scholarly journals Characterization and Etiopathogenic Approach of Pediatric Renal Biopsy Patients in a Colombian Medical Center from 2007-2017

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Mayerly Prada Rico ◽  
Carmen Inés Rodríguez Cuellar ◽  
Monica Fernandez Hernandez ◽  
Luz Stella González Chaparro ◽  
Olga Lucía Prado Agredo ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Medical Center ◽  
Pediatric Population ◽  
Systemic Disease ◽  
Renal Involvement ◽  
Histological Finding ◽  
Diagnosis And Prognosis ◽  
Biopsy Diagnosis ◽  
National Reference Center

Introduction. Renal biopsy is the principal instrument to evaluate the diagnosis and prognosis of children with kidney disease. There are relatively few studies establishing epidemiology of its findings in the pediatric population. Methods. A descriptive study was conducted to describe characteristics of pediatric patients who had undergone a renal biopsy over the last 10 years in a national reference center, trying to accomplish an etiopathogenic approach of biopsy findings. Results. 241 patients were included. Most frequent indications were nephrotic syndrome (34.1%) and systemic disease with renal involvement (30.2%). The most prevalent biopsy diagnosis was glomerulonephritis (44%) and among these patients, glomerulonephritis mediated by immune complexes was the most frequent pathogenic type (90.5%). When the biopsy was indicated for proteinuria plus hematuria and systemic disease with renal involvement, the most frequent biopsy diagnosis was glomerulonephritis (60 and 85%, respectively). For isolated hematuria, the predominant biopsy diagnosis was inherited diseases of the glomerular basement membrane (70%) and for nephrotic syndrome, podocytopathy (82%). Glomerulonephritis was more frequent in patients older than 10 yrs (65%) and the rate of postbiopsy major complications was low (1.2%). Conclusion. Immune complex glomerulonephritis was the most frequent histological finding, differing from previous reports. To our knowledge this is the first description that classifies biopsy findings according to the probable pathogenic mechanism.

Approach to the Patient with Glomerular Disease

2018 ◽  
Author(s):  
Richard J. Glassock ◽  
An S De Vriese ◽  
Fernando C. Fervenza
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Glomerular Diseases ◽  
Diagnosis And Prognosis ◽  
Protein Excretion ◽  
Clinical Syndromes ◽  
Organ Systems ◽  
Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

Approach to the Patient with Glomerular Disease

2018 ◽  
Author(s):  
Richard J. Glassock ◽  
An S De Vriese ◽  
Fernando C. Fervenza
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Rapidly Progressive Glomerulonephritis ◽  
Chronic Glomerulonephritis ◽  
Glomerular Diseases ◽  
Diagnosis And Prognosis ◽  
Protein Excretion ◽  
Clinical Syndromes ◽  
Organ Systems ◽  
Therapeutic Decision Making

Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement

scholarly journals Case Report: A Rare Presentation of NSAID-Induced Secondary Membranous Nephropathy in a Pediatric Patient

2021 ◽  
Vol 9 ◽  
Author(s):  
Siddharth Shah ◽  
M. Asope Elder ◽  
Jessica Hata
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Membranous Nephropathy ◽  
Ace Inhibitor ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Lower Abdominal Pain ◽  
Rare Presentation ◽  
Phospholipase A2 Receptor ◽  
Secondary Membranous Nephropathy

Background: Membranous nephropathy (MN) is a common cause of nephrotic syndrome in adults, but it is responsible for <5% of nephrotic syndrome cases in children. MN has primary and secondary forms. Secondary MN is caused by viral infections, autoimmune diseases like lupus, or drugs. Non-steroid anti-inflammatory drug (NSAID)-induced secondary MN is rarely described in the pediatric population. Thus, the clinical presentation and time to recovery are vastly unknown in the pediatric subgroup.Clinical Presentation: We report a case of a 15-year-old female who presented with acute onset of nephrotic range proteinuria, significant hypoalbuminemia, hyperlipidemia, and lower extremity edema related to the presence of nephrotic syndrome. She had a history of ibuprofen use periodically for 6 months before presentation because of menstrual cramps and intermittent lower abdominal pain. After the presentation, we performed a renal biopsy that reported stage 1–2 MN, likely secondary. The phospholipase A2 receptor (PLA2R) antibody on the blood test and PLA2R immune stain on the renal biopsy sample were negative. We performed a comprehensive evaluation of the viral and immune causes of secondary MN, which was non-revealing. She had stopped ibuprofen use subsequent to the initial presentation. She was prescribed ACE inhibitor therapy. After 6 months of ACE inhibitor treatment, the proteinuria had resolved.Conclusion: Proteinuria can last for several weeks when NSAID induces secondary MN and nephrotic syndrome. With the widespread use of NSAIDs prevalent in the pediatric community, further studies are needed to evaluate and study the role of NSAIDs in this condition.

