A Retrospective Analysis Of The Clinical And Pathological Features Of Elderly Patients With Kidney Disease And Risk Factors Of Left Ventricular Hypertrophy Of Elderly Patients With Chronic Kidney Disease

Objective1.The prevalence of kidney disease in the elderly is high,with complex etiology.Considering some differences of reference standards about renal biopsy needle and renal pathological in various regions,this study intends to analyze the clinical and pathological features and relationship between them of the old patients with kidney disease in our hospital.That can provide an important theoretical basis for the local elderly with kidney disease.2.The incidence and mortality rate of cardiovascular events in old patients with CKD is high,LVH is the main cause of heart failure and sudden cardiac death in patients with CKD.Early detection,intervention of cardiovascular disease is of a great significance to improve the prognosis of elderly patients with CKD.So retrospective analysis the risk factors of left ventricular hypertrophy in elderly patients with CKD1 ~4 stages.Method1.Collected the clinical manifestations and pathological types of 371 cases in our hospital during October in 2006 to December in 2014,who were older than 65 years old,and clinical manifestation for chronic kidney disease and / or acute renal injury.Then retrospective analyze the composition of their clinical manifestations and pathological types.2.To screen the 88 cases of old patients with CKD1~4 stages,who had performed the cardiac ultrasound and 24 hour ambulatory blood pressureat at the same time of renal biopsy,and calculate LVMI by Devereux formula,then divided the patients into LVH group and non-LVH group according to LVMI.Collected 24 hours ambulatory blood pressure index(24h-SBP,24h-DBP,24h-MBP,d-SBP,d-DBP,d-MBP,n-SBP,n-DBP,n-MBP),24 hour urine protein quantitation,Hb,PLT,Alb,Scr,UA,Cyc,Ca,P,TG,calcium and phosphorus product,CHOL,HDL,LDL.Then calculate e GFR by the CKD-EPI formula;if patients Alb<40g/L,corrected calcium value by Payne formula.Then to compare the differences between the two groups and analyze of risk factors for LVH.Results1.The results of clinical and pathological characteristics in elderly patients with kidney disease:(1)In the 371 cases of elderly patients,CKI and NS are the common clinical manifestations,account for 53.6%,33.2% respectively;Primary glomerular diseases is more common than secondary glomerular diseases,MN,Ig AN are the main types in the former,accounted for 20.2%(75/371),12.7%(47/371),respectively,and DN,HTN,kidney damage associated with tumors are common in the latter,each accounted for 10.8%(40/371),6.5%(24/371)and 2.7%(10/371).(2)MN,Ig AN are the principal types in patients with CKI,accounting for 18.1%,17.6% respectively.MN,DN are more common in patients with NS,accounting for 34.9%,8.9% respectively.In patients with AKI and NS complicated with AKI,AITN was the major pathological types,accounting for 75%,36.4% respectively.In patients with AUA,MN and Ig AN are common,each accounting for 35.7%,21.4%.2.The results of the analysis about risk factors of LVH in elderly patients with CKD1~4 phases:(1)In the 88 cases of elderly patients with CKD,LVH have 28 cases and account for 31.8%,the prevalence of LVH in CKD1 ~ 4 were11.1%(2/18)?30.8%(12/39)?44.4%(12/27)?50.0%(2/4),respectively;(2)Compared with non-LVH,patients with LVH have higher incidence of nocturnal hypertension,and higher levels of 24h-SBP,24h-MBP,d-SBP,d-MBP,n-SBP,n-MBP,serum phosphorus,calcium phosphorus product also elevated(P < 0.05);(3)There're positively correlations between LVH and the incidence of nocturnal hypertension,levels of 24h-SBP,24h-MBP,d-SBP,d-MBP,n-SBP,nMBP,serum phosphorus,calcium phosphorus product,e GFR<60ml/min.1.73m2(P < 0.05);(4)In patients with LVH,hypertension,daytime systolic blood pressure,serum phosphorus and eGFR<60 ml/min.1.73m2 are the risk factors.Conclusion1.In elderly patients with kidney disease,CKI is the most common clinical manifestation,and primary glomerular diseases is the chief pathologic type,in which MN,IgAN are the main types.While the secondary factors in elderly patients are complex and diverse,that DN,HTN,renal injury associated tumor are common types.2.In elderly patients with CKD1~4 phases,the incidence of LVH is high.Blood pressure level,history of hypertension,calcium and phosphorus metabolism disorder and renal function damage are significant causes of LVH in elderly patients with CKD.