Evaluation of Renal Biopsies in the Elderly: A Single-Center Experience

Chronic kidney disease (CKD) is increasingly prevalent in the elderly population, necessitating precise diagnostic approaches such as renal biopsy. However, concerns about procedural risk often deter clinicians from performing biopsies in older adults. To evaluate the clinical indications, histopathological findings, and complication rates of native kidney biopsies in patients aged 65 years and older. This retrospective single-center study included 165 elderly patients who underwent native kidney biopsy between 2008 and 2024. Demographic, clinical, laboratory, and histopathological data were analyzed. Biopsies of transplanted kidneys and those with inadequate clinical or pathological information were excluded. The mean age of the cohort was 70.7±4.9 years, and 60.6% were male. The most common indication for biopsy was nephrotic syndrome (63%), followed by acute kidney injury (24.2%). Membranous glomerulopathy (18.8%) was the most frequent histopathological diagnosis, followed by pauci-immune glomerulonephritis (13.9%) and AA amyloidosis (10.9%). Renal replacement therapy was required in 20.6% of cases. Biopsy-related complications were infrequent, including hematoma (1.8%), transfusion requirement (1.8%), and angiographic intervention (0.6%), with no procedure-related mortality. Renal biopsy in the elderly demonstrates high diagnostic yield and a low complication rate. Membranous glomerulopathy, pauci-immune glomerulonephritis, and AA amyloidosis were the leading treatable diagnoses. These findings support perform renal biopsy in older patients when clinically indicated, emphasizing that advanced age alone should not preclude histopathologic evaluation.