scholarly journals P0114BENEFITS AND CHALLENGES OF A RENAL BIOPSY REGISTRY AND NETWORK - FCGG EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wim Laurens ◽  
Johan De Meester ◽  
Ben Sprangers ◽  
Steven Van Laecke ◽  
Dendooven Amélie ◽  
...  
Keyword(s):  
Renal Disease ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Clinical Care ◽  
Adult Population ◽  
Age Groups ◽  
Time Frame ◽  
Renal Pathology ◽  
Renal Diseases ◽  
Renal Biopsies

Abstract Background and Aims End December 2016, a renal biopsy network in the Flemish region (Belgium) was founded as a collaboration between the renal pathologists and nephrologists. This FCGG network introduced a uniform renal biopsy request form, a well-structured report form of the renal pathology examination and a comprehensive list of renal pathology diagnoses. Method Following informed consent [99.5%] and in compliance with GDPR, the registration of the renal biopsies consists of basic categorical renal data, structured renal pathology information and the final clinical renal disease. Results In 2017 and 2018, 1385 renal biopsies were registered – 10.5 per million inhabitants per year; in addition, 28 patients had a repeat biopsy in the same time frame (2%). Of the pediatric patients ( age < 18 years; N=92; 6.6%), 23 had IgA nephropathy, 20 a minimal change disease and 15 another type of glomerulonephritis. The biopsy was reported as normal or non-diagnostic in 15 patients (16%) – the majority was clinically considered as glomerulonephritis. The spectrum of the adult population was quite similar across gender and age groups: 56% glomerulonephritis [= IgA nephropathy [19%] + FSGS [8%] + pauci-immune glomerulonephritis [7%] + other GN [22%] ), 10% tubulo-interstitial nephritis, 7% acute tubular necrosis [ATN], 7% diabetes mellitus, and 7% nephroangiosclerosis. Exceptions are pauci-immune glomerulonephritis as the most important renal disease in women aged 65 years and older, and lupus nephritis as the second most important glomerulonephritis in women aged 18-44 years. Only a small percentage of adult renal biopsies yielded no result (7%), clinically interpreted as glomerulonephritis in 50% of the cases. Conclusion The FCGG network has provided a more intense collaboration between renal pathologists and nephrologists mainly by standardizing the renal biopsy reading and reporting across all centers. More precise estimates of the prevalent renal diseases were provided for the first time; however, in order to get full information, renal diseases diagnosed by other techniques ( serology, genetic analysis ) should also be collected in the future. Efforts will be done to coordinate the clinical care of renal diseases, particularly the more rare renal diseases, and to offer access to new therapeutic molecules or new schemes, through this super-regional network.

scholarly journals P0134PROTEINURIA IS NOT ALWAYS ASSOCIATED WITH PROGNOSIS IN IGA NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Byoung-Soo Cho ◽  
Hyaejin Yun ◽  
Sungmin Jung ◽  
Hyun-soon Lee
Keyword(s):  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Surrogate Marker ◽  
Pulse Therapy ◽  
Methylprednisolone Pulse Therapy ◽  
Renal Pathology ◽  
Crescent Formation ◽  
Methylprednisolone Pulse ◽  
Renal Biopsies

