Clinicopathological spectrum of glomerular diseases in elderly.

Dineshkumar, T (2013) Clinicopathological spectrum of glomerular diseases in elderly. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Advances in modern health care have led to increase in geriatric population. The annual growth rate of people more than 60 years is faster than any other age group. Aging is associated with renal structural changes and functional decline. As life expectancy increases, the prevalence of elderly patients living with renal diseases is more. The biology of aging with associated co morbid illness like diabetes, hypertension, cardiovascular disease often modify the clinical presentations, pathological findings and natural history of renal disease in the elderly. The incidence of glomerular disease in elderly is varies in different population from 5 to 20% and it is ever increasing. Due to aging, co morbid illnesses and blunted immune response, clinical presentations are often atypical. Renal biopsy is the gold standard for diagnosing glomerular diseases, yet less than 15% renal biopsies were from age more than 60 years. This leads to under diagnosis and delay in treatment. The studies on geriatric nephrology in India are limited, that too in glomerular diseases were scarce. We intend to study the spectrum of glomerular diseases in the elderly and its clinico pathological correlation. AIMS : To study the clinico pathological spectrum of glomerular diseases in elderly patients and their outcomes. MATERIALS AND METHODS : Ours is a cross sectional descriptive study, done on elderly patients of age 60 or more years with clinical diagnosis of glomerular diseases and underwent renal biopsy in the department of Nephrology, Madras Medical College, Chennai, from August 2010 through December 2012. CONCLUSION : 1. 64% of glomerular diseases were due to secondary causes, primary renal disease contributes to about 36% 2. The most common cause of glomerulonephritis in our setup is post infectious glomerulonephritis, which contributes to 23% cases. 3. Vasculitis is the second most common cause glomerulonephritis in our elderly population, comprising 17% patients. 4. Membranous nephropathy is the most common cause of nephrotic syndrome in our study accounting for 16% total cases and 46% of patients with nephrotic syndrome. 5. One fourth of membranous nephropathy is due to secondary cause. Hence it is important to screen for chronic infections, malignancy and systemic illness in a newly detected patient with membranous nephropathy. 6. In contrast to other studies, minimal change disease is less common in elderly population in our study; On the contrary there is high prevalence of FSGS. 7. Patients with PIGN had better renal outcomes in our series when compared to other studies. 65% had complete recovery, 25% had persistent renal dysfunction and 10% developed ESRD. On univariate analysis, peak creatinine of more than 4mg at presentation, need for dialytic support and the presence of crescents in biopsy were found to have statistically significance. In multivariate analysis, only peak creatinine at presentation had statistical significance. 8. In patients with Vasculitis, the outcome was poor.15% died on initial admission, 30% became dialysis dependent, 30% had persistent renal dysfunction and only 5% made complete recovery. 9. Outcomes of nephrotic syndrome is not easy to assess in our population, since 40% were not started on immunosupression due to co morbid illness and about 25% were not on regular follow up.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinicopathological spectrum ; glomerular diseases ; elderly.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 04:42
Last Modified: 11 Jul 2017 07:29

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