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      Clinical Impact of Renal Biopsy on Outcomes in Elderly Patients with Nephrotic Syndrome

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          Abstract

          Background/Aims: The number of elderly patients with nephrotic syndrome (NS) is increasing. This study aimed to assess the implications of renal biopsy on the outcomes in elderly patients with NS. Methods: Ninety-nine patients diagnosed with NS who were over 60 years of age were reviewed. Secondary NS related to diabetes was excluded. Histopathological diagnosis, comparison of outcomes between the biopsied group (n = 64) and the nonbiopsied group (n = 35) and factors affecting renal survival were evaluated. Results: The biopsied group was significantly younger and had better renal function than the nonbiopsied group. More patients in the biopsied group than in the nonbiopsied group received immunosuppressive treatment (76.6 vs. 42.9%, p < 0.005), and achieved complete remission (45.3 vs. 26.5%, p = 0.013). The complication rates and renal survival rates were not different between the two groups, but the patient survival rates were significantly higher in the biopsied group (p < 0.005). Predictors for renal survival were renal function at diagnosis and response to treatment. Conclusion: Renal biopsy is essential for a correct diagnosis and directed therapeutic approach in elderly patients with NS and may improve the clinical outcomes of these patients.

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          Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases.

          Acute renal insufficiency is a common problem, yet one that is frequently reversible with proper diagnosis and treatment. Although it has been argued that a renal biopsy is not needed for diagnosis in most cases of acute renal failure in the elderly, other studies have shown frequent disagreements between clinical and renal biopsy diagnoses in such cases. To investigate the causes of acute renal insufficiency in patients aged at least 60 years who underwent a renal biopsy and possible correlations between biopsy findings and renal survival, we first identified all native renal biopsy specimens from patients aged 60 years or older processed at The University of Chicago Medical Center (Chicago, IL) from 1991 through 1998 and reviewed the clinical records to determine the indication for the biopsy. We then reviewed again the records of those patients who underwent biopsy because of acute renal insufficiency, recorded the primary renal biopsy diagnosis in each of these cases, and obtained follow-up information for patients who underwent biopsy before July 1996. During the study period, 1,065 of 4,264 biopsy specimens (25.0%) received were obtained from patients aged 60 years or older, and acute renal insufficiency was the indication for biopsy in 259 of these patients (24.3%). The most frequent primary diagnoses on these latter biopsy specimens were pauci-immune crescentic glomerulonephritis (GN) with or without arteritis, 31.2% of biopsy specimens; acute interstitial nephritis, 18.6%; acute tubular necrosis (ATN) with nephrotic syndrome, 7.5%; atheroemboli, 7.1%; ATN alone, 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-Schönlein 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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            Renal biopsy in the very elderly.

            Data regarding renal biopsy in the very elderly (>or=age 80 yr) are extremely limited. The aim of this study was to examine the causes of renal disease and their clinical presentations in very elderly patients who underwent native renal biopsy.
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              Timing of Complications in Percutaneous Renal Biopsy

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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2011
                December 2010
                03 August 2010
                : 117
                : 1
                : c20-c27
                Affiliations
                Departments of aInternal Medicine and bPathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
                Article
                319643 Nephron Clin Pract 2011;117:c20–c27
                10.1159/000319643
                20689321
                aa6e657e-f74f-4c0f-9a07-cb07d4d00bd5
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 04 January 2010
                : 03 May 2010
                Page count
                Figures: 2, Tables: 6, References: 27, Pages: 1
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                Elderly,Glomerulonephritis,Nephrotic syndrome,Renal biopsy
                Cardiovascular Medicine, Nephrology
                Elderly, Glomerulonephritis, Nephrotic syndrome, Renal biopsy

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