Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR).
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Yokoyama Hitoshi, Sugiyama Hitoshi, Sato Hiroshi, Taguchi Takashi, Nagata Michio, Matsuo Seiichi, Makino Hirofumi, Watanabe Tsuyoshi, Saito Takao, Kiyohara Yutaka, Nishi Shinichi, Iida Hiroyuki, Morozumi Kunio, Fukatsu Atsushi, Sasaki Tamaki, Tsuruya Kazuhiko, Kohda Yukimasa, Higuchi Makoto, Kiyomoto Hideyasu, Goto Shin, Hattori Motoshi, Hataya Hiroshi, Kagami Shoji, Yoshikawa Norishige, Fukasawa Yuichiro, Ueda Yoshihiko, Kitamura Hiroshi, Shimizu Akira, Oka Kazumasa, Nakagawa Naoki, Ito Takafumi, Uchida Shunya, Furuichi Kengo, Nakaya Izaya, Umemura Satoshi, Hiromura Keiju, Yoshimura Mitsuhiro, Hirawa Nobuhito, Shigematsu Takashi, Fukagawa Masafumi, Hiramatsu Makoto, Terada Yoshio, Uemura Osamu, Kawata Tetsuya, Matsunaga Akira, Kuroki Aki, Mori Yasukiyo, Mitsuiki Koji, Yoshida Haruyoshi, Committee for the Standardization of Renal Pathological Diagnosis and for Renal Biopsy and Disease Registry of the Japanese Society of Nephrology, and the Progressive Renal Disease Research of the Ministry of Health, Labour and Welfare of Japan
Аннотация
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: From July 2007 to November 2011, all of the elderly native renal biopsy patients who had been registered in the Japan Renal Biopsy Registry (J-RBR; 2802 including 1596 males and 1206 females) were identified. Their data were compared with a control group of 7416 patients who ranged in age from 20 to 64 years old and were registered on the J-RBR over the same period. In addition, the clinical and pathological classifications of 276 very elderly patients were also analyzed.
RESULTS: The indications for biopsy were nephrotic syndrome (NS) in 36.2 and 50.7 % of the elderly and the very elderly patients, chronic nephritic syndrome in 31.8 and 17.4 %, and acute kidney injury including rapidly progressive glomerulonephritis in 18.6 and 22.5 %, respectively. Primary glomerular disease was the most frequent diagnosis, followed by MPO-ANCA-positive nephritis, IgA nephropathy (IgAN), and diabetic nephropathy. In primary GN including IgAN, membranous nephropathy (MN) was the most frequent histological type, followed by IgAN and minor glomerular abnormalities. A comparison with the control group showed that MN, MPO-ANCA-positive nephritis, and amyloid nephropathy were more common in the elderly (P < 0.001), and IgAN was less common (P < 0.001). As for nephrotic syndrome in the elderly, MN was the most common histological type, followed by minimal change NS, diabetic nephropathy, amyloid nephropathy, and focal segmental glomerulosclerosis. There was a significant discrepancy between the urinary protein/creatinine ratio and daily proteinuria after the 7th decade of life.
CONCLUSIONS: Renal biopsy is a valuable diagnostic tool, even in elderly and very elderly Japanese patients. In the future, modified clinical guidelines for elderly renal disease should be developed.