Renal biopsy techniques have been used commonly worldwide for more than 70 years. They play an important role in the diagnosis, treatment, and prognosis of various renal diseases. Percutaneous renal ...biopsy (PRB) is currently the most important and widely used renal biopsy method. Although >90% of renal biopsies are PRBs, in certain settings, alternative renal biopsy techniques must be used, such as open, laparoscopic, transjugular, and transurethral renal biopsies. This review describes the history, advantages, and disadvantages of the various renal biopsy methods and discusses their current and future uses.
Percutaneous renal biopsy (PRB) is a safe and effective modality for sampling kidney tissue. In limited circumstances, alternative methods for kidney biopsy may be indicated. Historical ...contraindications for PRB such as bleeding diathesis, morbid obesity and solitary kidney have been called into question in the literature. We present a review of the literature on PRB and the risks and benefits associated with alternatives.
A review of the literature was performed through MEDLINE and PubMed. A total of 726 articles exist under the query, "percutaneous renal biopsy." Large series describing indications, contraindications, procedural methods, and complications were extracted. To further investigate the risks of percutaneous renal biopsy on solitary kidneys, the literature on percutaneous nephrolithotomy (PCNL) and biopsy of transplant kidneys were queried. Summaries of the data were compiled and synthesized in the body of the text.
Percutaneous renal biopsy is safe and effective in the majority of kidney units for the evaluation of medical renal disease. Rates of bleeding range from 0.3%-7.4%, and nephrectomy rates are exceedingly low (0.1%-0.5%). Bleeding rates in open and laparoscopic approaches are comparable and range from 0%-7.0%, with major complications ranging from 0%-6.1%.
The successes of percutaneous methods have called into question traditional contraindications such as solitary kidney, bleeding diathesis, and morbid obesity. In limited cases, alternative methods may be appropriate. We present a review of the literature for the various approaches and their associated complication rates.
Introduction: Freehand renal biopsy represents a valid alternative to the most widespread ultrasonography-guided technique, although some concerns can derive from the possible increased complication ...rate and lower adequacy rate. Objectives: In the present audit study, efficacy of freehand method have been established through the analysis of 328 consecutive renal biopsies in 322 patients, instead the safety of the procedure was assessed in 196 patients. Patients and Methods: We retrospectively reviewed hospital databases of all patients who underwent a percutaneous renal biopsy over an 18 years’ period at Santa Marta and Santa Venera hospital in Acireale. Results: The procedure led to a definitive diagnosis in the majority of cases (98.48%), being uninformative only in 5 out of 328 cases (1.52%). Comparing these results against a Proforma, resulting from analysis of best literature reports for the items studied, adverse event rates were similar. Conclusion: Freehand renal biopsy resulted a good option to obtain renal tissue, without serious side effects. We argue about safety and we prefer to reserve this invasive procedure to selected cases, avoiding renal biopsy if biochemical and instrumental data allow a definitive diagnosis as well as in high risk patients. Our policy protects patients from the adverse effects that can result from kidney biopsy.
Introduction: The contribution of renal biopsy is of major importance in many paediatrics renal diseases. This prospective study analysed the clinic-pathological spectrum of the biopsied cases, ...complications related to renal biopsy and its effect on management.
Methods: USG guided percutaneous renal biopsy was performed in indicated children. Laboratory findings, complications of the procedure, histological diagnosis and its effect on management were obtained from all patients who underwent renal biopsy from April 2019 to March 2020. The data were finally analysed using descriptive statistics.
Results: Total 50 cases were enrolled during the study period. There were 24 males and 26 females with age range from two to 16 years. The common indications for biopsy were acute nephritic syndrome (25 cases), including both primary glomerulonephritis (11 cases) and secondary glomerulonephritis (14 cases), of which lupus nephritis contributed (11/25) cases, followed by atypical/ steroid resistant or dependent nephrotic syndrome (18 cases). Among primary glomerulonephritis, diffuse proliferative glomerulonephritis was most common pathological finding (11/25). One had crescentric glomerulonephritis. Lupus nephritis predominantly had Class IV/V pathology (6/11). Of 18 nephrotic syndrome cases, nine had minimal-change-disease and five had focal-segmental-glomerulosclerosis. The complications associated with procedure were self-resolving gross hematuria in eight cases, perirenal hematoma requiring plasma transfusion in one case. Adequate renal tissue sample was obtained in 47 of the renal biopsies. Three cases underwent repeat biopsy. Immunosuppressive therapy was altered as per the biopsy report among 18 cases.