Abstract Background and Aims To date the most widely well studied risk factor for progression to ESRD in patients with IgA nephropathy is proteinuria. Recent report suggests proteinuria reduction as a surrogate end point in trial of IgA nephropathy(2019,CJASN). Sensitivity of most biomarkers such as blood and urine gd-IgA1 level, IgG/IgA autoantibody, sCD89, sCD71, NGAL, KIM-1, Cystatin-C etc were compared with the amount of proteinuria. Most nephrologists do not performing kidney biopsy in patients without proteinuria or proteinuria less than than 500mg/day even though IgA nephropathy is suspected. However we recently experienced severe IgA nephropathy (HSD Lee, grade IV) in patients with normal urinalysis, and more than half the patients showed stationary or aggravated renal pathology at the follow up renal biopsy although urinalysis findings were normalized after methylprednisolone pulse therapy. Method In our center we performed 892 renal biopsies during last 6 years, we experienced 253 IgA nephropathy, of which 152 cases were done follow up renal biopsies to see the pathologic changes who showed normalized urinalysis findings after methylprednisolone pulse therapy. Results Of the 253 patients 241 patients showed initial abnormal urinalysis like hematuria and or proteinuria. However eleven patients showed normal urinalysis at the time of renal biopsy, of which 5 cases were diagnosed as essential hypertension and 6 cases were normal urinalysis associated with lowered GFR. Of the 152 follow up renal biopsies we evaluated 99 cases who showed normalized urinalysis findings after therapy, of which 65 cases(65.7%) showed stationary or aggravated renal pathology. Conclusion In conclusion further long term studies are needed, proteinuria could not be a surrogate marker for prognosis of the IgA nephropathy, Regardless of proteinuria if associated with hypertension and or lowered GFR, renal biopsy should be done. Follow up renal biopsy might be needed to confirm the healing of IgA nephropathy regardless of urinary findings to see the disappearance of IgA deposition, decreasing mesangial and endocapillary hypercellularity, disappearance of crescent formation, decreasing sclerosis, etc.

MONOCLONAL ANTIBODY IDENTIFICATION OF FIBRIN DEPOSITS IN RENAL DISEASE

1987 ◽  
Author(s):  
A Bini ◽  
V D"Agati ◽  
C Pirani ◽  
B Kudryk ◽  
K L Kaplan
Keyword(s):  
Renal Disease ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Acute Interstitial Nephritis ◽  
Renal Diseases ◽  
Immunoperoxidase Technique ◽  
Intense Staining ◽  
Group I ◽  
Group Ii ◽  
Membranous Gn

Glomerular and vascular "fibrin" deposition has frequently been reported in human and experimental renal diseases. The biochemical form of this "fibrin" has not been well defined. We studied 16 renal biopsies (Bouin's fixed paraffin embedded) with the ABC-immunoperoxidase technique using monoclonal antibodies (MAbs); MAb I8C6 (Bβ1-42) to fibrinogen and fibrin I; MAb T2G1 (β15-42) to fibrin II; and MAb GC4 to fragment D or D-D. Polyclonal antisera to fibrinogen, albumin and IgG were used as controls. Renal biopsy specimens included 9 cases of microangiopathy (Group I: 6 hemolytic uremic syndrome (HUS), 1 sclerodero-ma, 2 acute humoral rejection) and 7 miscellaneous cases of other renal disease (Group II: 2 IgA nephropathy, 2 minimal change disease, 2 membranous GN, 1 acute interstitial nephritis). Fibrinogen and fibrin I were present on the glomerular (glom) endothelial cells in 8/9 Group I and 7/7 Group II cases, but was present in glom capillary lumens in Group I only. Staining of the endothelial aspect of interstitial capillaries, arterioles and arteries was also observed in both groups. Fibrin II was present in most glom and interstitial capillaries in both groups. However, intense staining for fibrin II was observed in arterioles and arteries in Group I only. Staining for fragments D and D-D was observed in glom capillaries in 6 Group I cases (6 HUS) and 3 Group II cases (2 IgA nephropathy, 1 membranous GN) but was most diffuse and intense in Group I. Traditional histochemical stains for fibrin (Lendrum and PTAH) were positive in 4 Group I cases only, indicating that the ABC technique is far more sensitive. Controls (14 needle biopsies of non-renal tissue) showed no vascular ractivity for fibrinogen, fibrin I, II and fragments D and D-D, suggesting that the vascular staining observed in renal biopsy tissue is not caused by the biopsy procedure itself. These findings indicate that 1) Fibrin formation and lysis occur in many renal diseases of both vascular and non—vascular origin. 2) Fibrinolytic activity is higher in the glom capillaries than in the larger vessels. 3) Damaged renal endothelium may be an active participant in these processes.

