老年肾病患者肾活检病理特点的回顾性分析

A retrospective analysis of:Pathological features of renal biopsy in elderly patients

目的探讨单中心15年60岁及以上老年肾活检患者常见病理类型和疾病谱变迁。方法回顾性分析2005年1月至2019年12月在我院行经皮肾活检穿刺的418例老年患者(年龄≥60岁)的肾脏病理资料,与同期年龄<60岁的肾活检患者的病理资料进行比较。根据肾活检时间分为2005~2009年、2010~2014年、2015~2019年三个时间段。结果(1)1572例资料完整的肾活检患者中,老年组患者为418例(26.6%),年龄67.8±5.7(60~85)岁;非老年组1154例(73.4%),年龄39.6±12.5(9~59)岁。三个时间段肾活检患者中老年组比例呈升高趋势(19.0%,23.2%,34.4%,χ^2=35.8,P<0.01);(2)老年组原发性肾小球疾病275例,占65.8%,最常见的病理类型为膜性肾病(57.1%),其次是IgA肾病(17.8%)和微小病变肾病(11.6%);非老年组最常见病理类型是IgA肾病(47.7%),其次是膜性肾病(28.2%)和微小病变肾病(10.7%);(3)老年组中继发性肾小球疾病中比例最高的是糖尿病肾病(26.7%),其次是抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(21.7%)和缺血性肾病(15.8%);老年组与非老年组比较,ANCA相关性血管炎(21.7%比4.5%,χ^2=25.781,P<0.001)、肾淀粉样变性(6.7%比2.1%,χ^2=4.942,P=0.026)比例增高;(4)老年组肾小管间质疾病中急性肾小管坏死占9.1%,急性/亚急性肾小管间质肾炎占27.3%,慢性肾小管间质肾炎疾病占54.5%,IgG4相关间质肾炎占9.1%,其疾病构成与非老年组相比差异无统计学意义(P>0.05);(5)随着时间变迁,三个时间段老年组肾活检例数增长明显的原发性肾小疾病病理类型有膜性肾病(32例、50例和75例)、微小病变肾病(5例、9例和18例)、IgA肾病(9例、10例和30例),继发性肾小球疾病有糖尿病肾病(4例、8例和20例)、缺血性肾病(1例、2例和13例)、ANCA相关性血管炎(4例、6例和16例),而非老年组中增长明显的原发和继发性肾小球疾病为膜性肾病(60例、78例和104例)和糖尿病肾病(7例、9例和30例)、缺血性肾病(2例、4例和19例)、狼疮性肾炎(15例、13例和26例)。结论老年肾活检患者所占比例增长明显,且病理类型的构成与非老年患者有所不同。原发性肾小球疾病仍是老年肾病患者的主要病理类型,其中最常见的是膜性肾病,其次是IgA肾病和微小病变肾病;继发性肾小球疾病最常见的是糖尿病肾病,其次是ANCA相关性血管炎和缺血性肾病。

Objective To investigate changes in common pathological types and disease spectrum in elderly patients undergoing renal biopsy in a single center over a 15-year period.Methods Renal pathological data of 418 elderly patients(aged 60 years)undergone percutaneous renal biopsy in our hospital from January 2005 to December 2019 were retrospectively analyzed and compared with those of patients aged<60 years during the same period.According to the time of kidney biopsy,patients were divided into three periods:2005-2009,2010-2014 and 2015-2019.Results Among the 1572 patients with complete renal biopsy data,418(26.6%)were in the elderly group,with an average age of 67.8±5.7(60-85)years,and 1154(73.4%)were in the non-elderly group,with an average age of 39.6±12.5(9-59)years.There was an trend of increasing proportions represented by elderly patients receiving renal biopsy over the three periods(19.0%,23.2%vs.34.4%,χ^2=35.8,P<0.01).There were 275 cases of primary glomerular disease in the elderly group,accounting for 65.8%.The most common pathological type was membranous nephropathy(57.1%),followed by IgA nephropalhy(17.8%)and minimal change disease(11.6%).IgA nephropathy(47.7%)was the most common pathological type in the non-elderly group,followed by IMN(28.2%)and minimal change discase(10.7%).Diabetic nephropathy(26.7%)was the most common secondary glomerular disease in the elderly group,followed by ANCA-associated vasculitis(21.7%)and ischemic renal disease(15.8%).Compared with the non-elderly group,the elderly group showed higher proportions of ANCA-associated vasculitis(21.7%vs.4.5%,χ^2=25.781,P<0.001)and renal amyloidosis(6.7%vs.2.1%,χ^2=4.942,P=0.026).In the elderly group,acute tubular necrosis accounted for 9.1%,acute/subacute tubulointerstitial nephritis accounted for 27.3%,chronic tubulointerstitial nephritis accounted for 54.5%,and IgG4-rclatcd interstitial nephritis accounted for 9.1%,with no significant difference in disease composition compared with the non-elderly group(P>0.05).Over the periods,there was a clear increase in primary glomerular diseases,including membranous nephropathy(32,50 and 75 cases),minimal change disease(5,9 and 18 cases)and IgA nephropathy(9,10 and 30 cases),and in secondary glomerular diseases,including diabetic nephropathy(4,8 and 20 cases),ischemic renal disease(1,2 and 13 cases)and ANCA-associated vascuhtis(4,6 and 16 cases),in the elderly group.The primary and secondary glomerular diseases that increased significantly in the non-elderly group were membranous nephropathy(60,78 and 104 cases),diabetic nephropathy(7,9 and 30 cases),ischemic renal disease(1,4 and 19 cases),and lupus nephritis(15,13 and 26 cases).Conclusions The elderly as a proportion of patients undergoing renal biopsy increase significantly,and the composition of pathological types is different from that of non-elderly patients.Primary glomerular diseases are still the main pathological type for elderly patients with kidney disease,with membranous nephropathy as the most common disease,followed by IgA nephropathy and minimal change disease.The most common secondary glomerular disease is diabetic nephropathy,followed by ANCA-associated vasculitis and ischemic renal disease.