Perfil clínico e histopatológico de glomerulopatias em idosos submetidos a biópsia de rim nativo no Brasil
Data
2022-10-23
Autores
Rodrigues, Gisane Cavalcanti 
Orientadores
Kirztajn, Gianna Mastroianni
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O envelhecimento populacional é uma realidade mundial. A população
idosa se caracteriza por apresentar um maior número de comorbidades, dentre elas,
a doença renal crônica (DRC). Segundo o Inquérito brasileiro de diálise de 2019, as
glomerulopatias estão entre as três principais causas de DRC no idoso. Sendo
assim, torna-se necessário conhecer a frequência relativa das principais
glomerulopatias no idoso e as formas de apresentação clínica dessas patologias,
facilitando, com isso, o diagnóstico e tomada de conduta.
Objetivo: Estabelecer as principais características clínicas, laboratoriais e
histopatológicas das glomerulopatias biopsiadas em idosos no Brasil.
Métodos: Análise retrospectiva de 613 biópsias renais de pacientes com 60 anos ou
mais, avaliadas pelo mesmo patologista, no período entre janeiro de 2015 a
dezembro de 2020.
Resultados: A maioria dos pacientes biopsiados eram do sexo masculino (58,7%),
procedentes do sudeste do Brasil (59,2%) e a idade média foi de 67,5 anos (mínimo
de 60 anos, máximo de 91 anos). A principal indicação clínica de biópsia renal foi
síndrome nefrótica (52,4%), seguida de alterações urinárias assintomáticas (21,4%)
e quadros agudos como glomerulonefrite rapidamente progressiva (10,1%) e lesão
renal aguda (8,9%). Considerando os pacientes muito idosos (80 anos ou mais) em
relação às outras faixas etárias (60 a 69 anos e 70 a 79 anos), a glomerulonefrite
rapidamente progressiva foi particularmente mais frequente 16,7% vs. 9,7% e
10,2%, respectivamente. De um modo geral, o diagnóstico histopatológico mais
encontrado foi de glomerulopatia membranosa (23,2%), seguida de glomerulonefrite
pauci-imune (12,7%), nefropatia diabética (10,3%) e glomeruloesclerose segmentar
e focal (9,8%). Quando avaliada a influência do sexo na distribuição dos
diagnósticos: nas mulheres, ocorreu uma maior frequência de nefrite lúpica,
glomerulonefrite pauci-imune, amiloidose e doença de lesões mínimas; nos homens,
foi mais frequente a nefropatia por IgA, glomerulonefrite membranoproliferativa,
glomeruloesclerose segmentar e focal e glomerulonefrite crônica. Em relação às
diferentes faixas etárias: nefropatia diabética foi mais frequente nos idosos mais
jovens, a amiloidose nos idosos entre 70 e 79 anos e a glomerulonefrite pauci-imune
naqueles com 80 anos ou mais. A apresentação clínica de síndrome nefrótica se
associou, principalmente, com os achados histopatológicos de glomerulopatia
membranosa, doença de lesões mínimas e glomeruloesclerose segmentar e focal.
As alterações urinárias assintomáticas se associaram mais com glomerulopatia
membranosa, glomerulonefrite crônica e nefropatia por IgA. Já os quadros crônicos
se associaram com nefropatia diabética, glomerulonefrite pauci-imune,
glomerulonefrite crônica e nefropatia por IgA. Por fim, nos quadros agudos, a
glomerulonefrite pauci-imune foi o achado mais comum.
Conclusão: No presente estudo, observou-se que a apresentação clínica mais
frequente no idoso com glomerulopatia submetido a biópsia renal foi a síndrome
nefrótica, seguida de alterações urinárias assintomáticas e quadros agudos (lesão
renal aguda e glomerulonefrite rapidamente progressiva), sendo que esses últimos
foram mais frequentes nos pacientes com 80 anos ou mais. O achado
histopatológico mais encontrado na população estudada como um todo foi a
glomerulopatia membranosa, seguida de glomerulonefrite pauci-imune, nefropatia
diabética e glomeruloesclerose segmentar e focal. Destacamos que grande parte
dos diagnósticos encontrados nos pacientes idosos são de doenças com potencial
de melhora com o tratamento específico, o que reforça a importância da biópsia
renal em idosos.
