123例老年肾脏病患者的肾病理和临床特征分析

目的：探讨老年人原发性肾小球疾病及继发性肾脏疾病肾活检病理类型及临床特点。方法：回顾分析2003年—2005年123例年龄≥65岁,资料完整,并经临床和肾活检确诊为原发性肾小球疾病或继发性肾脏疾病患者的肾脏活组织病理和临床资料,并与同期367例中青年患者的肾脏活组织检查和临床资料进行对比。结果：①老年患者原发性肾小球疾病中膜性肾病最为常见,占原发肾脏疾病的31.46%,其次为IgA肾病（25.84%）。中青年患者原发肾脏疾病中以IgA肾病最为常见,占39.49%,其次为系膜增生性肾小球肾炎,占22.88%。②老年IgA肾病患者病理以局灶节段性肾小球硬化（FSGS）为主,占21.74%,而中青年患者以弥漫系膜增生为主,占30.95%。③糖尿病肾病是老年人最常见的继发性肾脏疾病,占32.35%,狼疮性肾炎是中青年患者最常见的继发性肾脏疾病,占58.33%。④老年肾脏疾病患者尿蛋白定量（3.60±0.78g.24h^-1）显著高于中青年组（2.19±0.68g.24h^-1）,P〈0.05。高血压的发生率显著增高（73.98%比30.51%,P〈0.01）。结论：老年患者肾脏病理类型与中青年患者不一致,老年原发性肾小球疾病以膜性肾病为主,IgA肾病的病理类型以FSGS为主;中青年患者原发性肾小球疾病以IgA肾病为主,IgA肾病的病理类型以弥漫系膜增生为主。老年患者继发性肾脏疾病的发生率高,以糖尿病肾病最为常见。肾脏病理类型的不同,是老年肾脏病患者临床表现中尿蛋白多和高血压的发生率增高的原因之一。

Pathological Charicteristics of Renal Biopsy in 123 Elder Patients with Kidney Disease

Objective：To explore pathological charicteristics of renal biopsy in elder patients with primary glomerulonephritis and secondary kidney disease. Method： It was a retrospective study, enrolled 123 elder patients with kidney disease,while 367 young patients served as control group. Results： （1）In the elder patients,72.36% of the pathological type was primary glomerulonephritis,among which membranous nephropathy was most common and accounted for 31.46%. IgA nephropathy was followed and accounted for 25.84 %. In the young patients, IgA nephropathy was the most common pathological type （39.49%）, followed by mesangial proliferative glomerulonephritis （22.88 % ）. （2）Referring to IgA nephropathy, focal segmental glomerulonephritis （FSGS） was the most common pathological type in the elder patients, which accounted for 21.74%, while mesangial proliferative glomerulonephritis accouted for 30.95 % in the young patients. （3） In the elder patients,diabetic kidney disease was the most common in the secondary kidney disease which accounted for 32.35 %, and in the young patients,lupus nephritis was the most common and accounted for 58.33%. （4） The incidence of proteinuria and hypertension in elder patients were significantly higher than that in the young patients （73.98% vs. 30.51 % , P〈0. 01）. Conclusion： The renal biopsy pathological types was different between the elder and young patient. In the elder patients,membranous nephropathy was the most common type of primary kidney disease and focal segmental glomerulosclerosis was the primary type in IgA nephropathy,while IgA nephropathy was most common in young patients and mesangial proliferation was the primary type in IgA nephropathy. There is a higher incidence of secondary kidney diseases in the elder patients. Diabetic nephropathy and hypertensive nephropathy were most common secondary pathological types while it is lupus nephritis when referring to the young patients. The difference of renal pathological type＇s results in a hig