Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR)

被引：95

作者：

Yokoyama, Hitoshi ^{[1
]}

Sugiyama, Hitoshi ^{[2
]}

Sato, Hiroshi ^{[3
]}

Taguchi, Takashi ^{[4
]}

Nagata, Michio ^{[5
]}

Matsuo, Seiichi ^{[6
]}

Makino, Hirofumi ^{[2
]}

Watanabe, Tsuyoshi ^{[7
]}

Saito, Takao ^{[8
]}

Kiyohara, Yutaka ^{[9
]}

Nishi, Shinichi ^{[10
,11
]}

Iida, Hiroyuki ^{[12
]}

Morozumi, Kunio ^{[13
]}

Fukatsu, Atsushi ^{[14
]}

Sasaki, Tamaki ^{[15
]}

Tsuruya, Kazuhiko ^{[16
]}

Kohda, Yukimasa ^{[17
]}

Higuchi, Makoto ^{[18
]}

Kiyomoto, Hideyasu ^{[19
]}

Goto, Shin ^{[20
]}

Hattori, Motoshi ^{[21
]}

Hataya, Hiroshi ^{[22
]}

Kagami, Shoji ^{[23
]}

Yoshikawa, Norishige ^{[24
]}

Fukasawa, Yuichiro ^{[25
]}

Ueda, Yoshihiko ^{[26
]}

Kitamura, Hiroshi ^{[27
]}

Shimizu, Akira ^{[28
]}

Oka, Kazumasa ^{[29
]}

Nakagawa, Naoki ^{[30
]}

Ito, Takafumi ^{[31
]}

Uchida, Shunya ^{[32
]}

Furuichi, Kengo ^{[33
]}

Nakaya, Izaya ^{[34
]}

Umemura, Satoshi ^{[35
,36
]}

Hiromura, Keiju ^{[37
]}

Yoshimura, Mitsuhiro ^{[38
]}

Hirawa, Nobuhito ^{[39
]}

Shigematsu, Takashi ^{[40
]}

Fukagawa, Masafumi ^{[41
]}

Hiramatsu, Makoto ^{[42
]}

Terada, Yoshio ^{[43
]}

Uemura, Osamu ^{[44
]}

Kawata, Tetsuya ^{[45
]}

Matsunaga, Akira ^{[46
]}

Kuroki, Aki ^{[47
]}

Mori, Yasukiyo ^{[48
]}

Mitsuiki, Koji ^{[49
]}

Yoshida, Haruyoshi ^{[50
]}

机构：

[1] Kanazawa Med Univ, Sch Med, Div Nephrol, Uchinada, Ishikawa 9200293, Japan

[2] Okayama Univ, Dept Med & Clin Sci, Grad Sch Med Dent & Pharmaceut Sci, Okayama 7008530, Japan

[3] Tohoku Univ, Grad Sch Pharmaceut Sci, Sendai, Miyagi 980, Japan

[4] Nagasaki Univ, Dept Pathol, Grad Sch Biomed Sci, Nagasaki 852, Japan

[5] Univ Tsukuba, Dept Pathol, Fac Med, Tsukuba, Ibaraki, Japan

[6] Nagoya Univ, Dept Nephrol, Grad Sch Med, Nagoya, Aichi 4648601, Japan

[7] Fukushima Med Univ, Sch Med, Dept Nephrol Hypertens Diabetol Endocrinol & Meta, Fukushima, Japan

[8] Fukuoka Univ, Sch Med, Dept Internal Med, Div Nephrol & Rheumatol, Fukuoka 81401, Japan

[9] Kyushu Univ, Grad Sch Med Sci, Dept Environm Med, Fukuoka 812, Japan

[10] Kobe Univ, Grad Sch Med, Div Nephrol, Kobe, Hyogo 657, Japan

[11] Kobe Univ, Grad Sch Med, Kidney Ctr, Kobe, Hyogo 657, Japan

[12] Toyama Prefectural Cent Hosp, Dept Internal Med, Toyama, Japan

[13] Japanese Red Cross Nagoya Daini Hosp, Kidney Ctr, Nagoya, Aichi, Japan

[14] Kyoto Univ, Grad Sch Med, Dept Nephrol, Kyoto, Japan

[15] Kawasaki Med Sch, Dept Hypertens & Nephrol, Kurashiki, Okayama, Japan

[16] Kyushu Univ, Grad Sch Med Sci, Dept Med & Clin Sci, Fukuoka 812, Japan

[17] Kumamoto Univ, Grad Sch Med Sci, Dept Nephrol, Kumamoto, Japan

[18] Shinshu Univ, Sch Med, Div Nephrol, Matsumoto, Nagano 390, Japan

[19] Tohoku Univ, Div Integrated Nephrol & Telemed, Dept Community Med Supports, Tohoku Med Megabank Org ToMMo, Sendai, Miyagi 980, Japan

[20] Niigata Univ, Grad Sch Med & Dent Sci, Div Clin Nephrol & Rheumatol, Niigata, Japan

[21] Tokyo Womens Med Univ, Dept Pediat Nephrol, Tokyo, Japan

[22] Tokyo Metropolitan Childrens Med Ctr, Dept Nephrol, Tokyo, Japan

[23] Univ Tokushima, Grad Sch Med, Dept Pediat, Inst Hlth Biosci, Tokushima 770, Japan