PERCUTANEOUS RENAL BIOPSY IN CHILDREN

PEDIATRICS ◽  
1962 ◽  
Vol 30 (2) ◽  
pp. 287-296
Author(s):  
W. F. Dodge ◽  
C. W. Daeschner ◽  
J. C. Brennan ◽  
H. S. Rosenberg ◽  
L. B. Travis ◽  
...  
Keyword(s):  
Renal Disease ◽  
Renal Biopsy ◽  
Clinical Importance ◽  
Renal Diseases ◽  
Renal Lesion ◽  
Bleeding Tendency ◽  
Percutaneous Renal Biopsy ◽  
The One ◽  
Selection Of

Since 1951, when the percutaneous renal biopsy was introduced as an adjunctive method for study of patients with renal disease, reports of some 4,000 kidney biopsies have appeared in the literature. Only about 250 of these, however, have been performed in children. A biopsy specimen containing 5 to 10 glomeruli has been reported to be adequate for interpretation and to be representative of the total renal parenchyma in 84% of the cases with diffuse renal disease. Using a biopsy technique similar to that described by Kark, we have obtained an adequate specimen in 92% of 205 kidney biopsies performed in 168 children with diffuse renal diseases. Seven deaths have been previously reported in the literature. The circumstances surrounding the death of these seven patients and of the one death that occurred in our series are described. Perirenal hematoma has had a reported incidence of 0.4%. It has been our experience, as well as that of the other investigators, that if blood boss is replaced, the patient has an otherwise uneventful course and the mass subsequently disappears. Gross hematuria has had a reported incidence of 5.2%. Microscopic hematuria, lasting for 6 to 12 hours after biopsy, has been found to be the rule rather than the exception. The complications which have occurred have been associated with bleeding, and therefore a careful history concerning bleeding tendency and a study of the clotting mechanism is essential if the risk of needle renal biopsy is to be minimized. In addition to a bleeding tendency or defect in clotting mechanism, most investigators are agreed that the presence of only one kidney or an uncooperative patient are absolute contraindications to renal biopsy. The renal biopsy is primarily, at present, an additional and most useful investigative tool in the elucidation of the pathogenesis, natural history (by serial studies) and effectiveness of specific therapy upon the various renal diseases. It is of practical clinical importance in the selection of those patients with the nephrotic syndrome in whom glucocorticoid therapy is likely to be beneficial or the patient with anuria whose renal lesion is probably reversible with time; and, as a guide to the effectiveness of therapy in patients with pyelonephritis or lupus nephritis. It is not a technique that can be recommended for general or casual use. A classification of the pathohistobogic findings of diffuse glomerulonephritis, patterned after Ellis, is presented and discussed. This classification will be used in the description and discussion of various renal diseases and systemic diseases with associated nephritis in the three subsequent papers.

RENAL BIOPSY IN CHILDREN

PEDIATRICS ◽  
1958 ◽  
Vol 22 (6) ◽  
pp. 1033-1034
Author(s):  
ROBERT L. VERNIER ◽  
ROBERT A. GOOD
Keyword(s):  
Kidney Disease ◽  
Renal Biopsy ◽  
Needle Biopsy ◽  
Kidney Biopsy ◽  
Therapeutic Agents ◽  
Renal Diseases ◽  
Kidney Cortex ◽  
Percutaneous Needle Biopsy ◽  
Surgical Exploration ◽  
Renal Biopsies

RENAL biopsy offers invaluable aid in the clinical diagnosis of kidney disease and is an important technique in research designed to clarify the etiology, pathogenesis, and evaluation of therapeutic agents, in a variety of renal diseases. The majority of the scientific reports describing renal biopsy have concerned adult patients. The few available reports of renal biopsy in children do not discuss the risks attending the procedure or the specific problems peculiar to kidney biopsy in children. A review of our experience in 150 renal biopsies in children may afford a basis for evaluation of these questions. The available techniques of renal biopsy include: 1) surgical exploration and removal of a segment of kidney cortex, and 2) percutaneous needle biopsy.

The Relevance of Periglomerular Fibrosis in the Evaluation of Routine Needle Core Renal Biopsies

2011 ◽  
Vol 135 (1) ◽  
pp. 117-122
Author(s):  
Joseph Jenkins ◽  
Sergey V. Brodsky ◽  
Anjali A. Satoskar ◽  
Gyongyi Nadasdy ◽  
Tibor Nadasdy
Keyword(s):  
Renal Function ◽  
Renal Biopsy ◽  
Renal Injury ◽  
Interstitial Fibrosis ◽  
Renal Diseases ◽  
Glomerular Sclerosis ◽  
Poor Renal Function ◽  
Renal Biopsies ◽  
Biopsy Report ◽  
Relationship Of