Hodgkin Disease and Nephrotic Syndrome, a Rare Paraneoplastic Complication in Children with Literature Review

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4832-4832
Author(s):  
Sehba Dsilva ◽  
Gungor Karayalcin ◽  
Sharon Singh
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Minimal Change Disease ◽  
Pediatric Population ◽  
Minimal Change ◽  
Hodgkin Disease ◽  
Humoral Factors ◽  
History Of ◽  
Work Up ◽  
Nodular Sclerosing

Abstract The association between Hodgkin Disease (HD) and paraneoplastic Nephrotic Syndrome is well documented in adults but is relatively uncommon in the pediatric population. We describe two children with HD who initially presented with Nephrotic Syndrome. Case 1: 12- year-old boy who presented with a two-week history of periorbital edema, proteinuria and hypertension and was diagnosed with Nephrotic Syndrome. The renal biopsy showed minimal change disease. Since the patient developed dyspnea, further work-up was done and he was found to have a large mediastinal mass. Core needle biopsy of the mass was consistent with HD, nodular sclerosing type. Case 2: 14-year-old boy diagnosed to have Nephrotic Syndrome with biopsy proven minimal change disease and was treated intermittently with steroids over 6 months. He subsequently developed dyspnea and was found to have a right paratracheal mass and excisinal biopsy was consistent with HD, nodular sclerosing type. Both these patients initially presented with Nephrotic Syndrome which completely resolved after the first course of chemotherapy for HD. Upon review of literature, there have been 23 pediatric cases of Nephrotic Syndrome associated with HD in patients ranging in age between 2–15 years. The renal biopsy was not done for 8 of these patients and the diagnosis was established clinically. Fifteen patients had biopsies, 9 had minimal change disease, 1 mesangial hypercellularity, 1 glomerulosclerosis, 1 undetermined histology and 3 were normal. In all cases, the Nephrotic Syndrome was refractory to steroids and resolved with treatment of the HD. Pathogenesis of the Nephrotic Syndrome associated with HD is not known, however there are speculations about T-cell involvement and production of lymphokines and humoral factors which may be responsible for the glomerular damage.

scholarly journals Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

2016 ◽  
Vol 43 (1) ◽  
pp. 1-19 ◽  
Author(s):  
Marco Fiorentino ◽  
Davide Bolignano ◽  
Vladimir Tesar ◽  
Anna Pisano ◽  
Wim Van Biesen ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Renal Biopsy ◽  
Systemic Disease ◽  
Renal Involvement ◽  
Renal Diseases ◽  
Evidence Based ◽  
Source Population ◽  
Glomerular Diseases ◽  
Number Of Patients ◽  
Renal Histology

Background: Although the number of patients reaching end-stage kidney disease without a biopsy-proven diagnosis is increasing, the utility of renal biopsy is still an object of debate. We analyzed epidemiological data and the main indications for renal biopsy with a systematic, evidence-based review at current literature. Summary: There is a high discrepancy observed in biopsy rates and in the epidemiology of glomerular diseases worldwide, related to the different time frame of the analyzed reports, lack of data collection, the different reference source population and the heterogeneity of indications. The evidence-based analysis of indications showed that renal biopsy should be crucial in adults with nephrotic syndrome or urinary abnormalities as coexistent hematuria and proteinuria and in corticosteroid resistant-children with severe proteinuria. The knowledge of renal histology can change the clinical management in patients with acute kidney injury significantly, after the exclusion of pre-renal or obstructive causes of kidney damage. Scarce evidence indicates that renal biopsy can be useful in patients with advanced chronic kidney disease and its use should always be considered after weighing the benefits and potential risks. Renal biopsy should be crucial in patients with renal involvement due to systemic disease. In patients with diabetes with atypical features, renal biopsy may be fundamental to diagnose an unexpected parenchymal disease mislabeled as diabetic nephropathy. Finally, in elderly patients, the indications and the risks are not different from those in the general population. Key Message: Renal biopsy still remains a concrete approach for managing a substantial percentage of renal diseases.

