Altmış Beş Yaş ve Üzeri Hastalarda Böbrek Biyopsisi: Bir Klinikopatolojik Analiz

Yayın Yılı: 
2010
Cilt: 
19
Sayı: 
3
Sayfa Aralığı:: 
174-179
Yayın Dili: 
Türkçe
DOI: 
DOI 10.5262/tndt.2010.1003.04
Abstract (2. Language): 
AIM : Elderly patients with renal disease have recently attracted increased attention. There has also been an increase in renal biopsies in these patients. The aim of this study was to investigate the influence of the renal biopsy on the diagnosis, management and prognosis of renal diseases in the elderly. MA TERIAL and M ETHODS: We retrospectively reviewed the clinical files of 632 patients who had undergone renal biopsy in the department of Nephrology, Gulhane School of Medicine between 2000 and 2007. Thirty of these patients included in the present study were 65 or more years old. RESUL TS: The most common indication for renal biopsy was acute renal injury and acute on chronic renal disease (53.3%), nephrotic syndrome (40%) and non-nephrotic proteinuria (6.6%) in these patients. In the acute renal injury group, renal biopsy showed acute interstitial nephritis, acute tubular necrosis and crescentic glomerulonephritis while in the acute on chronic renal disease group it showed chronic interstitial nephritis, renal amyloidosis and chronic glomerulonephritis. In the nephrotic syndrome group, renal biopsy showed minimal change disease, renal amyloidosis, membranous glomerulonephritis and focal segmental glomerulosclerosis while in the non-nephrotic proteinuric group it showed focal segmental glomerulosclerosis. CONCLU SION: Study data suggest that renal biopsy has influence on the diagnosis, management and prognosis of renal disease the elderly patients. This procedure should be performed without any age limitation when a renal biopsy indication emerges in elderly patients.
Özet (Orjinal Dil): 
AMA Ç: Son zamanlarda yaşlı hastalarda gelişen böbrek hastalığına ilgi artarken, bu hastalarda yapılan böbrek biyopsi sayısı geçmişe oranla belirgin olarak artış göstermektedir. Bu çalışmadaki amacımız, böbrek biyopsisinin yaşlı hastalarda tanı, tedavi ve prognoz üzerine etkisini araştırmaktır. GEREÇ ve YÖN TEML ER: Bu çalışmada, 2000 - 2007 yılları arasında Gülhane Askeri Tıp Akademisi Nefroloji Kliniği’nde böbrek biyopsisi yapılan 632 hastanın dosyaları geriye dönük olarak incelendi. Çalışmaya alınan 30 hastanın yaşı 65 ve üzeri olarak saptandı. BUL GULA R: En sık böbrek biyopsi endikasyonları sırasıyla akut böbrek hasarı ve kronik böbrek hastalığı zemininde gelişen akut böbrek hasarı (%53,3), nefrotik sendrom (%40) ve nefrotik düzeyde olmayan proteinüri (%6,6) olarak saptandı. Akut böbrek hasarı olan hastalarda yapılan böbrek biyopsisinde sırasıyla akut interstisyel nefrit, akut tübüler nekroz ve kresentik glomerülonefrit saptandı. Bununla birlikte kronik böbrek hastalığı zemininde gelişen akut böbrek hasarı hastalarının böbrek biyopsilerinde; kronik tübülointerstisyel nefrit, renal amiloidoz ve kronik glomerülonefrit saptandı. Nefrotik sendromlu hastalarda yapılan böbrek biyopsilerinde minimal değişiklik hastalığı, renal amiloidoz, membranöz glomerülonefrit ve fokal segmental glomerüloskleroz saptanırken nefrotik düzeyde olmayan proteinürisi olan hastalarda fokal segmental glomerüloskleroz saptanmıştır. SONU Ç: Bu çalışma ile yaşlı bireylerde böbrek hastalığının tanı, tedavi ve prognozunda böbrek biyopsisinin önemli etkisinin olduğu gösterilmiştir. Yaşlı hastalarda böbrek biyopsi endikasyonu varlığında, yaşa sınırlı kalınmadan biyopsi işlemi yapılmalıdır.
Referanslar: 

