Pathology And Clinical Analysis Of Elderly Patients With Biopsy

Objective:To understand the epidemiological characteristics of renal biopsy in elderly hospital patients, analyze the relationship between pathology and clinical characteristics of the elderly, master the characteristics of elderly patients with kidney disease, so as to provide some basis for the diagnosis,treatment prevention and epidemiological studies of kidney disease in the elderlyMethod:A retrospective analysis of pathological type distribution of148patients(age>60years) who had the renal biopsy in the the First Affiliated Hospital of Dalian Medical University from October2008to April2014, analyze the relationship between pathological type and age,gender, analysis the relationship between different pathological type of primary glomerulonephritis and clinical classification,hematuria, proteinuria, analyze the incidence of hypertension, anemia, gross hematuria and CA125, CA19-9positive in the elderly with primary glomerulonephritis between macroalbuminuria group and non-macroalbuminuria group.Results:1. Various types of renal pathologyPrimary glomerulonephritis (PGN) accounted for128cases (86.5%), secondary glomerulonephritis (SGN) accounted for18cases (12.2%),tubulointerstitial diseases accounted for two cases (1.3%) in148patients.The three most common pathology types of cases with PGN were membranous nephropathy (MN)(75/128,58.6%),mesangial proliferative glomerulonephritis (MsPGN)(21/128,16.4%), IgA nephropathy (IgAN)(20/128,15.6%), the rest were focal segmental glomerulosclerosis (FSGS)(5/128,3.9%), minimal change disease (MCD)(3/128,2.3%),mesangial proliferative glomerulonephr-itis (MPGN)(3/128,2.3%),sclerosing glomerulonephritis (ScGN)(1/128,0.8%). Diabetic nephropathy (6/128,33.3%) is the most common pathology type of SGN, followed by lupus nephritis (3/128,16.7%),allergic purpura (3/128,16.7%),amyloidosis (3/128,16.7%),hepatitis B virus associated glomerulonephritis (1/128,5.6%),thin basement membrane nephropathy(1/128,5.6%),microscopic polyangiitis (1/128,5.6%). Compare the proportion of PGN in elderly patients with renal biopsy and the proportion of MN in PGN of our hospital with other domestic literature, indicating the proportion of our hospital was higher than other domestic literature.2. The relationship between renal pathology and gender in the elderly148cases contain84male cases(56.8%), with an average age of64(61,68) years old,64female cases (43.2%), with an average age of63(61,66) years old,the sex ratio is1.3:1.128PGN cases contain73male cases (57.0%),55female cases (43.0%), the sex ratio was1.3:1.18SGN cases contain11male cases (61.1%) and7females cases(38.9%),the sex ratio was1.6:1.Two tubulointerstitial disease cases were both female. The gender constitution between PGN and SGN were the same.3. The age distribution of different renal pathology typeThe average age of148cases was64(61,67) years old, the average age of PGN cases was63(61,66) years old, the average age of SGN cases was67.5(64,71) years old. The number of PGN who’s age was less than70years old was110(85.9%), the number of PGN who’s age was more than70years old was18(14.1%). The number of SGN who’s age was less than70years old was11(61.1%), the number of PGN who’s age was more than70years old was7(38.9%). Comparing the distribution of PGN and SGN in the60-70years age group and the70-80years age group, indicating that although the majority was PGN in the two age groups, but the proportion of SGN in elderly patients in the70-80years age group was significantly higher than elderly patients in the60-70years age group.4. The relationship of PGN pathology types and clinical manifestationsThe most common clinical manifestations of128elderly PGN patients was nephrotic syndrome (68/128,53.1%), followed by nephritic syndrome (39cases/128,30.5%), asymptomatic urinary abnormalities (14/128,10.9%), chronic renal failure (6/128,4.7%), acute renal failure (1/128,0.8%). The common pathology type of nephrotic syndrome was MN, followed by MsPGN. The common pathology type of nephritic syndrome was IgAN, followed by MsPGN and MN.5.The relations of PGN pathology classification and hematuria or proteinuriaIn128PGN cases, the common urine abnormalities was macroalbuminuria (65/128,50.8%), followed by moderate proteinuria (45/128,35.2%), a small amount of proteinuria (16/128,12.5%), simple hematuria (2/128,1.6%).6. The relationship between anemia, hypertension, gross hematuria and macroalbuminuria in elderly PGN casesGender and age constitute were the same in the two groups of elderly PGN cases, the incidence of high blood pressure and anemia in the two groups were the same.Compared with the macroalbuminuria group,non-macroalbuminuria group was more likely to have gross hematuria.7. The relationship between CA125, CA19-9and macroalbuminuria in elderly PGN casesThe CA19-9positive rate in the two groups were the same,compared with non-macroalbuminuria group,the macroalbuminuria group was more likely to have elevated CA125assay values.Conclusion:l.The major renal pathology type of elderly patients with renal biopsy was PGN, the ratio of PGN in elderly patients with renal biopsy of our hospital was higher than other domestic literature. The gender constitute of PGN and SGN was the same, men are more common than women in glomerular diseases. The proportion of SGN in elderly patients in the70-80years age group was significantly higher than elderly patients in the60-70years age group, although the majority renal pathology type was PGN in the two age groups.2. The three most common pathology types of PGN cases were MN,MsPGN and IgAN.DN is the most common pathology type of SGN.The proportion of MN in PGN of our hospital was higher than other domestic literature. 3.The most common clinical manifestations of elderly PGN patients was nephrotic syndrome. The common pathology type of primary nephrotic syndrome was MN, followed by MsPGN.4. The common urine abnormalities in elderly PGN cases was macroalbuminuria, and moderate proteinuria, a small amount of proteinuria and simple hematuria was not so common.5. The incidence of high blood pressure,CA19-9positive and anemia in the macroalbuminuria group and non-macroalbuminuria group of elderly PGN cases were the same, non-macroalbuminuria group was more likely to have gross hematuria,the macroalbuminuria group was more likely to have elevated CA125assay values.