Clinicopathological spectrum of glomerular disorders in adult versus elderly patients: a prospective observational study from a tertiary care centre in North India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20263110Keywords:
ANCA-associated vasculitis, Elderly, Glomerular disease, IgA nephropathy, India, Membranous nephropathy, Renal biopsyAbstract
Background: The clinicopathological spectrum of glomerular disorders differs between adult and elderly populations, yet comparative biopsy-based data from India are limited. We aimed to compare and characterise the histopathological profile, clinical presentation, and procedural safety of native kidney biopsy in adult (≤59 years) and elderly (≥60 years) patients at a tertiary care centre in north India.
Methods: A prospective observational study was conducted at AIIMS Rishikesh from October 2025 to February 2026. A total of 168 patients who underwent native kidney biopsy were enrolled and stratified into two age groups: adults (≤59 years, n=145) and elderly (≥60 years, n=23). Demographic, clinical, laboratory, histopathological, and post-procedural complication data were collected. Statistical analysis was performed using Chi-square/Fisher’s exact test for categorical variables and independent samples t-test for continuous variables.
Results: In adults, IgA nephropathy (14.4%), focal segmental glomerulosclerosis (FSGS, 13.1%), and membranous nephropathy (MN, 13.1%) predominated, while in elderly, MN (26.1%), diabetic kidney disease (DKD, 21.7%), pauci-immune crescentic glomerulonephritis (17.4%), and myeloma-related disorders (MGRS/LCCN, 17.4%) were most common. Hypertension (56.5% vs 28.3%; p=0.007), anuria (26.1% versus 7.6%; p=0.015), and serum urea (127.52 versus 82.08 mg/dl; p=0.004) were significantly higher in the elderly. ANA positivity was significantly higher in adults (55.0% versus 20.0%; p=0.040). Post-biopsy perinephric haematoma was significantly more frequent in the elderly (34.8% versus 11.0%; p=0.034).
Conclusions: Distinct age-specific differences in glomerular disease patterns were observed. The spectrum shifted from immune-mediated glomerulonephritis (IgAN, FSGS, lupus nephritis) in adults to metabolic, vascular, and paraprotein-related pathologies (MN, DKD, ANCA-GN, MGRS) in the elderly. Age alone should not preclude kidney biopsy, though heightened post-procedural vigilance is warranted in elderly patients.
References
Reisman L, Dikman S, Churg J, Kupfer S. Renal biopsy: Why and when. Mt Sinai J Med. 1996;63:178 90.
Yoon HE, Shin MJ, Kim YS, Choi BS, Kim BS, Choi YJ, et al. Clinical impact of renal biopsy on outcomes in elderly patients with nephrotic syndrome. Nephron Clin Pract. 2011;117:c20-7.
Perkowska-Ptasinska A, Deborska-Materkowska D, Bartosiewicz W, Stompór T, Żelichowski G, Nowak B, et al. Kidney disease in the elderly: biopsy-based data from 14 renal centers in Poland. Nephrol Dial Transplant. 2016;31(11):1837-48.
Beniwal P, Sharma S, Agarwal D, Chaudhary SC, Mahanta P, Joshi N, et al. Spectrum of renal histological lesions in elderly patients in Rajasthan: A hospital-based study. Indian J Nephrol. 2020;30(5):322-9.
Thangaraju S, Viswanathan V, Raman R, Ramakrishnan S, Rajendran R, Balaji S, et al. Spectrum of biopsy-proven renal disease in the elderly: A cohort study from a tertiary care center in South India. Indian J Nephrol. 2023;33(4):261-9.
Mittal T, Rathi M. Renal diseases in elderly: Clinicohistological study of 103 patients from a tertiary care centre in North India. Indian J Nephrol. 2014;24(3):145-52.
Rivera F, López-Gómez JM, Pérez-García R; Spanish Registry of Glomerulonephritis. Frequency of renal pathology in Spain 1994-1999. Nephrol Dial Transplant. 2002;17(9):1594-602.
Moutzouris DA, Herlitz L, Appel GB, Markowitz GS, Freudenthal B, Radhakrishnan J, et al. Renal biopsy in the very elderly. Clin J Am Soc Nephrol. 2009;4(6):1073-82.
Lefaucheur C, Stengel B, Nochy D, Martel P, Hill GS, Jacquot C, et al. Membranous nephropathy and cancer: epidemiologic evidence and determinants of high-risk cancer association. Kidney Int. 2006;70(8):1510-7.
Jayne D, Rasmussen N, Andrassy K, Bacon P, Tervaert JW, Dadoniené J, et al. A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med. 2003;349(1):36-44.
Gertz MA. Immunoglobulin light chain amyloidosis: 2022 update on diagnosis, prognosis, and treatment. Am J Hematol. 2022;97(6):818-29.
Bridoux F, Leung N, Hutchison CA, Touchard G, Sethi S, Fermand JP, et al. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015;87(4):698-711.
Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP; Italian Immunopathology Group, Italian Society of Nephrology. The Italian experience of the national registry of renal biopsies. Kidney Int. 2004;66(3):890-4.
Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis. 2012;60(1):62-73.
Downloads
Published
How to Cite
Issue
Section
