treatment.
[1] Moorthy AV, Zimmerman SW Renal disease in the elderly: clinicopathologic analysis of renal disease in 115 elderly patients. Clinical nephrology 1980 Nov;14(5):223-9
[2] Kingswood JC, Banks RA, Tribe CR et al. Renal biopsy in the elderly: clinicopathological correlations in 143 patients. Clinical nephrology 1984 Oct;22(4):183-7
[3] Ferro G, Dattolo P, Nigrelli S et al. Clinical pathological correlates of renal biopsy in elderly patients. Clinical nephrology 2006 Apr;65(4):243-7
[4] Preston RA, Stemmer CL, Materson BJ et al. Renal biopsy in patients 65 years of age or older. An analysis of the results of 334 biopsies. Journal of the American Geriatrics Society 1990 Jun;38(6):669-74
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