Background: Studies on renal histology results in very elderly patients are extremely rare. Methods: We analyzed histology and clinical findings in patients aged over 85 years undergoing renal biopsy and whose data were included in the Spanish Registry of Glomerulonephritis between 1994 and 2009. Results: A total of 17,680 native kidney biopsies were taken: 71 (0.4%) were from patients aged over 85 years. Acute kidney injury (AKI) was the main indication for biopsy (47%), followed by nephrotic syndrome (32%). Amyloidosis was the most common histological diagnosis (16.9%), followed by crescentic glomerulonephritis type 3 associated with systemic vasculitis (14.1%). When histological findings were correlated with clinical syndromes, we found that amyloidosis was the leading cause of AKI (18.8%), and also the main determinant of nephrotic syndrome, with the same frequency as membranous nephropathy (22%). Crescentic glomerulonephritis type 3 associated with vasculitis was related to a greater diversity of clinical syndromes, especially chronic kidney disease (40%) and AKI (40%). Conclusions: Renal biopsy in the very elderly provides us with useful information, despite the advanced age of the patients. AKI and nephrotic syndrome are the main indication for renal biopsy in this subgroup of patients, and amyloidosis is the most frequent histological pattern associated with both syndromes.

1.
Rivera F, López-Gómez JM, Pérez García R: Clinicopathological correlations of renal pathology in Spain. Kidney Int 2004;66:898-904.
2.
Rivera F, López-Gómez JM, Pérez García R: Frequency of renal pathology in Spain 1994-1999. Nephrol Dial Transplant 2002;17:1594-1602.
3.
López-Gómez JM, Rivera F, on behalf of Spanish Registry of Glomerulonephritis: Renal biopsy findings in acute renal failure in the cohort of patients in the Spanish Registry of Glomerulonephritis. Clin J Am Soc Nephrol 2008;3:674-681.
4.
Moorthy AV, Zimmerman SW: Renal disease in the elderly: clinicopathologic analysis of renal disease in 115 elderly patients. Clin Nephrol 1980;14:223-229.
5.
Kingswood JC, Banks RA, Tribe CR, Owen-Jones J, Mackenzie JC: Renal biopsy in the elderly: clinicopathological correlations in 143 patients. Clin Nephrol 1984;22:183-187.
6.
Haas M, Spargo BH, Wit EJ, Meehan SM: Etiologies and outcome of acute renal insufficiency in older adults: a renal biopsy study of 259 cases. Am J Kidney Dis 2000;35:433-447.
7.
Ferro G, Dattolo P, Nigrelli S, Michelassi S, Pizzarelli F: Clinical pathological correlates of renal biopsy in elderly patients. Clin Nephrol 2006;65:243-247.
8.
Preston RA, Stemmer CL, Matterson 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.
9.
Komatsuda A, Nakamoto Y, 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. Inter Med 1993;32:377-381.
10.
Davison AM, Johnston PA: Glomerulonephritis in the elderly. Nephrol Dial Transplant 1996;11:34-37.
11.
Nair R, Bell JM, Walker PD: Renal biopsy in patients aged 80 years and older. Am J Kidney Dis 2004;44:618-626.
12.
Moutzouris DA, Herlitz L, Appel GB, Markowitz GS, Freudenthal B, Radhakrishnan J, D'Agati VD: Renal biopsy in the very elderly. Clin J Am Soc Nephrol 2009;4:1073-1082.
13.
Oreopoulos DG, Glassock RJ, Jassal SV, O'Hare AM, Rosner MH, Swidler MA, Williams ME, Wiggins J: Geriatric nephrology: another milestone in a 25-year journey. Nephrol Self-Assess Prog 2011;10:6-57.
14.
Solez K, Racusen LC: Role of the renal biopsy in acute renal failure; in Ronco C, Bellomo R, La Greca G (eds): Blood Purification in Intensive Care. Contrib Nephrol. Basel, Kar-ger, 2001, vol 132, pp 68-75.
15.
Whittier WL, Korbet SM: Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol 2004;15:142-147.
16.
Spanish National Statistics Institute, 2010: www.ine.es/prensa/np587.pdf (in Spanish).
17.
Stratta P, Segoloni GP, Canavese C, Sandri L, Mazzucco G, Roccatello D, Manganaro M, Vercellone A: Incidence of biopsy-proven primary glomerulonephritis in an Italian province. Am J Kidney Dis 1996;27:631-639.
