| Purpose:with the intensification aging of the population in our country, the elderly kidney disease consultation rate is higher and higher, but the elderly often has multiple system is damaged, condition is complex, So its diffcult to misdiagnose, for treatment and prognosis.Ultrasound guided percutaneous renal biopsy has been widely used and is the most valuable mean to diagnosis glomerular disease,This technique has important significance for guiding medication and prognosis, elderly kidney disease is increasing year by year, but for elderly kidney pathological report is less, and large sample study is rare, so this article collects and summarizes the data of 1656 cases of elderly kidney disease patients in our hospital within 2001 to 2014 in order to understand more. 1656 cases of the elderly renal biopsy data of epidemic features and the relationship between pathological and clinical characteristics in center of southern hebei.Methodology: Retrospective analysis the renal biopsy diagnosed with the clinic data and pathological features of 1656 patients who aged 60 or more within 2001~9~18 to 2014~4~30 in the second hospital of Hebei medical university,and the clinic data and pathological features input computer, use EXCEL and SPSS software to establish a database, and to compare the clinical and pathological with the other group which contains 12750 cases mostly between the ages of 18 to 60 years old people comparing study, also use EXCEL software were analyzed with SPSS13.0 software processing.Results:1 These 1656 patients include 1023(61.78%) males and 633(38.22%) females. the male to female ratio is 1.62:1(range 60~87 years), mean age 66.18±4.37(68~87)years,males preponderance most kidney disease besides interstitial nephritis, LN, primary small vasculitis renal damage.2 Membranous nephropathy(MN) was the most common diagnosis(35.69%),followed by Ig A nephropathy(Ig AN,9.96%),minimal lesion(MCD,8.94%),diabetic nephropathy(DN, 8.82%), and hepatitis b virus associated nephritis(HBV-GN,7.10%).1656 cases of renal biopsy in elderly patients, membranous nephropathy is the common in all ages, especially in the group who are all more than 81~year~old. In the 60~≤65、>65~≤70,>70~≤75 age group,the top three are MN,Ig AN and MCD,HBV-GN in>75~≤80,81~year~old age group as the main secondary kidney disease, membranous nephropathy and Ig AN as the growthof the age its incidence has increased(P<0.05).3 The most common clinical syndrome is nephrotic syndrome(NS)(51.87%), followed by chronic glomerulonephritis(CGN)(31.40%) and acute kidney injury(AKI)(4.71%). elderly patients with pathological types varied, there are also vasculitis renal damage, gigantic globulin hematic disease and rheumatoid renal damage, etc. Membranous nephropathy(MN) was the most frequent diagnosis(56.19%) in NS,followed by MCD(16.73%), Amyloidsis(7.76%);he most common pathological type of CGN is MN, accounted for 37.17%, Ig AN, accounted for 23.89%, sclerosing glomerulonephritis(SCGN) accounted for 6.19%.Chronic renal failure(CRF) patients are with CIN, Ig AN, DN, SCGN majority.4 In 859 cases of elderly patients with NS, in which 686(79.86%) cases is primary NS,173(20.14%) cases is secondary NS, Membranous nephropathy(MN) was the most frequent diagnosis in primary NS(28.79%), followed by MCD 20.41% and FSGS(7.43%), secondary NS with hepatitis b virus associated nephritis was 81 cases, accounting for 46.82%, followed by 57 cases of amyloidosis, accounting for 32.95%, again for diabetic nephropathy, 12 cases, accounting for 6.94%.5 There are 1163(70.23%) cases of primary glomerular disease,392(23.67%) cases of secondary kidney disease and only 101(6.1%) cases of renal interstitial and tubules diseases,The most common primary glomerular disease is MN(50.82%), followed by MCD(12.73%) and Ig AN(14.19%);secondary kidney disease of 392 cases with HBV-GN see up to 29.85%, followed by DN 19.13 % and amyloidosis 18.2%.6 Within 1656 cases of elderly patients with 632 hypertension,(41.46%), with other major diseases such as diabetes, 296(85.05%) cases,(including the case of data errors), malignant tumors in 5 cases, 4 cases were cerebral thrombosis.7 Compared clinical and pathological data with the young adults in the same period,the young adults are still in the majority with male cases, male to female ratio is 1.10:1.The most common clinical types is NS(5538 cases, 43.44%), CGN(5153 cases, 40.42% and allergic purpura(508 cases, 3.98%). Pathology of membranous nephropathy(3239 cases, 25.40%), Ig A nephropathy(2756 cases, 21.62%) and glomerular small lesions(1681 cases, 13.18%) as the main pathological diagnosis. Kidney pathology in elderly and young adults is different, clinical and pathological compared to elderly all have significant difference(P<0.05). Elderly group and young adults group of MN has no significantly difference in proteinuria and DBP, but the elderly’s course of disease,serum creatinine and SBP is highter than young adults. Young adults of MCD patients of urinary protein,serum creatinine, systolic blood pressure and diastolic blood pressure are better than the elderly group, and have a longer average duration to elderly,There is no obvious difference in urinary protein, serum creatinine and DBP between elderly group and mature group in Ig AN,elderly group has longer duration and higher systolic blood pressure than young adults group.Conclusion:1 Among the 1656 cases of elderly patients,primary nephritic was the most important kidney disease in elderly. in the elderly of this area, the most common clinical manifestations is NS The elderly main pathological types in turn is MN. 2(1) There is no significant differences between the elderly group and the young in average time of the course of disease(P<0.05), average serum creatinine and SBP is higher than young who has MN.(2) Young adults group of patients with MCD average urinary protein, serum creatinine, SBP and DBP are better than the elderly group, and has a longer average duration(P<0.05).(3) Average urinary protein, serum creatinine and diastolic blood pressure in elderly group and young adults have no obvious difference in Ig AN, elderly group has long duration and SBP is higher than young group(P<0.05). |
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