Renal biopsy in patients over 75: 131 cases

Abstract

Introduction: Demographic analysis shows the ageing of the global population and the consequent increase in the age of hospitalized subjects and of patients starting dialysis. Hence, interest in the feasibility, safety, and usefulness of renal biopsy in elderly patients is growing. We examined the data of 131 patients over the age of 75 who underwent renal biopsy. We analyzed the safety of the procedure, treatment, and outcomes. Results: Histological diagnoses included: membranous glomerulonephritis (GN) 20.6%, crescentic GN 12.9%, IgAGN 10.6%, focal segmental glomerulosclerosis 9.1%, acute GN 4.5%, amyloidosis 9.1%, and acute tubular necrosis 3.8%. Mean glomerular obsolescence was 28.9 ± 27.9%. Mean age of the patients was 78.7 ± 5.73 years. At the time of biopsy, serum creatinine (SCr) was 4.47 ± 2.56 mg/dL and proteinuria was 4.82 ± 6.78 g/day. Targeted treatment was given to 51.9% of patients, 52.9% of whom had a good clinical response. Eight patients had clinically non-relevant side effects (11.7%). A positive response (defined as a more than 50% reduction of SCr, or by partial or complete remission of proteinuria) was observed in 36 patients (52.9%). 76 patients were monitored for 57 ± 9.89 months: 18 patients were on dialysis (follow-up 2.56 ± 3.61 months), 15 died (follow-up 58.5 ± 13.43 months), and 52 remained under nephrologic observation for 36 ± 31 months (SCr was 2.56 ± 0.75 mg/dL and proteinuria was 4.82 ± 6.78 g/day). Conclusion: In our experience, renal biopsy is safe even in very elderly patients; it allowed targeted treatment in 51.9% of patients, 52.9% of whom had a good clinical response, possibly contributing to prolonged patient survival and improved quality of life.

Elderly patients with glomerular diseases and IgA nephropathy

“…Studies in elderly patients in the United States showed similar findings of lacking significant increase in the procedurerelated complication rate, and in two-thirds of patients, treatment strategy was modified based on the biopsy findings. 4,5 Recent studies from Italy, 7 Spain, 18,19 Japan 20 and China 10,12 showed similar results of biopsy being valuable clinically for elderly patients.…”

“…Based on publications from 2000 to the present, the occurrence rates in patients >60 or 65 years of age were 8-10% in China, 10-12,29~4 -7% in the United States 4,5 and 5-7% in Europe. 8,9,30 However, when age cut-off was set at >75 or ≥80 years, the occurrence rate rose to the range of 7-10.6% in patients from Europe 7,19 and the United States, 4 similar to the rate in Asia, 14 suggesting an increased occurrence of IgA nephropathy in the very elderly across geographical and ethnic backgrounds. The pathogenesis of primary IgA nephropathy is detailed in recent reviews.…”

“…However, in patients who undergo kidney biopsy, due to variations in biopsy indication, local biopsy policy and practice style among institutions, the most common glomerular diseases in the elderly, based on the kidney biopsy, have been crescentic glomerulonephritis (GN) associated with ANCA‐mediated vasculitis . Similarly, in Europe, the top few kidney diseases from biopsy are crescentic GN, chronic GN, membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS) …”

“…4,5 Similarly, in Europe, the top few kidney diseases from biopsy are crescentic GN, chronic GN, membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS). [6][7][8][9] The kidney disease spectrum in the elderly based on the kidney biopsy varies between Europe/United States and Asia. A recent large single-centre study in China showed that about 3% (n = 851) of all biopsies (n = 29 425) in the years 2003-2012 were from patients ≥65 years of age.…”

Treatment of Rapidly Progressive Glomerulonephritis in the Elderly

“…Major side effects such as bleeding severe enough to require transfusion, vascular intervention, or nephrectomy are far rarer [11-14]. The few retrospective studies that have examined complication rates in the elderly (age >75 years) have reported low risk rates that do not differ from that of younger patients [15, 16]. One small prospective study comparing 26 patients >60 years of age with 184 younger subjects undergoing ultrasound-guided renal biopsy with a 16 gauge automated gun, reported a higher risk of gross hematuria post biopsy in the elderly group.…”