Clinicopathologic Spectrum of Nephrotic Syndrome in the Elderly

The elderly population is affected by a wide range of kidney diseases like young adult patients. However, their clinical course and morphological manifestations are affected by aging. Recognition, diagnosis, and management of glomerular disease in elderly persons have several unique challenges. We aimed to study the clinicopathologic spectrum of elderly patients with nephrotic syndrome (NS). In this retrospective study, we looked at 234 patients of adult NS who were biopsied during the last 5 years. Among them, 31 patients were above the age of 60 years (Elderly). Mean age in elderly patients was 67.48 ± 6.11 years, with age range from 60 to 86 years. Elderly NS patients constituted 13.2% of total adult NS patients. Nineteen patients (61.2%) were males and 12 (38.7%) were females. Hematuria was observed in 19% and hypertension in 48% patients. Mean serum albumin was 2.79 ± 0.39 g/dl and mean 24 h urinary protein was 3.77 ± 0.8 grams. Membranous nephropathy (MN) followed by minimal change disease (MCD) was the most common diagnosis. No major complication with biopsy was reported in our study as has been the case with most studies

Combined T2 and diffusion-weighted MR Imaging with template prostate biopsies in men suspected with prostate cancer but negative transrectal ultrasound-guided biopsies

PURPOSE: Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported. MATERIALS AND METHODS: A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study. RESULTS: In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate. CONCLUSIONS: Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate