50岁以上肾脏疾病的临床和病理分析

经肾穿刺明确诊断的50岁以上肾脏病者57例,与同期50岁以下的593例肾活检病例比较,前者膜性肾炎明显多见(P<0.05),其特征为肾小球硬化率较后者为高,间质纤维化和血管病变较严重,高血压多见,肾功能相对较差(p<0.05)。50岁以上组有3例伴癌肿、2例伴下腔和肾静脉血栓形成。间质性肾炎和糖尿病性肾病的发生率也明显较高。

RENAL DISEASE IN AGED OVER 50 YEARS A CLINICOPATHOLOGIC ANALYSIS

57 oases aged over 50 (elderly group) with Biopsy-proven renal diseases were analysed in regards to their clinical and pathologic presentation as compared with 593 cases aged under 50 (younger group) with renal disease also biopsied during the same period of time.Results showed that the incidence of primary glomerular disease was lower in the elderly group (64.9 vs 59.9%)in which membranous nephropathy(MN)was the most frequent glomerulonephropathy occupying 39.4% arid its inoidenoe was higher than that in the younger group (14.8%, p<0.01), however, IgA nephropathy (6.1 vs14.8%),intercapillary proliferative GN (IPGN) (O vs 6.2%) as well aa focal glomerular sclerosis (FGS) (O vs 5.3%) were less frequent (p<0.05). Glo-merular diseases secondary to diabetes (14.0 vs 3.2%), amyloidosis nephropathy (3.5 vs 0%) were higher in the elderly group (p<0.05) and lupus nephritis (5.3 vs 18.9%) was lower in the elderly. The inoidenoe of interstitial nephritis in these two groups were 10.5 and 2.7%, respectively.MN was the most common pathologic basis for the nephrotio syndrome seen in the elderly group which always had a higher inoidenoe of glomerular sclerosis. Interstitial fibrosis and fibromuscular hyperplasia in renal arterioles. 3 oases were found to be associated with malignancies. The other clinical characteristics of MN in the elderly included: higher incidence of hypertention, lower CCr, lower selectivity index in proteinuria and poorer response to steroid and/or immunosuppresive therapy.The mechanisms related to these pathologic and clinical manifestat tion in elderly group of renal diseases were discussed.