老年人急性肾功能不全的病因和结果:肾活检研究259例。

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哈斯M, 20 BH智慧EJ, Meehan SM

老年人急性肾功能不全的病因和结果:肾活检研究259例。

J肾脏说。2000年3月,35 (3):433 - 47。

PubMed ID
10692269 (在PubMed
]
文摘

急性肾功能不全是一个常见的问题,但一个频繁可逆与适当的诊断和治疗。尽管它一直认为,在大多数情况下不需要肾活检诊断急性肾功能衰竭的老年人,其他研究显示频繁的临床和肾活检诊断之间的分歧在这种情况下。探讨急性肾功能不全的原因至少60岁的病人接受了肾活检和可能的活检结果和肾存活率之间的相关性,我们首先确定本地肾活检标本60岁以上患者处理在芝加哥大学医学中心(芝加哥,IL)从1991年到1998年,回顾了临床记录来确定活检的适应症。然后我们再审核的记录因为急性肾功能不全病人活检,记录主肾活检诊断在每一种情况下,病人活检和获得随访信息之前,1996年7月。在研究期间,1065 4264活检标本(25.0%)接受了从60岁以上患者,和急性肾功能不全是这些患者的迹象在259年活组织检查(24.3%)。最常见的主要诊断后活检标本pauci-immune新月形的肾小球肾炎(GN)有或没有动脉炎,活检标本的31.2%;急性间质性肾炎,18.6%;急性肾小管坏死(ATN)肾病综合症,7.5%;atheroemboli, 7.1%;ATN,仅6.7%; light chain cast nephropathy (LCCN), 5.9%; postinfectious GN, 5.5%; anti-glomerular basement membrane antibody nephritis, 4.0%; and immunoglobulin A (IgA) nephropathy and/or Henoch-Schonlein nephritis, 3.6%. Eight biopsy specimens (3.2%) showed only benign nephrosclerosis without an apparent cause of acute renal insufficiency, and another six specimens were inadequate. The renal biopsy diagnosis was in agreement with the prebiopsy clinical diagnosis (or differential diagnosis) in 107 of the 161 cases (67%) in which such information was provided. The distribution of diagnoses was similar in patients in the age groups of 60 to 69, 70 to 79, and 80 years or older, although younger age correlated significantly with improved renal and patient survival. The relative risk for progression to end-stage renal disease (ESRD) also increased according to diagnostic categories: LCCN (greatest risk) > GN other than pauci-immune > atheroemboli congruent with pauci-immune crescentic GN > tubulointerstitial diseases other than LCCN (the latter category including ATN with nephrotic syndrome). Development of ESRD correlated significantly with decreased patient survival. In summary, renal biopsy in patients aged 60 years or older with acute renal insufficiency uncovered the cause in greater than 90% of the cases and provided clinically useful information with respect to expectation for renal survival and potential treatment options.

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