Yasin ŞAHİNTÜRK, Metin SARIKAYA, Mehmet KOK, Suleyman DOLU, Ayça İNCİ, Ali Rıza ÇALIŞKAN

The aging kidney: A 10-year renal biopsy study of geriatric population

Aim: To report our experience with the renal biopsy/complications and histopathologic patterns of renal diseases according to theirclinical presentation and to make the best disease management in the elderly patients.Material and Methods: Totally 136 patients were analyzed according to their renal biopsy histopathology, clinical diagnosis andbiopsy related complications between 2006 and 2016.Results: Nephrotic syndrome (NS) and acute kidney injury (AKI) were the leading indications for renal biopsy. Totally 65 patients(47%) were diagnosed as NS and 60 patients (44%) were AKI. The most frequent histopathologic diagnosis was amyloidosis (30%).Membranous nephropathy (22%) was the second frequent histopathologic diagnosis. Amyloidosis (18.3%) was the leading causeof nephrotic syndrome and membranous nephropathy (17.6%) was the second most seen cause. Amyloidosis (11%) was the mostlyseen histopathologic diagnosis of AKI. Back pain longer than 12 hours (10%) was the most common complication.Conclusion: According to our findings, renal disease of elderly differs from other age groups according to histopathologic distribution,early renal function loss and rapid progression to end stage renal disease. For an accurate early diagnosis and initiating specifictreatment, renal biopsy should be performed on an individual basis without an increased risk for renal biopsy related complications.

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1. Knoll, Greg A. Kidney transplantation in the older adult. Am J Kidney Dis 2013;61:790-7.
2. Jin B, Zeng C, Ge Y, et al. The spectrum of biopsy-proven kidney diseases in elderly Chinese patients. Nephrology Dialysis Transplantation. 2014;29;2251-9.
3. Korbet SM, Volpini KC, Whittier WL. Percutaneous renal biopsy of native kidneys: a single-center experience of 1,055 biopsies. Am J Nephrol 2014;39:153-62.
4. Hajivandi, Abdollah, and Massoud Amiri. World kidney day 2014: Kidney disease and elderly. J Parathyr Dis 2014;2:3-4.
5. Brown CM, Scheven L, O’Kelly P, et al. Renal histology in the elderly: indications and outcomes. J Nephrol 2012;25:240.
6. Shin JH, Pyo HJ, Kwon YJ, et al. Renal biopsy in elderly patients: clinicopathological correlation in 117 Korean patients. Clin Nephrol 2001;56:19-26.
7. Bowling CB, Muntner P. Epidemiology of chronic kidney disease among older adults: a focus on the oldest old. J Gerontol A Biol Sci Med Sci 2012;67:1379-86.
8. Older people in Statistics. Not for Service: Turkish Statistical Institution. Available from: www.who.int/ageing/about/ facts/en/index.html/Tuik News Bulletin Report. 2014
9. Moutzouris DA, Herlitz L, Appel GB. et al. Renal biopsy in the very elderly. Clin J Am Soc Nephrol 2009;4:1073-82.
10. Covic A, Schiller A, Volovat C, et al. Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases. Nephrol Dial Transplan 2005;21:419-24.
11. Stratta P, Canavese C, Marengo M, et al. Risk management of renal biopsy: 1387 cases over 30 years in a single centre. Eur J Clin Investig 2007;37:954-63.
12. Tøndel C, Vikse BE, Bostad L, et al. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988–2010. Clin J Am Society Nephrol 2012;7:1591-7.
13. Xu DM, Chen M, Zhao MH. Risk factors for severe bleeding complications in percutaneous renal biopsy. Am J Med Sci 2017;353:230-5.
14. Pan X, Xu J, Ren H, et al. Changing spectrum of biopsyproven primary glomerular diseases over the past 15 years: a single-center study in China. In New Insights into Glomerulonephritis 2013;181:22-30. Karger Publishers. 15. Levison, Sandra P. Renal disease in the elderly: the role of the renal biopsy. Am J Kidney Dis 1990;16:300-6.
16. Muriithi AK, Leung N, Valeri AM, et al. Biopsy-proven acute interstitial nephritis, 1993-2011: a case series. Am J Kidney Dis 2014;64:558-66.
17. González E, Gutiérrez E, Galeano C, et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Intern 2008;73:940-6.
18. Dhaun N, Bellamy CO, Cattran DC, et al. Utility of renal biopsy in the clinical management of renal disease. Kidney Int 2014;85:1039-48.
19. Haas M, Spargo BH, Wit EJC, et al. Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis 2000;35:433-47.
20. Polito MG, de Moura LA, Kirsztajn GM. An overview on frequency of renal biopsy diagnosis in Brazil: clinical and pathological patterns based on 9617 native kidney biopsies. Nephrol Dial Transplant. 2010;25:490-6.
21. Hoy WE, Samuel T, Mott SA, et al. Renal biopsy findings among Indigenous Australians: a nationwide review. Kidney Int 2012;82:1321-31.
22. Paripović D, Kostić M, Kruščić D, et al. Indications and results of renal biopsy in children: a 10-year review from a single center in Serbia. J Nephrol 2012;25:9.
23. Prasad N, Kumar S, Manjunath R, et al. Real-time ultrasoundguided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications. Clin Kidney J 2015;8:151-6.
24. Corapi KM, Chen JL, Balk EM, et al. Bleeding complications of native kidney biopsy: a systematic review and metaanalysis. Am J Kidney Dis 2012;60;62-73.
25. Cameron J. Stewart. Nephrotic syndrome in the elderly. Semin Nephrol 1996;16:319-29.
26. Fawcett IW, Hilton PJ, Jones NF, et al. Nephrotic syndrome in the elderly. Br Med J 1971;2:387-8.
27. Zech P, Colon S, Pointet PH, et al. The nephrotic syndrome in adults aged over 60: etiology, evolution and treatment of 76 cases. Clin Nephrol 1982;17:232-6.