P0437IS RENAL BIOPSY NEEDED FOR THE DIAGNOSIS OF NEPHROPATHIES OR IT IS SUFFICIENT WITH A CLINICAL DIAGNOSIS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Leonardo Calle Garcia ◽  
Astrid Rodriguez Gomez ◽  
Manuel Heras Benito ◽  
Giomar Urzola Rodriguez ◽  
Maria Jose Fernandez-Reyes Luis
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Clinical Diagnosis ◽  
Demographic Data ◽  
Kappa Coefficient ◽  
Clinical Report ◽  
Cross Sectional ◽  
Biopsy Diagnosis ◽  
Tubulointerstitial Nephropathy ◽  
Necrotizing Glomerulonephritis

Abstract Background and Aims Percutaneous renal biopsy (PRB) guided by ultrasound is the gold standard for the diagnosis of nephropathies and glomerulopathies. Sometimes, comorbidity and relative contraindications for PRB could condition us to consider clinical diagnosis as sufficient to treat renal pathology. This is a continuous challenge for the nephrologist due to the prognostic and therapeutic diversity of the different types of nephropathies. Therefore, we wonder if in most cases it is still necessary to perform PRB, or clinical diagnosis would be enough in a significant number of them. We decided to assess our PRB series over 15 years, comparing clinical and biopsy diagnosis, and learning about the complications associated with the technique. Method Cross-sectional analysis of the 262 PRB conducted between January 2003 and December 2018. In our department, before performing the PRB, doctors always make a clinical report with different diagnostic possibilities that facilitates the pathologist's work. For this study the first diagnostic option, being the most clinically compatible with the patient, was always taken. We also collected socio-demographic data, clinical data (hypertension and diabetes mellitus), pre and post-biopsy diagnosis, and complications associated with the technique. For the statistical analysis, the SPSS 15 program was used to calculate frequencies, and the Kappa coefficient for diagnostic concordance. Results 262 PRB were performed, of which 149 (56.9%) were performed in men and 113 (43.1%) in women. Average age: 58.6 ± 19.2 years. 173 patients were hypertensive (66%) and 50 had DM (19.1%). Renal pathologies by age are similar to the data reported by Spanish Society. The table shows the concordance measured by the kappa coefficient in the pre and post-PRB diagnosis of the most frequent nephropathies. There were 15 PRB with complications (5.8%): 12 minors (4.6%, haematuria and hematoma); and 3 major: 2 haemorrhages (0.8%) and 1 nephrectomy (0.4%). 33 PRB (12.6%) were inconclusive due to insufficient material. Conclusion From the data obtained, a high mismatch was observed in very common nephropathies in our environment, such as IgA nephropath and pauci-immune focal and segmental necrotizing glomerulonephritis. In contrast, PRB showed more cases of diabetic nephropathy and tubulointerstitial nephropathy. In the case of the pathologies due to nephrotic syndrome (table) we find a high discordance. This may be due to the fact that in all of those cases there was an initial nephrotic syndrome, and our clinical diagnosis was partly based on the frequency of glomerulopathies in the adult. In conclusion, the different concordances between pre and post-biopsy diagnoses show us that clinical diagnosis is not enough to obtain a final diagnosis. In most cases PRB is necessary for the definitive diagnosis. In addition, after the introduction of the ultrasound, complications have decreased, especially when the biopsy is performed by the nephrologist.

A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

2021 ◽  
pp. 1753495X2199021
Author(s):  
Priyanka S Sagar ◽  
Eddy Fischer ◽  
Muralikrishna Gangadharan Komala ◽  
Bhadran Bose
Keyword(s):  
Nephrotic Syndrome ◽  
Early Diagnosis ◽  
Renal Biopsy ◽  
Early Pregnancy ◽  
Minimal Change Disease ◽  
Minimal Change ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Prompt Diagnosis ◽  
In Pregnancy

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.

scholarly journals The Continuing Need for Electron Microscopy in Examination of Medical Renal Biopsies: Examples in Practice

2021 ◽  
pp. 1-15
Author(s):  
Michifumi Yamashita ◽  
Mercury Y. Lin ◽  
Jean Hou ◽  
Kevin Y.M. Ren ◽  
Mark Haas
Keyword(s):  
Electron Microscopy ◽  
Renal Biopsy ◽  
Renal Allograft ◽  
Comprehensive Evaluation ◽  
Diagnostic Value ◽  
Ultrastructural Studies ◽  
The Past ◽  
Biopsy Diagnosis ◽  
Renal Biopsies ◽  
Clinical Consequences

<b><i>Background:</i></b> For the better part of the past 6 decades, transmission electron microscopy (EM), together with routine light microscopy and immunofluorescence and/or immunohistochemistry (IHC), has been an essential component of the diagnostic workup of medical renal biopsies, particularly native renal biopsies, with increasing frequency in renal allograft biopsies as well. Studies performed prior to the year 2000 have indeed shown that a substantial fraction of renal biopsies cannot be accurately diagnosed without EM. Still, EM remains costly and labor-intensive, and with increasing pressure to reduce healthcare costs, some centers are de-emphasizing diagnostic EM. This trend has been coupled with advances in IHC and other methods in renal biopsy diagnosis over the past 2–3 decades. <b><i>Summary:</i></b> Nonetheless, it has been our experience that the diagnostic value of EM in the comprehensive evaluation of renal biopsies remains similar to what it was 20–30 years ago. In this review, we provide several key examples from our practice where EM was essential in making the correct renal biopsy diagnosis, ranging from relatively common glomerular lesions to rare diseases. <b><i>Key Messages:</i></b> EM remains an important component of the diagnostic evaluation of medical renal biopsies. Failure to perform EM in certain cases will result in an incorrect diagnosis, with possible clinical consequences. We strongly recommend that tissue for EM be taken and stored in an appropriate fixative and ultrastructural studies be performed for all native renal biopsies, as well as appropriate renal allograft biopsies as recommended by the Banff consortium.