[24] Wakayama Med Univ, Dept Pediat, Wakayama, Japan

[25] Sapporo City Hosp, Dept Pathol, Sapporo, Hokkaido, Japan

[26] Dokkyo Med Univ, Koshigaya Hosp, Dept Pathol, Koshigaya, Japan

[27] Natl Hosp Org Chiba E Natl Hospita, Clin Res Ctr, Chiba, Japan

[28] Nippon Med Sch, Dept Pathol, Tokyo 113, Japan

[29] Hyogo Prefectural Nisihinomiya Hosp, Dept Pathol, Nishinomiya, Hyogo, Japan

[30] Asahikawa Med Univ Hosp, Dept Internal Med, Div Cardiol Nephrol Pulmonol & Neurol, Asahikawa, Hokkaido, Japan

[31] Shimane Univ, Fac Med, Div Nephrol, Izumo, Shimane, Japan

[32] Teikyo Univ, Sch Med, Dept Internal Med, Tokyo 173, Japan

[33] Kanazawa Univ Hosp, Div Nephrol, Kanazawa, Ishikawa, Japan

[34] Iwate Cent Prefectural Hosp, Dept Nephrol, Morioka, Iwate, Japan

[35] Yokohama City Univ, Dept Med Sci & Cardiorenal Med, Grad Sch Med, Yokohama, Kanagawa 232, Japan

[36] Yokohama City Univ, Sch Med, Yokohama, Kanagawa 232, Japan

[37] Gunma Univ, Grad Sch Med, Dept Med & Clin Sci, Gunma, Japan

[38] Natl Hosp Org, Dept Nephrol & Rheumatol, Kanazawa Med Ctr, Kanazawa, Ishikawa, Japan

[39] Yokohama City Univ, Med Ctr, Yokohama, Kanagawa 232, Japan

[40] Wakayama Med Univ, Dept Internal Med, Div Nephrol, Wakayama, Japan

[41] Tokai Univ, Sch Med, Div Nephrol Endocrinol & Metab, Isesaki, Japan

[42] Okayama Saiseikai Gen Hosp, Dept Nephrol, Okayama, Japan

[43] Kochi Univ, Kochi Med Sch, Dept Endocrinol Metab & Nephrol, Kochi 780, Japan

[44] Aichi Childrens Hlth & Med Ctr, Dept Pediat Nephrol, Obu, Japan

[45] Natl Hosp Org, Hokkaido Med Ctr, Dept Nephrol, Sapporo, Hokkaido, Japan

[46] Yamagata Univ, Sch Med, Dept Pediat, Yamagata 99023, Japan

[47] Showa Univ, Sch Med, Div Nephrol, Tokyo 142, Japan

[48] Kyoto Prefectural Univ, Sch Med, Dept Med, Div Nephrol, Kyoto 606, Japan

[49] Japanese Red Cross Fukuoka Hosp, Nephrol & Dialysis Ctr, Fukuoka, Japan

[50] Univ Fukui, Div Nephrol, Dept Gen Med, Fac Med Sci, Fukui 910, Japan

来源：

CLINICAL AND EXPERIMENTAL NEPHROLOGY | 2012年 / 16卷 / 06期

关键词：

Elderly; Very elderly; Japanese; Renal biopsy; Registry; Nephrotic syndrome; IgA nephropathy; Rapidly progressive glomerulonephritis; Proteinuria;

D O I：

10.1007/s10157-012-0673-8

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Data regarding renal disease in the elderly (age a parts per thousand yen65 years old) and very elderly (age a parts per thousand yen80 years old) Japanese are extremely limited. The aim of this study was to examine the causes of renal disease and their clinical presentations in elderly patients who underwent renal biopsy. From July 2007 to November 2011, all of the elderly native renal biopsy patients who had been registered in the Japan Renal Biopsy Registry (J-RBR; 2802 including 1596 males and 1206 females) were identified. Their data were compared with a control group of 7416 patients who ranged in age from 20 to 64 years old and were registered on the J-RBR over the same period. In addition, the clinical and pathological classifications of 276 very elderly patients were also analyzed. The indications for biopsy were nephrotic syndrome (NS) in 36.2 and 50.7 % of the elderly and the very elderly patients, chronic nephritic syndrome in 31.8 and 17.4 %, and acute kidney injury including rapidly progressive glomerulonephritis in 18.6 and 22.5 %, respectively. Primary glomerular disease was the most frequent diagnosis, followed by MPO-ANCA-positive nephritis, IgA nephropathy (IgAN), and diabetic nephropathy. In primary GN including IgAN, membranous nephropathy (MN) was the most frequent histological type, followed by IgAN and minor glomerular abnormalities. A comparison with the control group showed that MN, MPO-ANCA-positive nephritis, and amyloid nephropathy were more common in the elderly (P < 0.001), and IgAN was less common (P < 0.001). As for nephrotic syndrome in the elderly, MN was the most common histological type, followed by minimal change NS, diabetic nephropathy, amyloid nephropathy, and focal segmental glomerulosclerosis. There was a significant discrepancy between the urinary protein/creatinine ratio and daily proteinuria after the 7th decade of life. Renal biopsy is a valuable diagnostic tool, even in elderly and very elderly Japanese patients. In the future, modified clinical guidelines for elderly renal disease should be developed.

引用

页码：903 / 920

页数：18

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