老年肾脏病肾活检的诊断价值与风险评估

目的探讨肾活检在老年肾脏病中的诊断价值与风险评估。方法回顾性分析我科住院行肾活检，且年龄≥60岁的123例老年肾脏病患者的临床病理资料及安全性。结果肾活检术成功率100％，肾活检取材肾小球数目均≥10个，共有6例出现轻度并发症，其中一过性肉眼血尿2例（占1．6％），肾周小血肿4例（占3．2％），余无严重并发症。123例患者中原发性肾小球疾病为105例（占85．4％），而继发性肾脏病为18例（占14．6％）。在原发性肾小球疾病中最常见的病理类型是膜性肾病26例（占26．0%），IgA。肾病25例（占25．0％），其次为系膜增生性肾小球肾炎19例（占19％）。而继发性肾脏病中病理类型以糖尿病肾脏病11例最多见（占47．8％）。最常见的临床表现是肾病综合征（占39．8oA）和慢性肾小球肾炎（占33．3％）。临床诊断与肾活检结果尚存在差异（P〈0．05）。结论肾活检在老年性肾脏疾病患者中应用的成功率高而并发症少且大多较轻，其病理结果对明确诊断和决定治疗方案具有重要指导意义。

Diagnostic value and risk evaluation of renal biopsy to senile patients with kidney diseases

Objective To evaluate diagnostic value and risk of renal biopsy under the ultrasound on senile patients with kidney diseases. Methods 123 senile patients over 60 years old with kidney diseases were subjected to renal biopsy in our department from Dec. 2000 to Dec. 2010 in our hospi- tal. The clinical and pathological records and safety were analyzed. Results Renal biopsy was performed successfully on 123 cases. The number of renal glomeruli was more than 10. Slight complications occurred in 6 cases, including 2 cases of transient gross hematuria（1.6%）, and 4 cases of perire- nal hematoma（3. 2%）. Of 123 senile patients with kidney diseases, there were 105 cases of primary glomerular disease（85.4%）, and 18 cases of the secondary renal diseases（ 14. 6 %）. In the primary glomerular diseases, the most common pathology type was the membranous nephropathy （26 cases, 26. 0% ）, IgA nephropathy（25 cases, 25.0 %）, next is the mesangial proliferative glomerulonephritis（ 19 cases, 19. 0%）. In the secondary glomerular disease, followed by diabetic nephropathy（11 cases, 47. 8%）. The most common clinical manifestation was the nephrotic syndrome（39. 8%） and the chronic nephritis（33.3%）. The clinical diagnosis and the renal biopsy results still had some differences （P〈0. 05）. Conclusion Renal biopsy presents a very high success rate with less complications in senile patients with kidney diseases. Its pathological findings are very useful to define diagnosis and make properly therapeutic schedule.