S SO1,2, B BOSE1,3, E FISCHER1, M KOMALA1,3, K SUD1,3, N WONG1
1Department of Renal Medicine, Nepean Hospital, Kingswood, Australia, 2Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 3University of Sydney, Nepean Clinical School, Kingswood, Australia
Aim: To retrospectively analyse the prevalence of renal histopathology diagnoses in elderly patients in the Nepean Blue Mountains Local Health District (NBMLHD) over 10 years.
Background: NBMLHD services a population numbering over 345,000. Australia’s elderly population (aged 65 and over) continues to grow, reflected in patient demographics. This audit describes the renal histopathology diagnoses in the elderly population in greater Western Sydney, a growing area of healthcare need.
Methods: Demographic, laboratory and renal histopathology data was collected from electronic health records in all patients aged 65 years and over who had a renal biopsy from 2008-2017. All biopsies were performed under radiologic guidance and analysed at Westmead Hospital histopathology laboratory.
Results: Of 117 biopsies, three were excluded because of inadequate sampling. The median age at biopsy was 71.6 years (65-86.6). 50 biopsies (44.2%) revealed glomerulonephritides (17 ANCA-associated vasculitis, 9 IgA nephropathy, 8 membranoproliferative glomerulonephritis, 7 membranous nephropathy, 9 other including focal segmental glomerulosclerosis, minimal change disease and lupus nephritis). Diabetic nephropathy was the next most common in 12 biopsies (10.6%), followed by hypertensive or ischaemic nephropathy in 8 (7%), amyloidosis in 8 biopsies and acute tubular necrosis in 8 biopsies. 7 biopsies (6.2%) showed interstitial nephritis. 20 biopsies showed other changes, including 2 thrombotic microangiopathy, 1 cast nephropathy and 1 oxalate nephropathy. One biopsy was normal.
Conclusions: Although we acknowledge the selection bias in our population, our audit of histopathological diagnoses in the elderly found a high prevalence of glomerulonephritides. This highlights that age should not be an absolute contraindication for renal biopsies, as these diagnoses have implications on management and clinical outcomes. This may help guide informed decision-making for both nephrologists and elderly patients.
Dr So is a second-year renal advanced trainee in the Western Sydney renal network.