Renal Biopsy in the Very Elderly: Analysis of 833 Native Renal Biopsies
Sadhna Dhingra, Patrick D Walker, Rongzhen Zhang, Chris Larsen. UT-Health, Medical School, Houston, TX; Nephropath, Little Rock, AR
Background: Increase in longevity due to better quality of medical care has led to an increase in the demographic subset of the very elderly population (age ≥ 80 years). This has a great impact on health care expenditures. With respect to renal disease, initiation of dialysis in the elderly population leads to a sharp decline in functional status within the first year. Though there are some studies reporting the clinical presentation and cause of renal disease in this subgroup, numbers of patients have been limited. Our study delineates the clinicopathologic correlation and significance of renal biopsies in the largest cohort of very elderly patients reported to date.
Design: Our databank was searched for all native renal biopsies obtained during a 10-year period from 2001 to 2010 in patients aged 80 years or older. The biopsies were received from multiple medical centers across the United States and showed a fair representation of all nephrology practice settings such as small community practice groups to tertiary care referral centers. A total of 833 cases were included. Cases with lack of clinical information or limited biopsy tissue were excluded from the study.
Results: The mean age was 83 years (range 80 to >100) and the male to female ratio was 1:1. The most common indications for renal biopsy were acute kidney injury (AKI) (65%), chronic progressive injury (16%) and nephrotic syndrome (10%). The most common findings in cases biopsied for AKI were pauci-immune glomerulonephritis (22%), acute tubular necrosis (14%) and acute interstitial nephritis (12%). Among cases with AKI, 34% needed immediate therapeutic intervention and 20% required potential modification of treatment, based on biopsy results. Overall arterionephrosclerosis was the most frequent histological diagnosis (17%) followed by pauci-immune glomerulonephritis (15%) and diabetic nephropathy (11%).
Conclusions: Renal biopsy is a valuable diagnostic tool to guide treatment in the very elderly patients, especially in a setting of rising creatinine, in order to prevent progression to end stage kidney disease and dialysis dependence.
Category: Kidney (does not include tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 288, Wednesday Afternoon