Analysis of pathological spectrum characteristics in elderly patients with nephrotic syndrome: a comparative study with non-elderly patients

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BACKGROUND: With the acceleration of population aging, elderly patients with nephrotic syndrome (NS) demonstrate a distinct histopathological profile compared to younger cohorts. This study aimed to characterize the renal histopathological spectrum in elderly NS patients from 2014 to 2023. METHODS: Pathological data from 628 elderly NS patients (≥60 years) were retrospectively analyzed and compared with a control group of 1416 younger NS patients (18-59 years). Pathological diagnosis were classified according to the 1995 WHO revised criteria for glomerular diseases. Statistical analyses were performed using the chi-square test. RESULTS: A progressive increase in the proportion of elderly patients with NS was observed, rising from 28.9% in 2014 to 37.6% in 2023. Among 544 elderly patients with primary NS, idiopathic membranous nephropathy (IMN) was the predominant pathological type (66.7%, 363/544), followed by minimal change disease (MCD) (18.6%, 101/544). Among 84 elderly patients with secondary NS, renal amyloidosis was most frequent (29.8%, 25/84), followed by diabetic nephropathy (DN) (25.0%, 21/84). The incidence of IMN increased from 63% in 2014-2018 to 71.2% in 2019-2023, while the incidence of MCD decreased from 21.7% to 15.1%. The incidence of DN decreased significantly from 34.3% in 2014-2018 to 14.3% in 2019-2023. Elderly NS patients exhibited significantly more severe glomerulosclerosis, tubular atrophy, interstitial fibrosis, inflammatory infiltration, and arteriolar hyalinization than younger patients. CONCLUSIONS: Among biopsy-confirmed cases in the elderly patients, IMN represents the predominant etiology of primary NS, while renal amyloidosis emerges as the leading cause of secondary NS. Elderly patients with NS exhibit more severe glomerulosclerosis and tubulointerstitial pathology compared to younger individuals.

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