| As the population increase,aging has gradually become a prominent public health problem worldwide.China is also confronting the problem of population aging.The segment with the fastest growth rate comprises individuals aged?65 years.With life expectancy increases,the incidence and prevalence of chronic kidney disease(CKD)and of end-stage renal disease(ESRD)exhibit an increasing trend.Renal biopsy provides important diagnostic information in elderly patients.Several studies have analyzed renal disease in elderly and very elderly patients from Europe,the United States and Asia.However,such studies are few in number,with limited cohorts of patients with biopsy-proven renal disease in China.Thus,the present investigation aimed to examine the spectrum of biopsy-proven renal diseases and their respective clinical manifestations in a large group of Chinese elderly patients and the results obtained from this study will increase the knowledge of renal diseases in Chinese elderly patients.IgA nephropathy(lgAN)is the most common form of primary glomerular disease in China.IgAN may present at any age3 but there is a peak incidence in the second and fourth decades of lifes,with less commonly occurring in elderly population.However,as the elderly population and rate of renal biopsy increase,the prevalence of IgAN in the elderly present an increasing trend.However,few paper have been published specifically on the clinacopathologic characteristics and long-term renal survival and related risk factors of IgAN in elderly patients.Thus,the aim of this study was to investigate the clinicopathologic characteristics,long-term renal survival and related risk factors in the elderly patients with IgA nephropathy.Part One:The Spectrum of Biopsy-Proven Kidney Disease in Chinese Elderly PatientsObjective:Studies on biopsy-proven renal disease in the elderly(age?65 years)are extremely limited in China.The aim of this study was to examine the spectrum of renal diseases and their clinical presentations in elderly patients undergoing renal biopsy.Methods:All native renal biopsies(n?851)performed in patients aged>65 years from January 2003 to December 2012 were retrospectively analyzed.The results were compared with a control group of 28,574 patients aged 18-64 years undergoing renal biopsy over the same period.Results:These 851 patients included 549 males and 302 females.Primary glomerular diseases(53.94%)occurred more frequently thari secondary glomerular diseases(36.49%).The clinical manifestations were nephrotic syndrome(NS)in 29.49%of the patients,chronic renal failure(CRF)in 24.68%5 proteinuria and hematuria m 13.28%,proteinuria in 10.93%,acute kidney injury(AKI)in 10.81%and AKI and NS in 8.93%.Membranous nephropathy(MN)was the most frequent diagnosis(28.79%),followed by diabetic nephropathy(DN,9.75%),IgA nephropathy(IgAN,9.64%)and vasculitis(6.82%).Vhen compared with the control group,the results showed that MN(P<0.0001),DN(P<0.0001),vasculitis(P<0.0001)and amyloidosis(P<0.0001)occurred more frequently and IgAN(P<0.0001),lupus nephritis(LN,P<0.0001)and minimal change disease(MCD,P<0.0001)occurred less frequently in the elderly.Conclusions:This study is the first and largest renal biopsy series to analyze patients aged ?65 years in China,and the results obtained from this study may increase the knowledge of renal diseases in elderly patients.Part Two:Clinicopathologic Characteristics,Long-Term Renal Survival and Related Risk Factors of Elderly Patients with IgA NephropathyObjective:To investigate the clinicopathologic characteristics,long-term renal survival and related risk factors in the elderly patients with IgA nephropathy(IgAN).Methods:Eighty-two patients aged?65years(mean age 68.9 ± 2.9 years,male/female ratio 1.28:1)and 328 patients aged 18-64 years(control group,mean age 35.1 ± 9.0 years,male/female ratio 0.96:1)with IgAN undergoing renal biopsy in 2003-2012 were included.All patients' clinical record were retrospectively reviewed and biopsies were re-evaluated and scored according to the Oxford classification.The outcome were defined as last eGFR reduced>50%from eGFR at the time of renal biopsy or the patient had reached ESRD.Results:The elderly patients had a higher MAP(100 mmHg vs 94 mmHg,P=0.001),higher urine protein excretion(1.65 g/24h vs 1.18 g/24h,P=0.011),higher serum creatinine(104.8 mmol/L vs 83.1 mmol/L,P<0.0001),lower eGFR(55.3 ±24.8 ml/min/1.73m2 vs 89.2 ± 28.2 ml/min/1.73m2,P<0.0001),higher serum uric acid(425 mmol/L vs 383 mmol/L,P=0.012),higher total cholesterol(5.56 mmol/L vs 4.55 mmol/L,P<0.0001)at time of renal biopsy compared with the control group.There were no differences in triglyceride,serum albumin between these two groups,On histology,a higher percentage of global glomerulosclerosis(19.8 ± 18.3%vs 12.5±11.0%,P=0.001),higher incidence of segmental glomerulosclerosis(72.0%vs 28.0%,P<0.0001),higher incidence of tubular atrophy/interstitial fibrosis(39.0%vs 24.7%,P?0.009)and higher incidence of arteriosclerosis(81.7%vs 29.3%,P<0.0001)were presented in the elderly group.During follow-up,the 3 and 5-year cumulative renal survival rates,calculated by Kaplan.Meier method,were 89.6%and 73.4%,which were significantly lower than that in the control group(96.5%and 88.0%,P=0.0002).For the elderly patients,multivariate Cox regression analysis showed that initial urine protein excretion(HR 1.847;95%CI,1.154-2.995;P=0.011),eGFR(HR 0.926;95%Cl,0.877-0.987;P=0.006)and presence of tubular atrophy/interstitial fibrosis(HR 5.850;95%Cl,1.633-20.958;P=0.007)at the time of renal biopsy were independent predictor for renal outcome.Conclusions:Elderly patients with lgAN were more common to present with hypertension,nephrotic range proteinuria,renal dysfunction and severe chronic histologic lesions.Renal outcome was predicted by the level of urine protein excretion,eGFR and the presence of tubular atrophy/interstitial fibrosis at the time of renal biopsy.Thus,early diagnosis was crucial to improve outcomes. |
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