Renal Biopsy in the Very Elderly

Abstract

Background and objectives: Data regarding renal biopsy in the very elderly (>age 80 yr) are extremely limited. The aim of this study was to examine the causes of renal disease and their clinical presentations in very elderly patients who underwent native renal biopsy.Design, setting, participants, & measurements: All native renal biopsies (n ‫؍‬ 235 including 106 men, 129 women) performed in patients aged >80 yr over a 3.67-yr period were retrospectively identified. Results were compared with a control group of 264 patients aged 60 to 61 who were biopsied over the same period.Results: The indications for biopsy were acute kidney injury (AKI) in 46.4%, chronic-progressive kidney injury in 23.8%, nephrotic syndrome (NS) in 13.2%, NS with AKI in 9.4%, and isolated proteinuria in 5.5%. Pauci-immune GN was the most frequent diagnosis (19%), followed by focal segmental glomerulosclerosis secondary to hypertension (7.6%), hypertensive nephrosclerosis (7.1%), IgA nephropathy (7.1%) and membranous nephropathy (7.1%). Comparison with the control group showed pauci-immune GN to be more frequent (P < 0.001) and diabetic glomerulosclerosis (P < 0.001) and membranous nephropathy (P < 0.05) less frequent in the very elderly. Diagnostic information had the potential to modify treatment in 67% of biopsies from the very elderly, particularly in those with AKI or NS.Conclusions: Renal biopsy in very elderly patients is a valuable diagnostic tool that should be offered in clinical settings with maximal potential benefit. Advanced age per se should no longer be considered a contraindication to renal biopsy.

Doenças renais em pacientes idosos submetidos à biópsia percutânea de rins nativos

“…9 Even in the very elderly, the indications for biopsy have also varied, because, as previously reported, the major indications for biopsy were AKF (46.4%), progressive chronic kidney disease (23.8%), nephrotic syndrome (13.2%), and association of AKF and nephrotic syndrome (9.4%). 10 In the present study, considering the patients with nephrotic syndrome, renal biopsy most frequently established the diagnosis of membranous nephropathy (almost 50% of the patients), followed by amyloidosis and focal segmental glomerulosclerosis and other glomerulopathies. In another study with elderly patients and nephrotic syndrome, primary membranous nephropathy was also the most frequent finding (40.8% of the patients), followed by minimal change disease (25%) and others; however, no patient with secondary membranous nephropathy has been reported.…”

“…9 However, that finding is not constant, because, in another study with patients over the age of 80 years, membranous nephropathy was the most frequent glomerulopathy, followed by amyloidosis (18%) and minimal change disease (16%). 10 It is worth noting that, in this study sample, two out of the 17 patients with membranous nephropathy, two out of the five patients with amyloidosis, and one unspecific glomerulopathy were well characterized as secondary. The greater frequency of secondary glomerulopathies in the elderly population has long been known.…”

“…The knowledge about the distribution of kidney diseases manifesting only as asymptomatic hematuria or proteinuria is even lower because renal biopsy is less indicated in such situations, because of the supposition that the disease has a benign behavior and no defined treatment. In another study, the indication of biopsy due to isolated hematuria or proteinuria has occurred in only two patients, diagnosed as having membranous nephropathy and amyloidosis, respectively 10 . In an additional study, the authors emphasized that no patient with that clinical manifestation was included.…”

“…In fact, several of those patients already had reduced levels of glomerular filtration rate, suggesting the presence of installed chronic kidney disease. In a previously published study, progressive chronic kidney injury in the elderly was the cause of biopsy in 23.8% of the patients 10 and the diagnoses were also extremely varied. The knowledge about the distribution of kidney diseases manifesting only as asymptomatic hematuria or proteinuria is even lower because renal biopsy is less indicated in such situations, because of the supposition that the disease has a benign behavior and no defined treatment.…”

“…One study with very elderly patients has shown that of eight patients with minimal change disease, five had AKI associated 10 . Another study has reported that association in nine patients.…”