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

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.

Download Full-text

Pattern of glomerular disease in a tertiary care hospital in Nepal: A Shree Birendra Hospital experience

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v7i4.6742 ◽

2012 ◽

Vol 7 (4) ◽

pp. 48-52

Author(s):

A Sharma ◽

RK Deo ◽

RR Shahi

Keyword(s):

Renal Disease ◽

Renal Biopsy ◽

Glomerular Disease ◽

Renal Diseases ◽

Histopathological Diagnosis ◽

Care Hospital ◽

Glomerular Diseases ◽

Patient Profile ◽

Nephritic Syndrome ◽

Number Of Patients

The incidence of renal diseases varies greatly in various parts of the world. Percutaneous renal biopsy is an important procedure for many patients with renal disease. This hospital based retrospective study evaluated the pattern of various glomerular diseases in Shree Birendra hospital. Hospital records were searched for all the patients undergoing renal biopsy for all indication and patient profile and histopathological examination record were obtained. All the patients undergoing renal biopsy for any cause from January 2007 to December 2010 were included in the study. A total of 46 patients underwent renal biopsy in the study period. The number of patients in the various age groups were - <16 years – 5 patients, 16-50 years – 34 patients and > 50 years – 7 patients. The number of male and female patients was 34 and 12 respectively. Major indication for undergoing renal biopsy in this study was Nephrotic Syndrome (n=29, 63%), followed by RPGN (n=8, 17%), Persistent proteinuria (n=6, 13%) and Nephritic syndrome (n=3, 7%). The most common histopathological diagnosis in the study was Membranous nephropathy (n=10, 22%), followed by Focal Segmental Glomerulosclerosis (n=9, 20%), Membranoproliferative glomerulonephritis (n=9, 20%) and Minimal change disease (n=6, 13%). USG guided renal biopsy is safe in adults and is a very useful tool for the diagnosis of renal disease. The pattern of glomerular disease varies in different settings. There is a need for further evaluation of glomerular disease with larger sample size to determine the pattern of glomerular disease in Nepal. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 48-52 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6742

Download Full-text

Circular RNAs as Novel Diagnostic Biomarkers and Therapeutic Targets in Kidney Disease

Frontiers in Medicine ◽

10.3389/fmed.2021.714958 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jianwen Yu ◽

Danli Xie ◽

Naya Huang ◽

Qin Zhou

Keyword(s):

Kidney Disease ◽

Kidney Diseases ◽

Expression Patterns ◽

Therapeutic Targets ◽

Kidney Injury ◽

Renal Diseases ◽

Circular Rnas ◽

Specific Expression ◽

Glomerular Diseases ◽

Diagnosis And Prognosis

Circular RNAs (circRNAs) are a novel type of non-coding RNAs that have aroused growing attention in this decade. They are widely expressed in eukaryotes and generally have high stability owing to their special closed-loop structure. Many circRNAs are abundant, evolutionarily conserved, and exhibit cell-type-specific and tissue-specific expression patterns. Mounting evidence suggests that circRNAs have regulatory potency for gene expression by acting as microRNA sponges, interacting with proteins, regulating transcription, or directly undergoing translation. Dysregulated expression of circRNAs were found in many pathological conditions and contribute to the pathogenesis and progression of various disorders, including renal diseases. Recent studies have revealed that circRNAs may serve as novel reliable biomarkers for the diagnosis and prognosis prediction of multiple kidney diseases, such as renal cell carcinoma (RCC), acute kidney injury (AKI), diabetic kidney disease (DKD), and other glomerular diseases. Furthermore, circRNAs expressed by intrinsic kidney cells are shown to play a substantial role in kidney injury, mostly reported in DKD and RCC. Herein, we review the biogenesis and biological functions of circRNAs, and summarize their roles as promising biomarkers and therapeutic targets in common kidney diseases.

Download Full-text

RENAL BIOPSY IN CHILDREN

PEDIATRICS ◽

10.1542/peds.22.6.1033 ◽

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.

Download Full-text

Renal medicine

10.1093/med/9780198810858.003.0008 ◽

2021 ◽

pp. 353-382

Author(s):

Gopesh K. Modi ◽

Vivekanand Jha

Keyword(s):

Kidney Disease ◽

Renal Disease ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Renal Stones ◽

Renal Diseases ◽

Acute Glomerulonephritis ◽

Glomerular Diseases ◽

Stage Renal Disease ◽

End Stage

Assessing renal function, Urinalysis, Proteinuria, Hematuria, Chyluria, Imaging in renal disease, Kidney biopsy, Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), Diabetic Nephropathy, End Stage Renal Disease and Dialysis, Kidney Transplantation, Glomerular diseases, Acute glomerulonephritis, Urinary schistosomiasis (bilharzia), Infections and Kidney Disease, Rapidly Progressive glomerulonephritis, Tubulointerstitial Disease, Urinary Tract Infection, Vesico-ureteric reflux, Renal Stones, Renal Disease in Pregnancy, Renal Artery Stenosis, Renal Mass, Inherited Renal Diseases

Download Full-text

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

International Journal of Nephrology ◽

10.1155/2018/9603453 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

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.

