Is focal segmental glomerulosclerosis common among the elderly? Geriatric biopsy results.

A s the overall life expectancy in the geriatric population increases, geriatric patients who have acute or chronic diseases are also living longer, and therefore, are utilizing outpatient clinics more frequently. The renal problems of the older patients are often bound to many extra-renal problems. A principal reason for this is that the glomerular filtration rate (GFR), which decreases along with aging, also decreases in cardiovascular diseases, or due to the nephrotoxic effects of drugs, which are used more frequently when treating the elderly. Diseases that are related to diabetic complications and side effects of therapeutic agents are also seen more often in this age group. Edema, when found in hypertensive patients is accepted as secondary to cardiac insufficiency, and the real incidence of renal pathology is overlooked. Age-related kidney injury observed histologically includes marked widening of the glomerular basal membrane (GBM), expansion of the mesangial compartment, enlargement of the glomerulus, and the development of glomerulosclerosis. Glomerulosclerosis is more common among the elderly (5% at age 40, and up to 30% at age 80). 1 This is explained by the physiological and pathological senescence, and this explanation of physiological senescence has been changed by the observation of an animal model study, aging itself caused focal or global glomerulosclerosis in normotensive rats. They concluded that early podocyte damage may be a factor driving the development of glomerulosclerosis through podocyte injury. 2 Podocytes are injured in many forms of human glomerular diseases as well, and is now considered to be the major culprit for the progression of chronic kidney disease (CKD). 3 In most cases of CKD, degeneration of the nephron follows the pattern of focal segmental glomerulosclerosis (FSGS). 4 It was formerly thought to be a nonspecific glomerular change occurring in a variety of conditions (reflux, obesity) or progression of minimal change disease (MCD). Identification of podocyte proteins (nephrin, podocin) and their mutations resulted in FSGS being considered as a primary podocyte disease in recent years. If aging is a factor driving development of FSGS through podocyte injury, by analyzing the kidney biopsies performed at our clinics over the past 8 years, we sought to clarify the reasons for kidney function disorders in older patients, and assessed the incidence of FSGS in geriatric patients. After the opening in 2004 of the new Nephropathology unit with immunofluorescence (IF) microscopy in Antalya Training Hospital, and in 2005 in Aydin Adnan Menderes University Hospital, …