老年肾病综合征临床病理特点及治疗转归

目的 探讨老年肾病综合征(nephrotic syndrome, NS)的临床病理特点及治疗转归。方法 回顾性研究2006年1月至2014年12月期间在我院行肾穿刺并表现为NS的193例患者的临床病理资料,分析老年NS的临床病理特点及获得随访的39例老年NS患者的治疗转归。结果 老年组患者中男性比例较高,占75.6%；老年组患者中初诊时存在肾功能损害、需要行肾脏替代治疗及高血压发生率均较中青年组高。老年组常见病理类型依次是膜性肾病、微小病变和局灶节段性肾小球硬化。在老年原发性NS中仍是膜性肾病的比例最高,达60.0%；其次是微小病变,占20.0%；局灶节段性肾小球硬化位居第3,占11.4%。老年继发性NS中以感染相关性肾病最多,占30.0%；其次是糖尿病肾病和自身免疫性疾病相关性肾病,各占20.0%。老年原发性和继发性NS的总缓解率分别为65.6%和71.5%；老年原发性NS接受糖皮质激素或免疫抑制剂治疗的患者中有33.3%的患者病程中出现一种以上感染性疾病,16.7%的患者出现类固醇性糖尿病,而继发性NS患者未出现感染性疾病。结论 老年NS有其自身的临床病理特点,老年NS患者应积极进行肾活检明确诊断,指导治疗。
Objective To review the clinicopathological characteristics and outcomes of nephrotic syndrome (NS) in elderly patients. Methods Clinical data of 193 patients with biopsy-confirmed NS admitted in hospital between January 2006 and December 2014 were reviewed retrospectively. Among them, the clinicopathological features and disease outcomes of 39 followed-up patients over 60 years were analyzed. Results Among 39 patients 30 were males (75.6%). The rates of renal damage, requirements of renal replacement treatment and hypertension in elderly patients were higher than those in younger patients. The most common pathological type in elderly patients was membranous nephropathy (60.0%), followed by minimal change disease (20.0%) and focal segmental glomerulosclerosis (11.4%). The most common secondary etiology was infection (30.0%), followed by diabetes (20.0%) and autoimmune diseases (20.0%). The total remission rates of primary and secondary NS in elderly patients were 65.6% and 71.5%, respectively. In elderly patients with primary NS treated with glucocorticoid or immunosuppressants, 33.3% had more than one infectious disease and 16.7% had steroid diabetes, while those with secondary NS had no infectious diseases. Conclusion Nephrotic symdrome in elderly patients have distinctive clinical and pathological characteristics, and for them renal biopsy is necessary