Download Full-text

Could IL-17A Be a Novel Therapeutic Target in Diabetic Nephropathy?

Journal of Clinical Medicine ◽

10.3390/jcm9010272 ◽

2020 ◽

Vol 9 (1) ◽

pp. 272 ◽

Cited By ~ 5

Author(s):

Carolina Lavoz ◽

Sandra Rayego-Mateos ◽

Macarena Orejudo ◽

Lucas Opazo-Ríos ◽

Vanessa Marchant ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Kidney Disease ◽

Immune Cells ◽

Current Knowledge ◽

Premature Mortality ◽

Active Role ◽

Renal Diseases ◽

Economic Implications ◽

Number Of Patients ◽

Stage Renal Disease

Chronic kidney disease has become a major medical issue in recent years due to its high prevalence worldwide, its association with premature mortality, and its social and economic implications. A number of patients gradually progress to end-stage renal disease (ESRD), requiring then dialysis and kidney transplantation. Currently, approximately 40% of patients with diabetes develop kidney disease, making it the most prevalent cause of ESRD. Thus, more effective therapies for diabetic nephropathy are needed. In preclinical studies of diabetes, anti-inflammatory therapeutic strategies have been used to protect the kidneys. Recent evidence supports that immune cells play an active role in the pathogenesis of diabetic nephropathy. Th17 immune cells and their effector cytokine IL-17A have recently emerged as promising targets in several clinical conditions, including renal diseases. Here, we review current knowledge regarding the involvement of Th17/IL-17A in the genesis of diabetic renal injury, as well as the rationale behind targeting IL-17A as an additional therapy in patients with diabetic nephropathy.

Download Full-text

The Spectrum of Biopsy-Proved Kidney Disease: A Retrospective Single Center Study in Erbil-Iraq

Asian Journal of Medical Sciences ◽

10.3126/ajms.v10i2.22365 ◽

2019 ◽

Vol 10 (2) ◽

pp. 46-51

Author(s):

Ahmed Al-Imam ◽

Mudhafar Abdullah Ali ◽

Safa Ezzaddin Al-Mukhtar

Keyword(s):

Renal Failure ◽

Renal Biopsy ◽

Immunofluorescence Microscopy ◽

Histopathological Examination ◽

Glomerular Disease ◽

Clinical Indication ◽

Renal Diseases ◽

Glomerular Diseases ◽

Nephritic Syndrome ◽

Management Protocol

BACKGROUND Renal biopsy is crucial to determine the pattern of the different types of renal diseases. It represents the gold standard of diagnostics for renal pathologies, including glomerular diseases, and it has an important value for the prognosis, monitoring disease progression, and planning the management protocol. AIMS AND OBJECTIVE To report the frequency of different pathological lesions affecting the kidney in patients who were admitted to our medical centre. MATERIALS AND METHODS This is a retrospective study of all patients with renal diseases who underwent percutaneous renal biopsy at the Erbil Kidney Centre for eight years (1st of January 2010 to 31st of December 2017). A total of 893 cases were biopsied and subsequently studied via histopathological examination and immunofluorescence microscopy. The study is ethically permitted by the Kurdistan Board for Medical Specialization. RESULTS The average age of the patients was 30.9 years. The most common clinical indication for biopsy included nephrotic syndrome (46.47%), acute renal failure (19.04%), chronic renal failure (15.34%), nephritic syndrome (7.39%), proteinuria alone (7.28%), and hematuria alone (4.48%). In patients with a primary glomerular disease, focal segmental glomerulosclerosis and minimal change disease were the most frequent (27.44% and 16.01%) in the younger patients (18.61±13.47 years), while membranous glomerulonephritis was more common in older patients (38.94±13.69 years). Patients with a secondary glomerular disease were mainly diagnosed with lupus nephritis, amyloidosis, and diabetic nephropathy. CONCLUSION The epitome of our study signifies that the spectrum of glomerular diseases varies based on age, sex, ethnicity, and geographical distribution. The implementation of renal biopsy proved to be a cornerstone in reaching the correct diagnosis. Future studies should implement the use of electron microscopy in conjunction with classical techniques of histopathology and immunofluorescence microscopy to diagnose equivocal cases of interest.

