分析老年(年龄≥60岁)肾脏病患者临床及肾脏病理特点。

收集2010年1月至2016年12月在我科行肾穿刺活检的老年患者742例，对其性别、年龄、原发性疾病、肾脏病理类型及肾穿刺后并发症进行回顾性分析。以卡方检验比较老年患者与青年患者肾活检并发症的发生率，数据采用SPSS 19.0统计学软件处理。

①742例老年患者，年龄60～88岁，平均年龄(72.7±11.3)岁；60～74岁637(85.8%)，75～88岁105例(14.2%)。男性426例(57.4%)。②患高血压者331例(44.6%)；贫血272例(36.7%)；高尿酸血症199例(26.8%)；低蛋白血症257例(34.6%)。CKD1～5期比例分别为27.4%、33.8%、29.8%、7.1%、1.9%。③与同期行肾活检年龄≤60岁患者比较，老年患者肾穿刺术后肾周大血肿、需要输血、需行肾动脉栓塞等严重出血并发症的风险无统计学差异(χ² ＝0.457、0.108、0.199，P>0.05)。④742例老年患者中，原发性肾小球疾病390例(52.6%)，继发性肾小球疾病268例(36.1%)，肾小管间质疾病72例(9.7%)，其他12例(1.6%)。原发性肾脏疾病以膜性肾病和系膜增生性肾小球肾炎最为常见，分别为30.4%和17.3%；继发性肾脏病中糖尿病肾病占21.3%、高血压肾损害和肿瘤相关性肾损害分别为12.3%和11.9%。

老年肾脏病患者高血压、贫血、高尿酸血症发生率高。原发性肾脏病以膜性肾病为多见，继发性肾脏病以糖尿病肾病、肿瘤相关肾损害最为常见。对于老年肾脏病患者均应结合临床，筛查继发病因。对于无肾穿禁忌证的老年肾脏病患者，应积极行肾活检应明确病理类型指导治疗、判断预后。

To analyze the clinical and renal pathological features of over-60-year-old patients with kidney diseases.

A total of 742 elderly patients diagnosed with the renal biopsy from January 2010 to December 2016 were retrospectively analyzed for the gender, age, primary disease, and renal pathology types. Chi-square test was used to compare the incidence of renal biopsy complications between elderly and young patients, and the data were treated with SPSS 19.0 statistical software.

① There were altogether 742 elderly patients, who aged 60-88 years, with an average age of (72.7 ± 11.3) years, among whom 637 patients (85.8%) aged 60-74 years, and 105 cases (14.2%) aged 75-88 years, with 426 males (57.4%). ② Between the less-than-60-year-old patients diagnosed with the renal biopsy during the same period of time, and the over-60-year-old patients, there were no statistically significant differences in the risk of severe bleeding complications including perirenal big hematoma, blood transfusion requirement, and renal artery embolization (χ²=0.457, 0.108, 0.199, respectively, all P>0.05). ③ There were 331 cases with hypertension (44.6%), 272 cases with anemia (36.7%), 199 cases with hyperuricemia (26.8%), and 257 cases with hypoproteinemia (34.6%). The proportions of patients with CKD stages 1-5 were 27.4%, 33.8%, 29.8%, 7.1%, and 1.9%, respectively. ④ Among the 742 elderly patients, there were 390 cases with primary glomerular diseases (52.6%), 268 cases with secondary glomerular diseases (36.1%), 72 cases with tubulointerstitial diseases (9.7%), and 12 cases with other diseases (1.6%). Membranous nephropathy (30.4%) and mesangial proliferative glomerulonephritis (17.3%) were the most common among the primary kidney diseases, while among the secondary kidney diseases, diabetic nephropathy accounted for 21.3%, hypertensive kidney damage 12.3%, and tumor-related kidney damage 11.9%.

Hypertension, anemia, and hyperuricemia are the most common in elderly patients with kidney diseases. Membranous nephropathy predominated the primary kidney diseases, while diabetic nephropathy and tumor-related kidney damage predominated the secondary kidney diseases. In the elderly patients, secondary causes should be screened. For elderly patients with kidney diseases, if without contraindications, the renal biopsy should be actively conducted for determining the pathological type, guiding the treatment, and evaluating the prognosis.