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Clinical and Experimental Nephrology

, Volume 16, Issue 6, pp 903–920 | Cite as

Renal disease in the elderly and the very elderly Japanese: analysis of the Japan Renal Biopsy Registry (J-RBR)

  • Hitoshi Yokoyama
  • Hitoshi Sugiyama
  • Hiroshi Sato
  • Takashi Taguchi
  • Michio Nagata
  • Seiichi Matsuo
  • Hirofumi Makino
  • Tsuyoshi Watanabe
  • Takao Saito
  • Yutaka Kiyohara
  • Shinichi Nishi
  • Hiroyuki Iida
  • Kunio Morozumi
  • Atsushi Fukatsu
  • Tamaki Sasaki
  • Kazuhiko Tsuruya
  • Yukimasa Kohda
  • Makoto Higuchi
  • Hideyasu Kiyomoto
  • Shin Goto
  • Motoshi Hattori
  • Hiroshi Hataya
  • Shoji Kagami
  • Norishige Yoshikawa
  • Yuichiro Fukasawa
  • Yoshihiko Ueda
  • Hiroshi Kitamura
  • Akira Shimizu
  • Kazumasa Oka
  • Naoki Nakagawa
  • Takafumi Ito
  • Shunya Uchida
  • Kengo Furuichi
  • Izaya Nakaya
  • Satoshi Umemura
  • Keiju Hiromura
  • Mitsuhiro Yoshimura
  • Nobuhito Hirawa
  • Takashi Shigematsu
  • Masafumi Fukagawa
  • Makoto Hiramatsu
  • Yoshio Terada
  • Osamu Uemura
  • Tetsuya Kawata
  • Akira Matsunaga
  • Aki Kuroki
  • Yasukiyo Mori
  • Koji Mitsuiki
  • Haruyoshi Yoshida
Original Article

Abstract

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.

Results

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.

Conclusions

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.

Keywords

Elderly Very elderly Japanese Renal biopsy Registry Nephrotic syndrome IgA nephropathy Rapidly progressive glomerulonephritis Proteinuria 

Notes

Acknowledgments

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.

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Copyright information

© Japanese Society of Nephrology 2012

Authors and Affiliations

  • Hitoshi Yokoyama
    • 6
  • Hitoshi Sugiyama
    • 1
  • Hiroshi Sato
    • 2
  • Takashi Taguchi
    • 3
  • Michio Nagata
    • 4
  • Seiichi Matsuo
    • 5
  • Hirofumi Makino
    • 1
  • Tsuyoshi Watanabe
    • 7
  • Takao Saito
    • 8
  • Yutaka Kiyohara
    • 9
  • Shinichi Nishi
    • 10
  • Hiroyuki Iida
    • 11
  • Kunio Morozumi
    • 12
  • Atsushi Fukatsu
    • 13
  • Tamaki Sasaki
    • 14
  • Kazuhiko Tsuruya
    • 15
  • Yukimasa Kohda
    • 16
  • Makoto Higuchi
    • 17
  • Hideyasu Kiyomoto
    • 18
  • Shin Goto
    • 19
  • Motoshi Hattori
    • 20
  • Hiroshi Hataya
    • 21
  • Shoji Kagami
    • 22
  • Norishige Yoshikawa
    • 23
  • Yuichiro Fukasawa
    • 24
  • Yoshihiko Ueda
    • 25
  • Hiroshi Kitamura
    • 26
  • Akira Shimizu
    • 27
  • Kazumasa Oka
    • 28
  • Naoki Nakagawa
    • 29
  • Takafumi Ito
    • 30
  • Shunya Uchida
    • 31
  • Kengo Furuichi
    • 32
  • Izaya Nakaya
    • 33
  • Satoshi Umemura
    • 34
  • Keiju Hiromura
    • 35
  • Mitsuhiro Yoshimura
    • 36
  • Nobuhito Hirawa
    • 37
  • Takashi Shigematsu
    • 38
  • Masafumi Fukagawa
    • 39
  • Makoto Hiramatsu
    • 40
  • Yoshio Terada
    • 41
  • Osamu Uemura
    • 42
  • Tetsuya Kawata
    • 43
  • Akira Matsunaga
    • 44
  • Aki Kuroki
    • 45
  • Yasukiyo Mori
    • 46
  • Koji Mitsuiki
    • 47
  • Haruyoshi Yoshida
    • 48
  1. 1.Department of Medicine and Clinical ScienceOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
  2. 2.Clinical Pharmacology and TherapeuticsTohoku University Graduate School of Pharmaceutical SciencesSendaiJapan
  3. 3.Department of PathologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of PathologyUniversity of Tsukuba, Faculty of MedicineTsukubaJapan
  5. 5.Department of NephrologyNagoya University Graduate School of MedicineNagoyaJapan
  6. 6.Division of NephrologyKanazawa Medical University School of MedicineUchinadaJapan
  7. 7.Department of Nephrology, Hypertension, Diabetology, Endocrinology, and MetabolismFukushima Medical University School of MedicineFukushimaJapan
  8. 8.Division of Nephrology & Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
  9. 9.Department of Environmental MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan
  10. 10.Division of Nephrology and Kidney CenterKobe University Graduate School of MedicineKobeJapan
  11. 11.Department of Internal MedicineToyama Prefectural Central HospitalToyamaJapan
  12. 12.Japanese Red Cross Nagoya Daini Hospital, Kidney CenterNagoyaJapan
  13. 13.Department of NephrologyKyoto University Graduate School of MedicineKyotoJapan
  14. 14.Department of Nephrology and HypertensionKawasaki Medical SchoolKurashikiJapan
  15. 15.Department of Medicine and Clinical ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
  16. 16.Department of NephrologyKumamoto University Graduate School of Medical SciencesKumamotoJapan
  17. 17.Division of NephrologyShinshu University School of MedicineMatsumotoJapan
  18. 18.Division of Integrated Nephrology and Telemedicine, Department of Community Medical SupportsTohoku Medical Megabank Organization (ToMMo), Tohoku UniversitySendaiJapan
  19. 19.Division of Clinical Nephrology and RheumatologyNiigata University Graduate School of Medical and Dental SciencesNiigataJapan
  20. 20.Department of Pediatric NephrologyTokyo Women’s Medical UniversityTokyoJapan
  21. 21.Department of NephrologyTokyo Metropolitan Children’s Medical CenterTokyoJapan
  22. 22.Department of Pediatrics, Institute of Health BioscienceThe University of Tokushima Graduate School of MedicineTokushimaJapan
  23. 23.Department of PediatricsWakayama Medical UniversityWakayamaJapan
  24. 24.Department of PathologySapporo City HospitalSapporoJapan
  25. 25.Department of PathologyDokkyo Medical University Koshigaya HospitalKoshigayaJapan
  26. 26.National Hospital Organization Chiba–East National Hospita, Clinical Research CenterChibaJapan
  27. 27.Department of PathologyNippon Medical SchoolTokyoJapan
  28. 28.Department of PathologyHyogo Prefectural Nisihinomiya HospitalNishinomiyaJapan
  29. 29.Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal MedicineAsahikawa Medical University HospitalAsahikawaJapan
  30. 30.Division of NephrologyShimane University Faculty of MedicineIzumoJapan
  31. 31.Department of Internal MedicineTeikyo University School of MedicineTokyoJapan
  32. 32.Division of NephrologyKanazawa University HospitalKanazawaJapan
  33. 33.Department of NephrologyIwate Prefectural Central HospitalMoriokaJapan
  34. 34.Department of Medical Science and Cardiorenal MedicineYokohama City University Graduate School of Medicine and School of MedicineYokohamaJapan
  35. 35.Department of Medicine and Clinical ScienceGunma University Graduate School of MedicineGummaJapan
  36. 36.Department of Nephrology and RheumatologyNational Hospital Organization Kanazawa Medical CenterKanazawaJapan
  37. 37.Yokohama City University Medical CenterYokohamaJapan
  38. 38.Division of Nephrology, Department of Internal MedicineWakayama Medical UniversityWakayamaJapan
  39. 39.Division of Nephrology, Endocrinology and MetabolismTokai University School of MedicineIsesakiJapan
  40. 40.Department of NephrologyOkayama Saiseikai General HospitalOkayamaJapan
  41. 41.Department of Endocrinology, Metabolism and NephrologyKochi University, Kochi Medical SchoolKochiJapan
  42. 42.Department of Pediatric NephrologyAichi Children’s Health and Medical CenterObuJapan
  43. 43.Department of NephrologyNational Hospital Organization Hokkaido Medical CenterSapporoJapan
  44. 44.Department of PediatricsYamagata University School of MedicineYamagataJapan
  45. 45.Division of NephrologyShowa University School of MedicineTokyoJapan
  46. 46.Division of Nephrology, Department of MedicineKyoto Prefectural University School of MedicineKyotoJapan
  47. 47.Nephrology and Dialysis CenterJapanese Red Cross Fukuoka HospitalFukuokaJapan
  48. 48.Division of Nephrology, Department of General MedicineUniversity of Fukui, Faculty of Medical SciencesFukuiJapan

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