老年人原发性肾病综合征52例临床分析

目的 观察老年原发性肾病综合征患者临床特征及预后.方法 回顾性分析52例老年原发性肾病综合征患者的临床病理特点,并与64例非老年原发性肾病综合征患者进行比较.对老年原发性肾病综合征患者给予常规治疗,口服糖皮质激素泼尼松1 mg·kg-1·d-1,维持治疗8周后,若症状得到缓解,逐渐降低剂量至维持量后,再逐渐停药;若症状没有缓解,则加用环磷酰胺或环孢霉素、骁悉等治疗.结果 老年组并存高血压、感染、慢性肾功能不全和血尿者,与非老年组比较差异均有统计学意义(P＜0.05),两组血白蛋白、24 h尿蛋白定量和急性肾功能不全发生率,差异无统计学意义(P＞0.05).老年人肾病综合征病理类型以膜性肾病、IgA肾病和局灶节段性肾小球硬化为主,分别占46.2%、23.1%和11.5%,非老年组以系膜增生性肾小球肾炎IgA肾病和微小病变性肾病为主,分别占32.8%、25.0%和20.3%.治疗后完全缓解31例,部分缓解18例,无效3例,完全缓解率为59.6%.结论 老年人原发性肾病综合征临床病理以膜性肾病为主,采用糖皮质激素和免疫抑制剂治疗临床疗效显著,但在不同病理类型中具有差异.

Abstract：

Objective To observe the clinical characteristics and prognosis of primary nephrotic syndrome (PNS) in the elderly. Methods The clinical and pathological features of 52 elderly patients with PNS and 64 non-elderly patients with PNS were retrospectively analyzed and compared.The elderly patients with PNS received routine treatment:oral corticosteroids prednisone 1mg·kg-1 ·d-1.After 8 weeks maintenance treatment,if symptoms were alleviated,the prednisone dose was gradually reduced to a maintenance dose, then was stopped gradually. If symptoms were not alleviated, the cyclophosphamide or cyclosporine, mycophenolate mofetil was added. Results There were significant differences in the numbers of patients complicated with hypertension, infection,chronic renal insufficiency and hematuria between the elderly group and non-elderly group (P＜0. 05＝.But there were no significant differences in the level of blood albumin, quantitative measurement of 24 hours urinary protein and incidence rate of acute renal insufficiency between the two groups (P＞0.05). The major pathological types of PNS in the elderly were membranous nephropathy (46.2 %),IgA nephropathy (23. 1 %) and focal segmental glomerulosclerosis ( 11.5 %), respectively. And the major pathological types of PNS in non-elderly group were mesangial proliferative glomerulonephritis (32.8%), IgA nephropathy ( 25.0% ) and minimal change nephropathy ( 20. 3 %), respectively.Complete remission after treatment was found in 31 patients(59.6%), partial remission in 18 cases and inefficacy in 3 cases. Conclusions The major clinicopathological type of PNS in the elderly is membranous nephropathy and should be treated using corticosteroids and immunosuppressive agents,with different effects in different pathological types.

Clinical features of primary nephrotic syndrome in 52 elderly patients

Objective To observe the clinical characteristics and prognosis of primary nephrotic syndrome (PNS) in the elderly. Methods The clinical and pathological features of 52 elderly patients with PNS and 64 non-elderly patients with PNS were retrospectively analyzed and compared.The elderly patients with PNS received routine treatment:oral corticosteroids prednisone 1mg·kg-1 ·d-1.After 8 weeks maintenance treatment,if symptoms were alleviated,the prednisone dose was gradually reduced to a maintenance dose, then was stopped gradually. If symptoms were not alleviated, the cyclophosphamide or cyclosporine, mycophenolate mofetil was added. Results There were significant differences in the numbers of patients complicated with hypertension, infection,chronic renal insufficiency and hematuria between the elderly group and non-elderly group (P＜0. 05＝.But there were no significant differences in the level of blood albumin, quantitative measurement of 24 hours urinary protein and incidence rate of acute renal insufficiency between the two groups (P＞0.05). The major pathological types of PNS in the elderly were membranous nephropathy (46.2 %),IgA nephropathy (23. 1 %) and focal segmental glomerulosclerosis ( 11.5 %), respectively. And the major pathological types of PNS in non-elderly group were mesangial proliferative glomerulonephritis (32.8%), IgA nephropathy ( 25.0% ) and minimal change nephropathy ( 20. 3 %), respectively.Complete remission after treatment was found in 31 patients(59.6%), partial remission in 18 cases and inefficacy in 3 cases. Conclusions The major clinicopathological type of PNS in the elderly is membranous nephropathy and should be treated using corticosteroids and immunosuppressive agents,with different effects in different pathological types.