老年肾病患者经皮肾穿刺活检术的临床病理分析及安全性评估

目的 探讨老年肾病患者行经皮肾穿刺活检术的安全性,同时分析其病理分型及临床资料. 方法 回顾性分析2006年1月至2016年10月在解放军第174医院行经皮肾穿刺活检术212例老年肾病患者(年龄>60岁)的临床资料.结果 212例患者中,经肾穿刺病理证实原发性肾小球疾病154例(72.64%),继发性肾小球疾病58例(27.36%).8例临床表现为急性肾衰竭,其中4例病理表现为继发性新月体型肾炎.原发性肾小球肾炎中最常见的病理类型为膜性肾病(42.86%),其次是IgA肾病(25.32%);而继发性肾小球肾炎中最常见的是糖尿病肾病 (37.93%,包括1例糖尿病肾病合并膜性肾病),其次是乙肝相关性肾病(13.79%).全部患者均取到肾小球,无一例患者出现严重并发症,观察到的主要并发症是肾周血肿52例、腰痛61例和肉眼血尿5例.肾周血肿主要是小血肿,主要发生在24h内,肉眼血尿主要发生在8h内. 结论 老年肾病患者经皮肾穿刺活检术并发症少,风险小,其在临床治疗过程中起到不可忽视的指导作用.

Clinical and pathological analysis and safety evaluation of percutaneous renal biopsy in elderly patients with renal disease

Objective To investigate the safety of percutaneous renal biopsy in elderly patients with renal disease,and to analyze the pathological type and clinical datas. Methods the clinical data of 212 elderly patients with renal disease (age over the age of 60 years) were retrospectively analyzed in the 174th People`s Liberation Army Hospital. Results TAmong the 212 patients who were diagnosed by renal biopsy,there were 154 cases of primary glomerular disease,accounting for 72.64%,and secondary glomerular disease in 58 cases,accounting for 27.36%.8 cases of clinical manifestations were acute renal failure,of which 4 patients were secondary crescentic glomerulonephritis (ANCA associated vasculitis). The most common type of primary glomerulonephritis in all elderly patients was membranous nephropathy (42.86%),followed by IgA nephropathy (25.32%); The most common type of secondary glomerulonephritis is diabetic nephropathy (37.93%,including 1 cases of diabetic nephropathy with membranous nephropathy),followed by hepatitis B associated nephropathy (13.79%).The renal biopsies were successfully taken in all patients. No serious complication occurred in all cases. The main complications such as perirenal hematoma(52 cases),lumbago(61 cases) and gross hematuria(5 cases) were observed after biopsy. Perirenal hematoma is mainly small hematoma,and it mostly occurred within 24 h.Gross hematuria occurred within 8 h. Conclusion Percutaneous renal biopsy in elderly patients with renal disease has less complications and less risk,which plays an important role in clinical treatment.