Publication:

Clinicopathological spectrum of glomerular disorders in adult versus elderly patients: a prospective observational study from a tertiary care centre in North India

Background The clinicopathological spectrum of glomerular disorders differs between adult and elderly populations, yet comparative biopsy-based data from India are limited. We aimed to compare and characterise the histopathological profile, clinical presentation, and procedural safety of native kidney biopsy in adult (≤59 years) and elderly (≥60 years) patients at a tertiary care centre in north India.

Methods A prospective observational study was conducted at AIIMS Rishikesh from October 2025 to February 2026. A total of 168 patients who underwent native kidney biopsy were enrolled and stratified into two age groups: adults (≤59 years, n=145) and elderly (≥60 years, n=23). Demographic, clinical, laboratory, histopathological, and post-procedural complication data were collected. Statistical analysis was performed using Chi-square/Fisher’s exact test for categorical variables and independent samples t-test for continuous variables.

Results In adults, IgA nephropathy (14.4%), focal segmental glomerulosclerosis (FSGS, 13.1%), and membranous nephropathy (MN, 13.1%) predominated, while in elderly, MN (26.1%), diabetic kidney disease (DKD, 21.7%), pauci-immune crescentic glomerulonephritis (17.4%), and myeloma-related disorders (MGRS/LCCN, 17.4%) were most common. Hypertension (56.5% vs 28.3%; p=0.007), anuria (26.1% versus 7.6%; p=0.015), and serum urea (127.52 versus 82.08 mg/dl; p=0.004) were significantly higher in the elderly. ANA positivity was significantly higher in adults (55.0% versus 20.0%; p=0.040). Post-biopsy perinephric haematoma was significantly more frequent in the elderly (34.8% versus 11.0%; p=0.034).

Conclusions Distinct age-specific differences in glomerular disease patterns were observed. The spectrum shifted from immune-mediated glomerulonephritis (IgAN, FSGS, lupus nephritis) in adults to metabolic, vascular, and paraprotein-related pathologies (MN, DKD, ANCA-GN, MGRS) in the elderly. Age alone should not preclude kidney biopsy, though heightened post-procedural vigilance is warranted in elderly patients.