|
Title Renal Biopsy in the Elderly Patients: Data from the Singapore General Hospital Native Kidney Biopsy Registry |
|
Type Poster Presentation |
|
Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
|
Topic Chronic Kidney Disease: Glomerular, Tubulointerstitial and Inherited Kidney disorders |
|
Main Author Nicholas Yue Shuen Yoon1 |
|
Presenting Author Nicholas Yue Shuen Yoon1 |
|
Co-Author Cynthia Ciwei Lim2 Jackie Sim1 Keng Thye Woo2 Yok Mooi Chin2 Wei Ling Teng2 Marjorie Foo2 Jason Choo2 |
|
Department / Institution / Country NA / Yong Loo Lin School of Medicine / Singapore1 Department of Renal Medicine / Singapore General Hospital / Singapore2 |
|
Abstract Content: Introduction, Method, Result, Conclusion Introduction: Kidney biopsy is increasingly performed in older adults but is associated with increased adverse events such as bleeding. It is thus important to ascertain a clear benefit, such as establishing diagnoses that will affect clinical management. As the spectrum of disease in the local elderly is not known, we aimed to evaluate the histopathology and treatment among elderly (≥65 years) with biopsy-proven kidney disease. Methods: The Singapore General Hospital Native Kidney Biopsy Registry, a clinical audit database started in November 2015, was reviewed for clinical, histological and pharmacotherapy data of patients who had kidney biopsies performed between June 2016 and June 2018. Results: Among 398 consecutive patients, 93 (23.4%) were elderly. At presentation, the elderly were more likely to be diabetic (57.1%vs.29.5%, p<0.001) with higher serum creatinine (145(101, 238) vs. 94(63, 187)µmol/L, p<0.001); nephrotic syndrome (36.3%vs.33.3%) and dialysis requirement (5.5%vs.4.4%) were not different between the groups (p>0.05). Lupus nephritis was more common among younger patients (23.7%vs.4.3%, p<0.001), while histological features of focal segmental glomerulosclerosis (43.0%vs.24.7%, p=0.001), hypertensive nephrosclerosis (38.7%vs.18.8%, p<0.001) and acute tubular injury (23.7%vs.9.5%, p=0.001) were more frequent in the elderly. ANCA-associated vasculitis (3.2%vs.1.0%), membranous nephropathy (7.5%vs.5.9%), diabetic nephropathy (25.8%vs.18.1%) and interstitial nephritis (18.3%vs.12.8%) were not different between the groups (p>0.05). Immunosuppressant after biopsy was less frequent in the elderly (33.3%vs.50.7%, p=0.006). Elderly patients who received immunosuppressant had lower serum creatinine [102 (73, 256)vs.162 (115, 217)µmol/L, p=0.01] and were more likely to have membranous nephropathy (19.4%vs.1.8%, p=0.009) and without diabetic nephropathy (0%vs.42.1%, p<0.001) than those who did not have immunosuppressant. Conclusion: As a third of elderly with biopsy-proven kidney disease were treated with immunosuppression, we should further evaluate infective and metabolic adverse events among these vulnerable individuals. |