Abstract Context—Renal interstitial fibrosis and, to a lesser extent, sclerotic glomeruli correlate with poor renal function. However, not all nonfunctional glomeruli are sclerotic. Many or most glomeruli with periglomerular fibrosis, while retaining blood flow, probably do not filter; therefore, they may not contribute to renal function. Objective—To examine the relationship of periglomerular fibrosis and the sum of globally sclerotic glomeruli and glomeruli with periglomerular fibrosis (GSG+PF) with interstitial fibrosis and renal function. Design—Native kidney biopsies from 177 patients with chronic renal injury were assessed for interstitial fibrosis, glomerular sclerosis, and GSG+PF. Renal biopsies with active or acute lesions were not included. The percentage of globally sclerotic glomeruli and GSG+PF was correlated with the degree of interstitial fibrosis and serum creatinine levels. Results—The percentage of GSG+PF correlates better with the degree of interstitial fibrosis and renal function than does the percentage of globally sclerotic glomeruli alone. This appears particularly true in chronic renal diseases of patients without diabetes. The number of globally sclerotic glomeruli correlates better with interstitial fibrosis and renal function than does the sum of globally and segmentally sclerotic glomeruli. Conclusions—The percentage of GSG+PF in a renal biopsy specimen provides a better estimate of chronic renal injury than does the percentage of sclerotic glomeruli alone, probably because many or most glomeruli with periglomerular fibrosis are nonfunctional. Therefore, we recommend that the number of glomeruli with periglomerular fibrosis also be provided in the renal biopsy report.

scholarly journals The modern spectrum of biopsy-proven renal disease in Chinese diabetic patients—a retrospective descriptive study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4522 ◽  
Author(s):  
Diankun Liu ◽  
Ting Huang ◽  
Nan Chen ◽  
Gang Xu ◽  
Ping Zhang ◽  
...  
Keyword(s):  
Renal Disease ◽  
Renal Biopsy ◽  
Descriptive Study ◽  
Clinical Indication ◽  
Diabetic Patients ◽  
Tubular Necrosis ◽  
Diabetic Renal Disease ◽  
Tubulointerstitial Nephropathy ◽  
Renal Biopsies ◽  
Male Patients

Background Renal biopsies performed in diabetic patients are increasing and becoming more complex. Comprehensive data on modern spectrum of biopsy-proven renal disease in Chinese diabetic patients are lacking. Methods In a nationwide renal biopsy survey including 71,151 native biopsies from 2004 to 2014, diabetic patients were identified according to the clinical diagnosis from referral records. The clinical data were extracted from referral records and pathological reports. Results A total of 1,604 diabetic patients, including 61 patients with T1DM, were analyzed in this study. The median age is 51.39 ± 11.37 years. Male patients accounted for 58% of the population. We found that only 44.7% of diabetic patients had the isolated pathological diagnosis of diabetic nephropathy (DN), while 49.1% had non-diabetic renal disease (NDRD) alone, and 6.2% had NDRD superimposed on DN. Nephrotic syndrome (n = 824, 51.4%) was the most common clinical indication for renal biopsy. Among 887 patients with NDRD, membranous nephropathy (n = 357) was the leading diagnosis, followed by IgA nephropathy (n = 179). Hypertensive renal disease (n = 32), tubulointerstitial nephropathy (n = 27) and acute tubular necrosis (n = 16) accounted for 3.5%, 2.9%, 1.7% of the NDRD cases respectively. Nearly a half (49.2%) of patients with T1DM had NDRD. Discussion Over 55% diabetic patients with kidney disease were diagnosed as non-diabetic renal disease, among which MN and IgAN were the most common two pathological types.

scholarly journals Future of the Renal Biopsy: Time to Change the Conventional Modality Using Nanotechnology

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Hamid Tayebi Khosroshahi ◽  
Behzad Abedi ◽  
Sabalan Daneshvar ◽  
Yashar Sarbaz ◽  
Abolhassan Shakeri Bavil
Keyword(s):  
Renal Disease ◽  
Renal Biopsy ◽  
Diagnostic Methods ◽  
Renal Outcome ◽  
Renal Diseases ◽  
Pathological Findings ◽  
Renal Imaging ◽  
Pathological Conditions ◽  
Conventional Modality

