Abstract
BackgroundLonger life expectancy is associated with an increasing prevalence of kidney disease. Aging itself may cause renal damage, but the spectrum of kidney disorders that affect elderly patients is diverse. Few studies, mostly form US, Asia and West Europe found differences in the prevalence of some types of kidney diseases between elderly and younger patients based on renal biopsy findings, with varied proportion between glomerulopathies and arterionephrosclerosis as a dominant injury found. Here, for the first time in Eastern Europe we analyzed native kidney biopsy findings and their relationship to clinical characteristics at the time of biopsy in elderly individuals (aged ≥65) in comparison to younger adults (aged 18–64).MethodsBiopsy and clinical data from 352 patients aged ≥65 were retrospectively identified, analyzed and compared with a control group of 2214 individuals aged 18–64. All kidney biopsies studied were examined at Medical University of Warsaw in years 2009–14.ResultsIn elderly patients the leading indication for biopsy was nephrotic range proteinuria without hematuria (34.2%) and the most prevalent pathologic diagnoses were: membranous glomerulonephritis (MGN) (18.2%), focal segmental glomerulosclerosis (FSGS) (17.3%) amyloidosis (13.9%) and pauci immune glomerulonephritis (12.8%). Hypertension and age-related lesions very rarely were found an exclusive or dominant finding in a kidney biopsy (1.7%) and a cause of proteinuria (1.1%) in elderly individuals. There were 18.2% diabetics among elderly individuals, and as much as 75% of them had no morphologic signs of diabetic kidney disease in the renal biopsy. Amyloidosis, MGN, pauci immune GN, crescentic GN and light and/or heavy chain deposition disease (LCDD/HCDD) were more frequent whereas IgA nephropathy (IgAN), lupus nephritis (LN) and thin basement membrane disease (TBMD) were less common among elderly than in younger patients.ConclusionsProteinuria, a dominating manifestation in elderly patients subjected to kidney biopsy was most commonly related to glomerulopathies. The relatively high prevalence of potentially curative kidney diseases in elderly individuals implicates the importance of renal biopsy in these patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0410-8) contains supplementary material, which is available to authorized users.
Highlights
Longer life expectancy is associated with an increasing prevalence of kidney disease
Senescence is associated with an eGFR decline by approximately 0.8–1.7 ml/min per year, which limits renal function reserve and makes an individual more vulnerable to the influence of injurious factors, common in the elderly population, such as hypertension, cardiovascular disease, diabetes, and drugs nephrotoxicity [1, 2]
Among patients studied we identified 352 elderly individuals as well as a control group of 2214 patients aged 18–64 years
Summary
Longer life expectancy is associated with an increasing prevalence of kidney disease. Mostly form US, Asia and West Europe found differences in the prevalence of some types of kidney diseases between elderly and younger patients based on renal biopsy findings, with varied proportion between glomerulopathies and arterionephrosclerosis as a dominant injury found. Patients constitute the largest age group among all individuals with chronic kidney disease (CKD). The elderly are affected by the same types of kidney diseases as younger individuals, but their clinical course and morphological manifestation may be influenced by aging. The complexity of the background as well as clinical and morphological manifestations of kidney injury impede precise disease recognition, make it difficult to establish prognosis, and hinder proper treatment selection. Many nephrologists no longer consider older age as a contraindication to immunosuppressive treatment, which is in line with the growing number of kidney biopsies performed in elderly patients [4]
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