Clinicopathologic features and prognosis of elderly patients with diabetic nephropathy

Objective To analyze the clinicopathologic features and prognostic of elderly patients with diabetic nephropathy (DN).Methods A retrospective analysis was done to evaluate the clinicopathological features of 25 elderly patients diagnosed as DN by renal biopsy from the Department of Nephrology of China-Japan Friendship Hospital from May, 2005 to May, 2017. The prognosis of 15 elderly patients who were followed up for 6-125 months after biopsy was analyzed. Kidney ending events were defined as creatinine multiplication; maintenance renal replacement therapy; eGFR <15 ml·min^-1·(1.73 m²)^-1or death.Results In these 25 elderly patients with DN, there was one case of typeⅠ, 2 cases of typeⅡa, 6 cases of typeⅡb, 16 cases of type Ⅲ. eGFR in patients of class Ⅲ and Ⅱb was significantly lower than in those of class Ⅰ+Ⅱa. Hemoglobin in patients of class Ⅲ was significantly lower than in those of class Ⅱb. Fifteen elderly patients with DN were followed up for more than 6 months, and 8 cases had kidney ending events, including 2 deaths, 4 cases of maintenance renal replacement therapy due to end-stage renal disease (ESRD), 2 cases of creatinine multiplication without ESRD. An average survival time of elderly DN patients without kidney events was 35 (23, 47) months, and 1-, 2- and 4-year kidney events-free cumulative survival rate was 84.8%, 58.2% and 31.1% respectively. Age, proteinuria, blood pressure, cardiovascular and cerebrovascular events and stains were closely related to renal function in elderly patients with DN.Conclusions Renal function failure progresses faster in elderly patients with DN. Controling the proteinuria, blood pressure and cardiovascular and cerebrovascular events is the key of treatment.