1. Nair R, Bell JM, Walker PD: Renal biopsy in patients aged 80 years
and older. Am J Kidney Dis 2004; 44(4): 618-626
2. Colombo V, Confalonieri R, Minola E, Minetti L: Renal biopsies
in the elderly. A 20 years’ experience. Contrib Nephrol 1993; 105:
102–106
3. Donadio JV: Treatment and clinical outcome of glomerulonephritis
in the elderly. Contrib Nephrol 1993; 105: 49–57
4. Preston RA, Stemmer CL, Materson BJ, Perez-Stable E, Pardo V:
Renal biopsy in patients 65 years of age or older. An analysis of the
results of 334 biopsies. J Am Geriatr Soc 1990; 38: 669–674
5. Komatsuda A, Nakamoto Y, Imai H, Imai H, Yasuda T, Yanagisawa
MM, Wakui H, Ishino T, Satoh K, Miura AB: Kidney diseases
among the elderly-a clinicopathological analysis of 247 elderly
patients. Intern Med 1993; 32(5): 377–381
6. Pascual J, Liaño F, Ortuño J: The elderly patient with acute renal
failure. J Am Soc Nephrol 1995; 6(2): 144–153
Cilt/Vol: 19, No: 3, 2010, Sayfa/Page: 174-179 179
Türk N efroloji D iyaliz ve Transplantasyon D ergisi Oğuz Y et al: Renal Biopsy in Patients Aged 65 Years and Older
Turkish Nephrology, Dialysis and Transplantation Journal
7. Prakash J, Hota JK, Singh S, Sharma OP: Clinical spectrum of
chronic renal failure in the elderly: A hospital based study from
eastern India. Int Urol Nephrol 2006; 38 (3–4) : 821–827
8. Uezono S, Hara S, Sato Y, Komatsu H, Ikeda N, Shimao Y, Hayashi
T, Asada Y, Fujimoto S, Eto T: Renal biopsy in elderly patients: A
clinicopathological analysis. Ren Fail 2006; 28(7) : 549–555
9. Haas M, Spargo BH, Wit Emst-Jan C, Meehan SM: Etiologies and
outcome of acute renal insuffiency in older adults: A renal biopsy
study of 259 cases. Am J Kidney Dis 2000; 35(3) : 433–447
10. Rosenfeld JB, Shohat J, Grosskopf I, Boner G: Acute renal failure:
A disease of the elderly? Adv Nephrol 1987; 16: 159–167
11. Colvin RB, Fang LST: Interstitial nephritis, in Tisher CC, Brenner
BM (eds): Renal Pathology (ed 2). Philadelphia: Lippincott, 1994;
723-768
12. Wilson DM, Turner DR, Cameron JS, Ogg CS, Brown CB, Chantler
C: Value of renal biopsy in acute intrinsic renal failure. BMJ 1976;
2: 459–461
13. Cameron JS: Nephrotic syndrome in the elderly. Semin Nephrol
1996; 16: 319–329
14. Johnston PA, Brown JS, Davison AM: The nephrotic syndrome in
the elderly: Clinico-pathologic correlation in 317 patients. Geriatric
Nephrol Urol 1992; 2: 85–90
15. Moran D, Korzets Z, Bernheim J, Bernheim J, Yaretz A: Is renal
biopsy justified for the diagnosis and management of the nephrotic
syndrome in the elderly? Gerontology 1993; 39(1): 49–54
16. Kohli HS, Jairam A, Bhat A, Sud K, Jha V, Gupta KL, Sakhuja V:
Safety of kidney biopsy in elderly: A prospective study. Int Urol
Nephrol 2006; 38: 815–820
17. Whittier WL, Korbet SM: Timing of complications in percutaneous
renal biopsy. J Am Soc Nephrol 2004; 15: 142–147
18. Parrish AE: Complications of percutaneous renal biopsy: A review
of 37 years’ experience. Clin Nephrol 1992; 38: 135–141

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