Renal biopsy in very elderly patients (over 80 years): clinical presentation, histological diagnosis, and long-term outcome

Patterns of kidney diseases diagnosed by kidney biopsy and the impact of the COVID-19 pandemic in Yogyakarta, Indonesia: A single-center study

BACKGROUND

Glomerular diseases rank third among the causes of chronic kidney disease worldwide and in Indonesia, and its burden continues to increase, especially regarding the sociodemographic index. Kidney biopsy remains the gold standard for the diagnosis and classification of glomerular diseases. It is crucial for developing treatment plans, determining the degree of histologic changes, and identifying disease relapse.

AIM

To describe the patterns of biopsy-proven kidney diseases in adult patients.

METHODS

We retrospectively reviewed the demographic, histopathologic, clinical, and laboratory data of 75 adult patients with biopsy-proven kidney diseases at our institution recorded from 2017 to 2022.

RESULTS

Among the patients, 43 (57.3%) were females, and the mean age was 31.52 years ± 11.70 years. The most common histopathologies were lupus nephritis (LN) (33.3%), minimal change disease (MCD) (26.7%), and focal segmental glomerulosclerosis (10.7%). LN (41.7%) was frequently diagnosed in women and MCD (28.1%) in men. The most common cause of nephritic syndrome was LN (36.7%) and of nephrotic syndrome was MCD (40%).

CONCLUSION

Different kidney disease patterns were observed in different sexes, age categories, clinical syndromes, and biopsy dates relative to the coronavirus disease 2019 pandemic.

Kidney biopsy in very elderly patients: indications, therapeutic impact and complications

BACKGROUND

Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients.

METHODS

Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed.

RESULTS

104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months.

CONCLUSIONS

KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.

Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study

Purpose

To identify the clinical characteristics, histopathological features, and prognosis of kidney disease in a large cohort of elderly patients from Northeast China.

Methods

We retrospectively analyzed the renal disease spectrum in 7,122 patients who underwent renal biopsies at the Second Hospital of Jilin University from 2006 to 2020. Patients were grouped according to age: below 60 years (non-elderly group, n = 5923) and at least 60 years (elderly group, n = 1199). The clinical and pathological characteristics of renal biopsy patients in the groups were analyzed using the t-test and chi-square test.

Results

Compared with the non-elderly group, the elderly group had significantly fewer patients with primary glomerulonephritis, but more patients with tubulointerstitial disorders (p < .05). The incidence of IgA nephropathy, mesangial proliferative glomerulonephritis, and lupus nephritis was significantly lower in elderly patients than in non-elderly patients. The incidence of membranous nephropathy, membranoproliferative glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, systemic vasculitis-associated renal damage, and amyloid nephropathy was significantly higher in elderly patients than in non-elderly patients (p < .05). The incidence of perinephric hematoma (≥4 cm²) in elderly patients with renal biopsy was lower than that in non-elderly patients. We noted that 79.9% of primary glomerulonephritis patients who received immunosuppressive therapy showed a remission rate of 83.5%.

Conclusion

The spectrum of kidney disease in the elderly is different from that in the younger population.