Download Full-text

Inherited renal diseases

10.1093/med/9780199568741.003.0169 ◽

2018 ◽

Author(s):

William G. Herrington ◽

Aron Chakera ◽

Christopher A. O’Callaghan

Keyword(s):

Clinical Practice ◽

Kidney Disease ◽

Polycystic Kidney Disease ◽

Renal Involvement ◽

Renal Diseases ◽

Systemic Diseases ◽

Polycystic Kidney ◽

Adult Polycystic Kidney Disease

The causes of inherited renal diseases can be divided into cystic, glomerular, tubular, and systemic diseases. By far, the most common of these in clinical practice is adult polycystic kidney disease (APKD). This chapter reviews APKD, other inherited cystic renal diseases, inherited glomerular and tubular diseases, and inherited systemic diseases with renal involvement.

Download Full-text

Renal involvement in pediatric patients with COVID-19: an up-to-date

Current Pediatric Reviews ◽

10.2174/1573396317666210924121550 ◽

2021 ◽

Vol 17 ◽

Author(s):

Yuri Márcio Campos ◽

André Luís Vieira Drumond ◽

Mariane de Matos Gamonal ◽

Milena Pereira Parreira ◽

Ana Cristina Simões e Silva

Keyword(s):

At Risk ◽

Acute Kidney Injury ◽

Pediatric Patients ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Renal Involvement ◽

Kidney Injury ◽

Renal Diseases ◽

Glomerular Diseases ◽

Report Data

Background: In pediatric patients, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been mostly associated with mild symptoms. However, as in adults, renal involvement has been reported in children and adolescents with Coronavirus Disease 2019 (COVID-19). Objective: This review aimed to report data about renal involvement in pediatric COVID-9. The focuses were on the pathophysiology of acute kidney injury in Pediatric Inflammatory Multisystem Syndrome Temporally Associated (PIMS-TS) with SARS-CoV-2 and the possible impact of SARS-CoV-2 infection upon kidney function, as well as data concerning patients with previous kidney diseases, including Nephrotic Syndrome and Chronic Renal Disease. The implications for COVID-19 outcome in pediatric patients were also discussed. Methods: This integrative review searched for articles on renal involvement in pediatric COVID-19 patients. The databases evaluated were PubMed and Scopus. Results: The emergence of PIMS-TS with SARS-CoV-2 has shown that pediatric patients are at risk of severe COVID-19, with multi-organ involvement and dysfunction. In addition to intense inflammation, several systems are affected in this syndrome, collectively creating a combination of factors that results in acute kidney injury. Several studies have proposed that kidney cells, including the podocytes, might be at risk of direct infection by SARS-CoV-2, as high levels of ACE2, the virus receptor, are expressed on the membrane of such cells. Some cases of glomerular diseases triggered by SARS-CoV-2 infection and relapses of previous renal diseases have been reported. Conclusion: Further studies are necessary to establish risk factors for renal involvement in pediatric COVID-19 and to predict disease outcome.

Download Full-text

Trends of renal diseases in Germany: review of a regional renal biopsy database from 1990 to 2013

Clinical Kidney Journal ◽

10.1093/ckj/sfz023 ◽

2019 ◽

Vol 12 (6) ◽

pp. 795-800 ◽

Cited By ~ 5

Author(s):

Corinna M Zink ◽

Sabine Ernst ◽

Jochen Riehl ◽

Udo Helmchen ◽

Hermann-Josef Gröne ◽

...

Keyword(s):

Renal Biopsy ◽

Immunoglobulin A ◽

Temporal Variations ◽

Current Data ◽

University Hospital ◽

Renal Diseases ◽

Glomerular Diseases ◽

Tubular Necrosis ◽

Disease Entities ◽

Primary Glomerular Disease

Abstract Background Several renal biopsy registries in Europe have shown geographical and temporal variations in the patterns of renal diseases. However, there is a lack of current data on trends of renal disease in Central Europe. Methods After exclusion of transplant and re-biopsies, the renal biopsy registry of the German RWTH Aachen University Hospital included data of 1208 biopsies over a period of 24 years (1990–2013). Trends in the biopsy rate and diagnosis of glomerular diseases were analysed. Results The average annual biopsy incidence was 6.1 biopsies per 100 000 population. The frequency of kidney biopsies increased significantly over the years (P < 0.001). Primary glomerulonephritis (GN) accounted for nearly two-thirds (58.4%) of all native kidney biopsies, and immunoglobulin A-nephropathy (IgAN) was the leading histological diagnosis (34.7%) followed by necrotizing GN (RPGN) at 18.7%. IgAN increased 2-fold over the study periods (+195%, P < 0.001). Focal segmental glomerulosclerosis accounted for 6.1% of all diagnoses, and its frequency rose to 3.9-fold (+388%, P < 0.001). Lupus nephritis showed a doubling in incidence (P = 0.0499), while acute tubular necrosis decreased to 3.5-fold (P = 0.0008). All other disease entities failed to exhibit linear trends over time. In children, the most common pathologies were IgAN (26.1%) and minimal change disease (21.7%), whereas RPGN (19.4%) dominated in the group of patients >60 years. Conclusion IgAN was the most common primary glomerular disease in our centre and its prevalence increased over 24 years.

Download Full-text