Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR)
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Background and objectives
Data regarding renal disease in the elderly (age ≥65 years old) and very elderly (age ≥80 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.
Design, setting, participants, and measurements
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.
KeywordsElderly Very elderly Japanese Renal biopsy Registry Nephrotic syndrome IgA nephropathy Rapidly progressive glomerulonephritis Proteinuria
The authors gratefully acknowledge the assistance of their colleagues at the centers and affiliated hospitals who helped with the data collection for the J-RBR/J-KDR. We also sincerely thank Ms. Mayumi Irie in the UMIN-INDICE for establishing and supporting the registration system of J-RBR&J-KDR and Ms. Yoshimi Saito for preparing this manuscript. This study was supported in part by the committee of the Japanese Society of Nephrology and a Grant-in-Aid for Progressive Renal Disease Research from the Ministry of Health, Labour, and Welfare of Japan.
Conflicts of interest
None of the authors has any conflicts of interest to disclose for this article.
- 1.White Book of Aging from the Government of Japan. http://www8.cao.go.jp/kourei/whitepaper/w-2011/gaiyou/pdf/1s1s.pdf (Accessed, April 2, 2012).
- 9.Sugiyama H, Yokoyama H, Sato H, Saito T, Kohda Y, Nishi S, et al. Committee for Standardization of Renal Pathological Diagnosis and Working Group for Renal Biopsy Database, Japanese Society of Nephrology, Tokyo, Japan: Japan Renal Biopsy Registry: Japan Renal Biopsy Registry: the first nationwide, web-based, and prospective registry system of renal biopsies in Japan. Clin Exp Nephrol. 2011;15:493–503.PubMedCrossRefGoogle Scholar
- 10.Churg J, Bernstein J, Glassock RJ, editors. Renal disease: classification and atlas of glomerular diseases. 2nd ed. New York: IGAKU-SHOIN; 1995. p. 4–20.Google Scholar
- 11.Matsuo S, Imai E, Saito T, Taguchi T, Yokoyama H, Narita I, et al. Guidelines for the treatment of nephrotic syndrome. Jpn J Nephrol. 2011;53:136–41 (article in Japanese).Google Scholar
- 16.Brown CM, et al. Renal histology in the elderly: indications and outcomes. J Nephrol. doi: 10.5301/JN.2011.8447.
- 24.Matsuo S, Yamagata K, Makino F, Arimura Y, Muso E, Nitta K, et al. Guidelines for the treatment of rapidly progressive nephritic syndrome. Jpn J Nephrol. 2011;53:509–555. (article in Japanese).Google Scholar
- 25.Ozaki S, Atsumi T, Hayashi T, Ishizu A, Kobayashi S, Kumagai S, et al. Severity-based treatment for Japanese patients with MPO-ANCA-associated vasculitis: the JMAAV study. Mod Rheum. doi: 10.1007/s10165-011-0525-5.