老年肾脏病152例临床与病理特点分析

Clinicopathologic characteristics of 152 cases of renal disease in elderly

目的了解老年肾脏病患者的临床表现及病理特点。方法回顾性分析152例经皮肾活检确诊的老年（≥60岁）肾脏病患者的临床表现和病理类型。结果肾活检患者中原发性肾小球疾病最为常见（114例，占75％），主要表现为。肾病综合征（53．51％）、慢性肾炎综合征（30．70％）、隐匿性肾炎（8．77％）、急进性肾炎综合征（4．39％）和急性肾炎综合征（2．63％）。病理改变主要为系膜增生（48．25％）、局灶性节段性肾小球硬化症（13．16％）、膜性肾病（11．40％）、新月体性肾炎（6．14％），轻微病变（6．14％）为主。继发性肾脏疾病占全部病例的25％，原发病以糖尿病肾病（28．95％）、急性肾小管坏死（23．68％）居多。以急性。肾衰竭为临床表现的23例患者的病理类型主要为急性肾小管坏死（39．13％）和新月体性肾炎（30．43％）。将本组患者与同期行肾活检的非老年组比较，在原发性肾脏病中，膜性肾病和新月体性。肾炎的检出率明显高于非老年组，而IgA肾病的检出率明显低于非老年组；继发性肾脏病患者中，本组以糖尿病肾病及急性肾小管坏死居多，而非老年组则以狼疮性肾炎（65．84％）和乙型肝炎病毒相关性肾炎（14．01％）居多。结论老年肾活检患者以原发性肾小球疾病最常见，肾病综合征是最常见的临床表现，病理改变则以系膜增生最为多见。

Objective To interstigate the clinieopathologci characteristics of senile patient with renal disease. Methods A retrospective analysis of 152 renal biopsies was performed. Results A diagnosis of primary glomerular disease was made in 75% of the cases （114 cases ）. Nephrotic syndrome （53.51% ）was the most frequent clinical presentation, chronic nephritic syndrome （30.70%） ranks the second, and then followed by asymptonatic urinary abnormalities（ 8.77% ）, rapidly progressive glomerulone phritis （4.39%）, acute nephritis syndrome （2.63 % ）. Mesangial proliferation was the most common pathological change（48.25% ）, followed by focal segmental glomerulosclerosis （ 13. 16% ）, membranous nephropathy（ 11.40% ）, cresentie nephritis （6.14%）, mininal changes （6.14%）. The secondly renal disease was noted in 25% , including diabetci nephropathy （ 28. 95% ） , acute tubular necrosis （ ATN, 23.68% ）. In patients resented with acute renal failur（23 cases） ,the most common histologcial types were ATN（39.13% ）, eresentic nephritis（30.43% ）. In primary renal diseases, the incidence of MN and eresentic nephritis were higher in senile patients than that less than 60 years of age, while that of IgAN was lower. In secondary renal disease, the incidence of diabetic nephropathy and ATN were prominent in the elderly patients, while lupus nephritis and hepatitis B virus associated glomerulouephritis were less encountered. Conclusion Primiary glomerular diaease predominates in senite patient,Nephrotic syndrome is the most common clinical diagnosis. Mesangial proloferation is the most common pathological pattems in senite patient with renal disease.