Biopsy-Proven Renal Diseases in the Elderly: A Developing Country Perspective

Renal diseases are one of the common causes of morbidity and mortality in elderly population. Currently, the spectrum of renal diseases in elderly population in our country is unknown. The aim of this study was to determine the pattern of renal diseases in elderly patients in Pakistan. In this retrospective, observational study, we included all consecutive patients aged ≥60 years, on whom native renal biopsies were performed during a period of 25 years from January 1994 to December 2018. The final histologic diagnosis was categorized into four groups, primary glomerular diseases (PGDs), secondary glomerular diseases (SGDs), tubulointerstitial disease (TID), and vascular diseases (VDs). A total of 324 renal biopsies are performed in the study period. The mean age was 64.6 ± 5.1 years, range of 60-80 years with a male-to-female ratio of 3.26:1. The mean serum creatinine at biopsy was 4.1 ± 2.86 mg/dL. Indications for biopsy were acute kidney injury (AKI) in 141 (43.5%), followed by nephrotic syndrome (NS) in 128 (39.5%). Renal disease category was PGD in 204 (63%), SGD in 42 (13%), TID in 58 (17.9%), and VD in 20 (6.1%). Focal segmental glomerulosclerosis (FSGS) is the leading cause of PGD in 55 (27%). Among SGD, amyloidosis was the most common cause in 27 (64.3%). In patients who were biopsied for AKI, majority were crescentic glomerulonephritis accounting for 28 (19.8%). In conclusion, AKI and NS are the common biopsy indications in our population. Overall FSGS is the most common histologic diagnosis in this cohort.