Renal biopsy in elderly patients: clinicopathological correlation in 117 Korean patients

Aim: In the elderly with renal disease, the clinical presentations are freq uently inconsistent with the pathologic findings. We tried to clarify the d ifferences in pathological findings between the young and the elderly, in K orea and in Western countries, and the usefulness of a percutaneous renal b iopsy in the elderly with renal disease. Patients and methods: We analyzed the clinical presentations and spectrums of renal histopathology by reviewi ng medical records and renal biopsy reports retrospectively in 117 Korean p atients aged 60 years or more with renal disease. Results: 85 patients had primary renal disease. The remaining 32 patients had renal diseases associa ted with systemic conditions. Out of the 85 patients with primary renal dis ease, 61 cases presented as idiopathic nephrotic syndrome. Compared with re nal biopsy results of younger adult patients (age 15 - 59, n = 1908), membr anous nephropathy, crescentic glomerulonephritis, membranoproliferative glo merulonephritis, amyloidosis, light chain disease, and thrombotic thrombocy topenic purpura were more prevalent, but IgA nephropathy and lupus nephriti s were less common in the elderly patients. In clinical presentation, nephr otic syndrome and rapidly progressive renal failure were more prevalent, bu t asymptomatic urinary abnormality was less common in elderly patients. The responsiveness to treatment was good in elderly patients with minimal-chan ge lesion (complete remission in all patients) but poor in crescentic glome rulonephritis, IgA nephropathy, and membranoproliferative glomerulonephriti s. From the above findings, the clinical presentation, patterns of histopat hology and responsiveness to treatment of elderly Korean patients were simi lar to those of the younger Korean control group and the Western elderly gr oup. Conclusion: Percutaneous renal biopsy is a useful diagnostic aid and c an be used as a therapeutic guideline even in elderly patients with renal d isease.