Kidney Biopsy in Elderly Patients: Is It Really the Case to Desist?

Introduction: Italy is the second country in the world for elderly population, after Japan, with an estimated population over 75 years of 11,7% while 7,18% are those over 80s. Of those, 42,3% have three or more chronic diseases (ISTAT data 2019). We investigated our kidney biopsy (KB) database from 2002 to 2024, looking at all the KB performed in patients over 80s, in our nephrology unit. Case Description: We performed a KB in a 84 female with acute kidney injury and nephrotic syndrome, approaching dialysis. We diagnosed a “Light Chain Cast Nephropathy” in the setting of Multiple Myeloma with multiple osteolytic lesions. She rapidly started steroids and Bortezomib showing rapid and stable improvement of clinical symptoms and laboratory tests. We wondered if age still represent a limit to perform KB. From 2002 to 2024 we performed 7150 KB; 1,8% were performed in patients with an age over 80. Of the 131 patients, 54 were females and 77 were males, with a median age of 82 (range 80 to 96). Figure 1 shows renal biopsy diagnoses. The most frequent diagnoses were Membranous Nephropathy (19%), Vasculitis (15,2%), Amyloidosis (12,2%), followed by Light chain Cast Nephropathy (8,3 %), Minimal Change Disease and Focal Segmental Glomerulosclerosis (7,6% respectively). Discussion: These diagnoses may represent a challenge, particularly in elderly patients with comorbidities. Personalized therapy can help in slow the progression of renal damage, improving their outcome even in vulnerable patients, as occurred in our case report. We will investigate the outcomes of each patient related to clinical presentation, diagnose, comorbidities and treatment. Our preliminary data show the importance of histological diagnosis, confirming the power of renal biopsy even in advanced ages, in order to identify the underlying pathology and evaluate which is the most appropriate personalized treatment option.