At the present time, imaging guided renal biopsy is used to provide diagnoses in most types of primary and secondary renal diseases. It has been claimed that renal biopsy can provide a link between diagnosis of renal disease and its pathological conditions. However, sometimes there is a considerable mismatch between patient renal outcome and pathological findings in renal biopsy. This is the time to address some new diagnostic methods to resolve the insufficiency of conventional percutaneous guided renal biopsy. Nanotechnology is still in its infancy in renal imaging; however, it seems that it is the next step in renal biopsy, providing solutions to the limitations of conventional modalities.

Frequency of Renal Diseases in Diabetic Patients

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Misbah Arshad ◽  
Mamoona Ashfaq ◽  
Zainab Sharmeen ◽  
Zargham Mazhar ◽  
Kashifa Ehsan
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Nephropathy ◽  
Kidney Disease ◽  
Renal Disease ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Renal Diseases ◽  
Diabetic Patients ◽  
Protein Loss ◽  
Cross Sectional

Diabetic nephropathy, also known as diabetic kidney disease is the chronic loss of kidneyfunction occurring in those with diabetes mellitus. Diabetic nephropathy is one of the leading causes ofchronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. Protein loss in the urine due todamage to the glomeruli may become massive, and cause a low serum albumin with resulting generalizedbody swelling (edema) and result in the nephrotic syndrome. Objective: The aim of this study was todetermine the frequency of renal disease in diabetic patients and its complications in Pakistan.Methods: A cross sectional study was conducted at Renal and Diabetic Departments of the Sir GangaRam Hospital, Lahore, over a period of 3 months, after obtaining the ethical approval from The Universityof Lahore. A total number of 100 Diabetic patients were selected through non probability convenientsampling technique. Patients of both sexes and all age groups were included. Results: In this study 60%were male and 40% were female. About 41% diabetic patients were 1-6 month of age, 42% were 1-5 yearsold and 1% of 18-23 years old who had renal diseases while 9% patients were without any renal disease.whereas the prevalence of diabetes is more in infants than others which is 35%. But there was notsignificant association between onset of renal diseases with the onset of diabetes mellitus with p-value0.24.Conclusions: Results of current study showed that diabetes mellitus effecting individuals of all agesequally but there was not significant association between diabetes and renal diseases.

scholarly journals Toward Noninvasive Diagnosis of IgA Nephropathy: A Pilot Urinary Metabolomic and Proteomic Study

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Michaela Neprasova ◽  
Dita Maixnerova ◽  
Jan Novak ◽  
Colin Reily ◽  
Bruce A. Julian ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Renal Biopsy ◽  
Iga Nephropathy ◽  
Invasive Procedure ◽  
Pilot Project ◽  
Urine Samples ◽  
Renal Diseases ◽  
Single Individual ◽  
Healthy Controls ◽  
Spot Urine

IgA nephropathy is diagnosed by renal biopsy, an invasive procedure with a risk of significant complications. Noninvasive approaches are needed for possible diagnostic purposes and especially for monitoring disease activity or responses to treatment. In this pilot project, we assessed the utility of urine samples as source of biomarkers of IgA nephropathy. We used spot urine specimens from 19 healthy controls, 11 patients with IgA nephropathy, and 8 renal-disease controls collected on day of renal biopsy. Urine samples were analyzed using untargeted metabolomic and targeted proteomic analyses by several experimental techniques: liquid chromatography coupled with mass spectrometry, immunomagnetic isolation of target proteins coupled with quantitation by mass spectrometry, and protein arrays. No single individual biomarker completely differentiated the three groups. Therefore, we tested the utility of several markers combined in a panel. Discriminant analysis revealed that combination of seven markers, three metabolites (dodecanal, 8-hydroxyguanosine, and leukotriene C4), three proteins (α1-antitrypsin, IgA-uromodulin complex, and galactose-deficient IgA1), and heparan sulfate, differentiated patients with IgA nephropathy from patients with other renal diseases and healthy controls. Future studies are needed to validate these preliminary findings and to determine the power of these urinary markers for assessment of responses to therapy.

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