老年患者肾活检病理诊断10年回顾

Renal pathology of elderly patients with renal biopsy： a retrospective analysis in a single unit

目的 研究老年肾脏病患者近10年肾活检病理特点.方法 回顾性分析2005年11月至2015年11月在本院接受肾活检的408例老年患者的临床及病理资料.按照肾活检时间分为A组（2005年11月至2010年10月接受肾活检的患者）和B组（2010年11月至2015年11月接受肾活检的患者）,比较两组的病理构成及变化.结果 患者主要临床诊断为肾病综合征（61.8％）及慢性肾炎综合征（29.4％）,近5年因急性肾功能不全接受肾活检比例减少（P＜0.001）.原发性肾小球疾病占67.4％（275/408）,继发性肾小球疾病占26.0％（106/408）,两种肾病并存占3.2％ （13/408）,小管间质疾病占2.2％（9/408）,小管间质疾病近5年比例减少（P＜0.05）.原发性肾小球病以膜性肾病（60.0％）及IgA（13.5％）肾病为主;继发性肾小球病以乙肝相关性肾炎（14.2％）、系统性血管炎肾损害（14.2％）为主;广东籍人群继发性肾小球病以乙肝相关性肾炎为主（15.6％）;乙肝相关性肾炎近5年高于前5年（P＜0.05）.结论 肾活检老年人群病理谱原发性肾小球疾病占多数,原发性肾小球疾病以膜性肾病为主,继发性肾小球病以乙肝相关性肾炎为主.近5年因急性肾功能不全接受肾活检比例减少,可能是导致小管间质疾病诊断率降低的原因,应重视急性肾功能不全患者的肾活检;肾活检标本常规行乙肝抗原检测后诊断比例明显上升,为避免漏诊建议肾活检标本常规行乙肝抗原检测.

Objective To explore the pathological characteristics of elderly patients with renal biopsy in recent ten years.Methods Clinical and pathological data were analyzed in 408 elderly patients undergoing renal biopsy in the hospital between November 2005 and November 2015.According to the time of receiving renal biopsy,the patients were divided into two groups：group A （patients receiving biopsy between November 2005 and October 2010） and group B （patients receiving biopsy between November 2010 and November 2015）.Results The main clinical presentation was nephrotic syndrome （61.8％） and chronic nephritis syndrome （29.4％）.Compared with the patients from 2005 to 2010,the proportion of renal biopsy due to acute renal failure was decreased in recent 5 years （P ＜0.001）.Patients with primary glomerular disease were 67.4％ （275/408）,while secondary glomerular diseases were 26.0％ （106/408）.Patients with tubulo-interstitial disease accounted for 2.2％ （9/408） and patients incorporated with two renal diseases were 3.2％ （13/408）.The diagnosis rate of tubulo-interstitial disease was significantly decrease in group B （P ＜ 0.05）.In patients with primary glomerular diseases,membranous nephropathy was the most common pathologic category which accounting for 60.0％ followed by IgA nephropathy which accounting for 13.5％.Meanwhile,in patients with secondary glomerular diseases,the major pathological types were hepatitis B virus-associated glomerulonephritis （14.2％）,systemic vasculltis-associated glomerulonephritis （14.2％）,respectively.The diagnosis rate of hepatitis B virus-associated glomerulonephritis in the patients from Guangdong was significantly higher in group B （P ＜ 0.05）.Conclusions Primary glomerular disease is the most common renal disease in elderly patients with renal biopsy.The major pathologic category of primary glomerular diseases is membranous nephropathy,while the major pathologic type of secoudary glomerular disease is hepatitis B virus-associated glomerulonephritis.The diagnosing rate of tubule-interstitial disease is significantly decrease in recent 5 years which accounting for the decreasing of patients who undergoing renal biopsy due to acute renal failure.Clinicians should pay more attention to receive renal biopsy in patients with acute renal failure.The diagnosing rate of hepatitis B virus-associated glomerulonephritis is significantly higher followed by the routine detection of hepatitis -B antigen in renal biopsy.It suggests that routine detection of hepatitis-B antigen in renal biopsy will be benefit to diagnose.