scholarly journals Proteinuria Indicates Decreased Normal Glomeruli in ANCA-Associated Glomerulonephritis Independent of Systemic Disease Activity

2021 ◽  
Vol 10 (7) ◽  
pp. 1538
Author(s):  
Désirée Tampe ◽  
Peter Korsten ◽  
Philipp Ströbel ◽  
Samy Hakroush ◽  
Björn Tampe
Keyword(s):  
Disease Activity ◽  
Systemic Disease ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Clinicopathological Characteristics ◽  
Renal Outcome ◽  
Study Results ◽  
Renal Biopsies ◽  
Stage Renal Disease

Background: Renal involvement is a common and severe complication of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), potentially resulting in a pauci-immune necrotizing and crescentic ANCA glomerulonephritis (GN) with acute kidney injury (AKI), end-stage renal disease (ESRD) or death. There is recent evidence that the degree of proteinuria at diagnosis is associated with long-term renal outcome in ANCA GN. Therefore, we here aimed to systematically describe the association between proteinuria and clinicopathological characteristics in 53 renal biopsies with ANCA GN and corresponding urinary samples at admission. Methods: A total number of 53 urinary samples at admission and corresponding renal biopsies with confirmed renal involvement of AAV were retrospectively included from 2015 to 2021 in a single-center study. Results: Proteinuria correlated with myeloperoxidase (MPO) subtype, diagnosis of microscopic polyangiitis (MPA) and severe deterioration of kidney function. Proteinuria was most prominent in sclerotic class ANCA GN and ANCA renal risk score (ARRS) high risk attributed to nonselective proteinuria, including both glomerular and tubular proteinuria. Finally, there was no association between proteinuria and systemic disease activity, suggesting that proteinuria reflected specific renal involvement in AAV rather that systemic disease activity. Conclusions: In conclusion, proteinuria correlated with distinct clinicopathological characteristics in ANCA GN, mostly attributed to a reduced fraction of normal glomeruli. Furthermore, proteinuria in ANCA GN reflected specific renal involvement in AAV rather than systemic disease activity. Therefore, urinary findings could further improve our understanding of mechanisms promoting kidney injury and progression of ANCA GN.

scholarly journals Clinical manifestations of focal segmental glomerulosclerosis in Japan from the Japan Renal Biopsy Registry: age stratification and comparison with minimal change disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takaya Ozeki ◽  
Shoichi Maruyama ◽  
Toshiyuki Imasawa ◽  
Takehiko Kawaguchi ◽  
Hiroshi Kitamura ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Biopsy ◽  
Focal Segmental Glomerulosclerosis ◽  
Clinical Diagnosis ◽  
Clinical Characteristics ◽  
Minimal Change Disease ◽  
Multivariable Analysis ◽  
Laboratory Data ◽  
Minimal Change ◽  
Segmental Glomerulosclerosis

AbstractFocal segmental glomerulosclerosis (FSGS) is a serious condition leading to kidney failure. We aimed to investigate the clinical characteristics of FSGS and its differences compared with minimal change disease (MCD) using cross-sectional data from the Japan Renal Biopsy Registry. In Analysis 1, primary FSGS (n = 996) were stratified by age into three groups: pediatric (< 18 years), adult (18–64 years), and elderly (≥ 65 years), and clinical characteristics were compared. Clinical diagnosis of nephrotic syndrome (NS) was given to 73.5% (97/132) of the pediatric, 41.2% (256/622) of the adult, and 65.7% (159/242) of the elderly group. In Analysis 2, primary FSGS (n = 306) and MCD (n = 1303) whose clinical diagnosis was nephrotic syndrome (NS) and laboratory data were consistent with NS, were enrolled. Logistic regression analysis was conducted to elucidate the variables which can distinguish FSGS from MCD. On multivariable analysis, higher systolic blood pressure, higher serum albumin, lower eGFR, and presence of hematuria associated with FSGS. In Japanese nationwide registry, primary FSGS patients aged 18–64 years showed lower rate of NS than those in other ages. Among primary nephrotic cases, FSGS showed distinct clinical features from MCD.

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