老年人肾脏疾病的临床表现与病理特点分析

Clinical manifestations and pathological features of kidney diseases in elderly patients

目的分析肾脏疾病在老年人中的临床表现和病理特点。方法收集60岁以上老年肾脏病患者51例,对其临床表现及肾活检病理进行分析。结果 51例老年肾脏病患者中,原发性肾小球疾病33例,继发性肾脏疾病18例。临床表现为肾病综合征(NS)28例,肾炎综合征10例,慢性肾功能衰竭(CRF)5例,急性肾损伤(AKI)4例,肾病综合征合并急性肾损伤4例。老年原发性肾小球疾病最常见的病理类型为膜性肾病(17例),其次是Ig A肾病(5例),系膜增生性肾小球肾炎(4例)。在继发性肾脏疾病中,最常见的诊断是乙型肝炎病毒相关性肾炎(4例),其次为ANCA相关性血管炎肾损害和肾淀粉样变(各3例)。结论老年原发性肾小球疾病多见,且以膜性肾病为主。老年继发性肾脏病以乙型肝炎病毒相关性肾炎、血管炎肾损害和肾淀粉样变多见。肾病综合征是老年肾脏病患者最常见的肾活检适应证。对病因不明的老年肾脏病患者,应及早行肾脏病理活检,有助于明确诊断及治疗。

Objective To analyze the clinical manifestations and pathological characters of kidney diseases in elderly patients. Methods We collected 51 kidney disease patients more than 60 years old in our hospital from January 2011 to December 2014 and analyzed their clinical manifestations and pathological characters. Results All of the 51 cases with kidney diseases were diagnosed by renal biopsy,of whom 33 cases suffered from primary glomerular disease. The most common indication for renal biopsy was nephrotic syndrome（ 54. 90%）,followed by nephritic syndrome（ 19. 61%） and chronic kidney injury（ 9. 80%）. The most common renal histopathology in primary glomerular disease was idiopathic membranous nephropathy（ 51. 52%）,followed by Ig A nephropathy（ 15. 15%） and mesangioproliferative glomerulonephritis（ 12. 12%）. HBV-related glomerulonephritis（ HBV-GN 22. 22%） was the most common secondary kidney disease,followed by ANCA-associated vasculitis（ 16. 67%）,and amyloidosis（ 16. 67%）.Conclusion Primary glomerular disease is the most common renal disease in elderly patients. Membranous nephropathy and HBV-related glomerulonephritis are the most common primary renal disease and the secondary renal disease,respectively. Nephrotic syndrome is the major clinical indication of renal biopsy in the elderly.