老年肾病综合征的临床表现和病理类型分析

Nephrotic syndrome in the elderly:clinical and pathological analyses

目的 进一步了解老年肾病综合征的临床表现和病理特点。 方法 对北京协和医院 1980～ 1999年底住院老年肾病综合征病人进行临床表现和病理类型分析。 结果 住院成人肾病综合征病人共 5 13例 ,其中老年肾病综合征 61例 ,占 11 9%。原发病为原发性肾小球肾炎者 49例 ,占 80 3 % ,糖尿病肾病者 7例 ,占 11 5 %。临床表现以浮肿、血尿为主 ,贫血的发生率为 5 4 1% ,慢性肾功能不全 (CRF)为 3 2 8%。肾活检发现 ,在非糖尿病肾病中 ,系膜增殖性肾小球肾炎最常见 ,其次是局灶增殖性肾小球肾炎 ,并且肾间质纤维化比较多见 ( 15 /2 1)。老年肾病综合征病人用激素或激素加免疫抑制剂治疗的缓解率为 47 8% ,有效率为 3 0 4% ,未缓解率为 2 1 7%。一般激素或激素加免疫抑制剂效果较好 ,单用雷公藤多甙效果不如前者。合并感染者占 2 3 %。 结论 在肾病综合征病人中老年人所占比例并不高 ,其临床表现与年轻人的肾病综合征相似 ,但合并贫血、急性肾功能不全 (ARF)、CRF和感染的比例较高 ,最常见的病因是慢性肾小球肾炎 ,其病理类型以系膜增殖型肾小球肾炎最常见 ,其次是局灶增殖型肾小球肾炎。老年肾病综合征患者对激素或激素加免疫抑制剂治疗的反应尚可。

Objective To understand the nephrotic syndrome in the elderly. Methods clinical and pathological analyses were performed in 61 patients with nephrotic syndrome,whose ages were over 60 between the beginning of 1980 and the end of 1999 in PUMC hospital. Results 513 cases of nephrotic syndrome were diagnosed in an adult population,61(11 9%)of whom were older than 60 years at the first onset.Among them,49 cases (80 3%),had chronic glomerulonephitis 7 cases(11 5%) had diabetic nephropathy.The clinical features presented little difference from those of younger patients,although 54 1% of the patients manifested anemia,18% showed acute renal insufficiency and 32 8% displayed chronic renal insufficiency.Mesangial glomerulonephritis is the particularly common type in biopsy.Damage to the interstitium in the kidney was often observed.Steroid and immunosuppressive agent were effective,with the relief rate of 47 8%,the effective rate of 30 4% and the uneffective rate 21 7%. Conclusions The nephrotic syndrome in elderly patients is not common and the clinical features differ little from those of younger patients,although complicated anemia,inpotentially acute renal insufficiency and chronic renal insufficiency are more common than those in the young.The ratio of infection are higher than that in their younger counterparts.Chronic glomerulonephritis is the most common cause of the nephrotic syndrome in the elderly,mesangial glomerulonephritis is particularly common in pathological detection.Nephrotic syndrome in the elderly responded well to corticosteroids and immunosuppressive agents.