18.
Korbet SM: Percutaneous renal biopsy. Semin Nephrol 2002;22:254-267.
19.
Zhou XJ, Rakheja D, Yu X, Saxena R, Vaziri ND, Silva FG: The aging kidney. Kidney Int 2008;74:710-720.
20.
Moran D, Korzets Z, Bernheim J, Bernheim J, Yaretzky A: Is renal biopsy justified for the diagnosis and management of the nephrotic syndrome in the elderly? Gerontology 1993;39:49-54.
21.
Levison SP: Renal disease in the elderly: the role of the renal biopsy. Am J Kidney Dis 1990;16:300-306.
22.
Jefferson JA, Alpers CE: Diagnosis: should renal biopsies be performed in the very elderly? Nat Rev Nephrol 2009;5:561-562.
23.
Parrish AE: Complications of percutaneous renal biopsy: a review of 37 years' experience. Clin Nephrol 1992;38:135-141.
24.
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;28:549-555.
25.
Rychlík I, Jancová E, Tesar V, Kolsky A, Lácha J, Stejskal J, Stejskalová A, Dusek J, He-rout V: The Czech registry of renal biopsies. Occurrence of renal diseases in the years 1994-2000. Nephrol Dial Transplant 2004;19:3040-3049.
26.
Anderson S, Eldadah B, Halter JB, Hazzard WR, Himmelfarb J, Horne FM, Kimmel PL, Molitoris BA, Murthy M, O'Hare AM, Schmader KE, High KP: Acute kidney injury in older adults. J Am Soc Nephrol 2011;22:28-38.
27.
Michel DM, Kelly CJ: Acute interstitial nephritis. J Am Soc Nephrol 1998;9:506-515.
28.
González E, Gutiérrez E, Galeano C, Chevia C, de Sequera P, Bernis C, Parra EG, Delgado R, Sanz M, Ortiz M, Goicoechea M, Quereda C, Olea T, Bouarich H, Hernández Y, Segovia B, Praga M, Grupo Madrileño de Nefritis Intersticiales: Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 2008;73:940-946.
29.
Cagnoli L, Italian Society of Nephrology: Instructions and implementations for percutaneous renal biopsy. Guidelines for the therapy of glomerular nephropathies. G Ital Nefrol 2003;20:S3-S47.
30.
Glassock RJ: Glomerular disease in the elderly population. Geriatr Nephrol Urol 1998;8:149-154.
31.
Donadio JV Jr: Treatment and clinical outcome of glomerulonephritis in the elderly. Contrib Nephrol 1993;105:49-57.
32.
Yoon HE, Shin MJ, Kim YS, Choi BS, Kim BS, Choi YJ, Kim YO, Yoon SA, Yang CW: Clinical impact of renal biopsy on outcomes in elderly patients with nephrotic syndrome. Nephron Clin Pract 2010;117:c20-c27.
33.
Bergesio F, Bertoni E, Bandini S, Rosati A, Salvadori M: Changing pattern of glomerulonephritis in the elderly: a change of pre-v-alence or a different approach? Contrib Nephrol 1993;105:75-80.
34.
McGrogan A, Franssen CF, de Vries CS: The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrol Dial Transplant 2011;26:414-430.
35.
Schmitt R, Coca S, Kanbay M, Tinetti ME, Cantley LG, Parikh CR: Recovery of kidney function after acute kidney injury in the elderly: a systematic review and meta-analysis. Am J Kidney Dis 2008;52:262-271.
36.
Schlanger LE, Bailey JL, Sands JM: Geriatric nephrology: a missing area of nephrology's expertise. Nephrol Self-Assess Prog 2011;10:1-5.
37.
Modesto-Segonds A, Ah-Soune MF, Durand D, Suc JM: Renal biopsy in the elderly; in Sessa A, Meroni M, Battini G (eds): Glomerulonephritis in the Elderly. Contrib Nephrol. Basel, Karger, 1993, vol 105, pp 107-116.
38.
Cameron JS: Nephrotic syndrome in the elderly. Semin Nephrol 1996;16:319-329.
39.
Lachmann HJ, Gillmore JD: Renal amyloidosis. Br J Hosp Med 2010;71:83-86.
40.
Wen YK, Chen ML: Differences in new-onset IgA nephropathy between young adults and the elderly. Ren Fail 2010;32:343-348.
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