Introduction: Population aging is a global reality. The elderly population is characterized by having a greater number of comorbidities, including chronic kidney disease (CKD). According to the Brazilian dialysis survey 2019, glomerulopathies are among the three main causes of CKD in the elderly. Therefore, it is necessary to know the main glomerulopathies in the elderly and their forms of presentation, to facilitate diagnosis and management. Objective: To establish the main clinical, laboratory and histopathological characteristics of biopsied glomerulopathies in the elderly in Brazil. Methods: Retrospective analysis of 613 renal biopsies from patients aged 60 years or older, evaluated by the same pathologist, in the period between January 2015 and December 2020. Results: Most patients undergoing biopsy were male (58.7%), from Southeastern Brazil (59.2%) and the mean age was 67.5 years (varied from 60 years to 91 years). The main clinical indication for renal biopsy was nephrotic syndrome (52.4%), followed by asymptomatic urinary abnormalities (21.4%) and acute conditions such as rapidly progressive glomerulonephritis (10.1%) and acute renal injury (8.9%). Considering very elderly patients (80 years or older) in relation to other age groups (60-69 and 70-79 years), rapidly progressive glomerulonephritis was particularly more frequent 16.7% vs. 9.7% and 10.2%, respectively. In general, the most common histopathological diagnosis was membranous glomerulopathy (23.2%), followed by pauci-immune glomerulonephritis (12.7%), diabetic nephropathy (10.3%) and focal segmental glomerulosclerosis (9.8 %). When the influence of gender on the distribution of diagnoses was evaluated: in women, there was a higher frequency of lupus nephritis, pauci-immune glomerulonephritis, amyloidosis and minimal lesion disease; in men, IgA nephropathy, membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis, and chronic glomerulonephritis were more frequent. Particular features of the different age groups were detected: diabetic nephropathy was more frequent in the younger elderly, amyloidosis in the elderly between 70 and 79 years old, and pauci-immune glomerulonephritis in those aged 80 or older. The clinical presentation of nephrotic syndrome was mainly associated with the histopathological findings of membranous glomerulopathy, minimal lesion disease and focal segmental glomerulosclerosis. Asymptomatic urinary abnormalities were more associated with membranous glomerulopathy, chronic glomerulonephritis and IgA nephropathy. Chronic conditions were associated with diabetic nephropathy, pauci-immune glomerulonephritis, chronic glomerulonephritis and IgA nephropathy. Finally, in acute cases, pauci-immune glomerulonephritis was the most common finding. Conclusion: In the present study, it was observed that the most frequent clinical presentation in the elderly with glomerulopathy undergoing renal biopsy was nephrotic syndrome, followed by asymptomatic urinary changes and acute conditions (acute renal failure and rapidly progressive glomerulonephritis), were more frequent in patients aged 80 years or older. The most common histopathological finding found in the population studied as a whole was membranous glomerulopathy, followed by pauci-immune glomerulonephritis, diabetic nephropathy, and focal segmental glomerulosclerosis. We emphasize that most of the diagnoses found in elderly patients are diseases with potential for improvement with specific treatment.
Introduction: Population aging is a global reality. The elderly population is characterized by having a greater number of comorbidities, including chronic kidney disease (CKD). According to the Brazilian dialysis survey 2019, glomerulopathies are among the three main causes of CKD in the elderly. Therefore, it is necessary to know the main glomerulopathies in the elderly and their forms of presentation, to facilitate diagnosis and management. Objective: To establish the main clinical, laboratory and histopathological characteristics of biopsied glomerulopathies in the elderly in Brazil. Methods: Retrospective analysis of 613 renal biopsies from patients aged 60 years or older, evaluated by the same pathologist, in the period between January 2015 and December 2020. Results: Most patients undergoing biopsy were male (58.7%), from Southeastern Brazil (59.2%) and the mean age was 67.5 years (varied from 60 years to 91 years). The main clinical indication for renal biopsy was nephrotic syndrome (52.4%), followed by asymptomatic urinary abnormalities (21.4%) and acute conditions such as rapidly progressive glomerulonephritis (10.1%) and acute renal injury (8.9%). Considering very elderly patients (80 years or older) in relation to other age groups (60-69 and 70-79 years), rapidly progressive glomerulonephritis was particularly more frequent 16.7% vs. 9.7% and 10.2%, respectively. In general, the most common histopathological diagnosis was membranous glomerulopathy (23.2%), followed by pauci-immune glomerulonephritis (12.7%), diabetic nephropathy (10.3%) and focal segmental glomerulosclerosis (9.8 %). When the influence of gender on the distribution of diagnoses was evaluated: in women, there was a higher frequency of lupus nephritis, pauci-immune glomerulonephritis, amyloidosis and minimal lesion disease; in men, IgA nephropathy, membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis, and chronic glomerulonephritis were more frequent. Particular features of the different age groups were detected: diabetic nephropathy was more frequent in the younger elderly, amyloidosis in the elderly between 70 and 79 years old, and pauci-immune glomerulonephritis in those aged 80 or older. The clinical presentation of nephrotic syndrome was mainly associated with the histopathological findings of membranous glomerulopathy, minimal lesion disease and focal segmental glomerulosclerosis. Asymptomatic urinary abnormalities were more associated with membranous glomerulopathy, chronic glomerulonephritis and IgA nephropathy. Chronic conditions were associated with diabetic nephropathy, pauci-immune glomerulonephritis, chronic glomerulonephritis and IgA nephropathy. Finally, in acute cases, pauci-immune glomerulonephritis was the most common finding. Conclusion: In the present study, it was observed that the most frequent clinical presentation in the elderly with glomerulopathy undergoing renal biopsy was nephrotic syndrome, followed by asymptomatic urinary changes and acute conditions (acute renal failure and rapidly progressive glomerulonephritis), were more frequent in patients aged 80 years or older. The most common histopathological finding found in the population studied as a whole was membranous glomerulopathy, followed by pauci-immune glomerulonephritis, diabetic nephropathy, and focal segmental glomerulosclerosis. We emphasize that most of the diagnoses found in elderly patients are diseases with potential for improvement with specific treatment.