Introduction:
As the life expectancy is increasing, there is a rise in elderly population and consequent increase in patients with renal disease.Elderly patients with comorbidities also get renal biopsy safely under USG guidance.Here we tried to compare the renohistopathological spectrum of biopsy proven kidney diseases in our elderly population(Age<60 years) with the younger population(Age 18-59 years).Understanding the impact of age on renal pathology is crucial in optimising treatment strategies.
Methods:
This was a single centre ,retrospective,observational study done at kauvery hospital, alwarpet,chennai,India.All the native kidney biopsies of elderly patients ( >60 years of age) from January 2015-July 2024 were included in the analysis and data were compared with the younger(18 -59 years) population.Test for statistical significance used is z- test to identify the difference between two proportions.P <0.05 is considered statistically significant.
Results:
A total of 300 native kidney biopsies were performed during this study period.Out of these 200 young and 72 elderly were included in this study.Among elderly,Majority of patients were Male(n=52) and mean age 69.
In elderly,the various indications for performing renal biopsy were nephrotic syndrome 35%,acute nephritic syndrome 25%, AKI in 25% and rapidly progressive renal failure 5%,unexplained azotaemia in 10%.
Primary glomerular disease in 36.11%(n=26)which included Membranous nephropathy in 46.15% ,Focal segmental glomerulosclerosis in 26.92% ,IgA nephropathy 11.5%,minimal change disease in 7.6% and membranoproliferative glomerulonephritis in 7.6% in each.
Secondary glomerulonephritis in 40.2%(n=29)which included infection related glomerulonephritis in41.3% ,diabetic nephropathy in 31%,pauci immune vasculitis in 13.7%,amyloidosis in10.3%,anti-GBM disease in 3%.
Tubulointerstitial pathology in 23.6%(n=17)which included Acute tubular injury in 47%,ATI with myoglobin casts in 17.6%,acute interstitial nephritis in 23.5% and acute pyelonephritis in 11.7%.
Membranous nephropathy(46.4%) is the most common primary glomerular disease and most common cause of nephrotic syndrome.Infection related glomerulonephritis(41.4%) is the most common secondary glomerular disease and the most common cause of acute nephritic syndrome.
Comparison with young adult patients:
Table 1.Distribution of biopsy proven renal disease in the elderly and the young
Table 2.Distribution of primary glomerular diseases in the elderly and the young
MN-Membranous nephropathy, FSGS-Focal segmental glomerulosclerosis, MCD-Minimal Change Disease, MPGN- Membranoproliferative Glomerulonephritis
Table 3.Distribution of secondary glomerular diseases in the elderly and the young
IRGN-Infection Related Glomerulonephritis,DN-Diabetic Nephropthy,ANCA-Anti-neutrophil Cytoplasmic Antibody,LCDD-Light Chain Deposition Disease,GBM-Glomerular Basement Membrane
Our study showed the distribution of Glomerular diseases were not significantly lesser in elderly patients as compared to young adults(76.4% vs 82.5%, P=0.19). Prevalence of IgA nephropathy was significantly lower in elderly patients than in younger patients(P= 0.03),among secondary glomerular diseases IRGN is more prevalent in elderly(P < 0.01) .Kidney biopsies in the elderly revealed a significantly higher prevalence of tubulointerstitial pathology(23.6 vs 12.5, P=0.03).Primary vascular pathology was not seen in elderly patients.
Conclusions:
In our study, though overall prevalence of glomerulonephritis is not different between two groups ,IgA nephropathy is more common in younger patients and IRGN more common in elderly.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.