Conclusions: Our study showed that renal biopsy is a safe, reliable and effective technique in children. It resolutes many diagnostic dilemma and helps in effective management.
Introduction: Renal involvement is very common in myeloma. The evaluation of renal status plays an important role in diagnosis and prognosis of patients with myeloma. The kidney biopsy will show ...various patterns of injury and the chronicity of the disease which help in planning the treatment options. Myeloma comprises a significant number of malignancies but no data regarding renal biopsy changes in myeloma is available from North Kerala, India. Aim: To describe the various morphological patterns of renal involvement in all myeloma patients who required a renal biopsy for evaluation of renal dysfunction. Materials and Methods: It was a retrospective, descriptive study conducted at Government Medical College, Kozhikode, a tertiary care centre from January 2016 to December 2019. A total of 63 patients of myeloma who underwent a renal biopsy for evaluation of renal dysfunction as the initial presentation or immediately after diagnosis were included in this study. Serum electrophoresis, skeletal survey, complete blood counts, bone marrow study and biochemical evaluation for serum creatinine, total protein, albumin globulin ratio were done in all patients. Data was analysed using standard analytical techniques with Statistical Package for the Social Sciences (SPSS) version 16.0 for Windows. Results: A total of 63 patients presented with renal dysfunction as initial symptom underwent renal biopsy. Most common age group of the study population was between 50 to 70 years. In 47 patients (74%) the renal dysfunction was the initial presenting symptom of myeloma. The presenting features were acute renal failure, nephrotic syndrome and acute nephritis. The renal biopsy findings included myeloma cast nephropathy, amyloidosis, proliferative glomerulonephritis and tubulointerstitial nephritis with cast nephropathy being most common pattern. Acute renal failure was more common in cast nephropathy while amyloidosis presented with nephrotic syndrome. The serum creatinine and calcium levels, plasma cell counts and degree of anaemia had a correlation with histological pattern of injury. Conclusion: Acute Kidney injury due to myeloma cast nephropathy is a medical emergency and prompt therapy with measures to reduce light chain load along with correction of dehydration can reduce renal damage and increase the patient survival. Many newly described entities like fibrillary and immunotactoid nephropathy can occur in myeloma and these can be identified only by electron microscopic evaluation of kidney tissue. They have important prognostic impact and significance when renal transplants are planned for. So renal biopsy supported by newer methods like immunohistochemistry and electron microscopy is a must to keep pace with newer advances in myeloma treatment like autologous stem cell transplantation.
Introduction:
Renal biopsy is a useful diagnostic procedure. In developing countries, two techniques of renal biopsy, blind percutaneous renal biopsy and real-time ultrasound-guided percutaneous ...renal biopsy, have been performed. The majority of studies compared these using different types and sizes of biopsy needle. The aim of this study was to compare both techniques in resource constraint country.
Method:
We reviewed renal biopsy database, between 1 January 2014 to 30 June 2017. The primary outcome was the total number of glomeruli. The other outcomes were tissue adequacy and bleeding complications. We also analyzed multivariable logistic regression to find factors associated with tissue adequacy and bleeding complications.
Result:
Of the 204 renal biopsies, 100 were blind percutaneous renal biopsy and 104 real-time ultrasound-guided percutaneous renal biopsy. The number of native renal biopsies was 169 (82.8%). Baseline characteristics of two groups were comparable. The mean number of total glomeruli from real-time ultrasound-guided percutaneous renal biopsy was significantly more than blind percutaneous renal biopsy (20.8 ± 12.1 vs 16.0 ± 13.0, p = 0.001). The real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissues than blind percutaneous renal biopsy (45.2% vs 16%, p < 0.001) and was the only factor associated with adequate tissue. Moreover, 16 renal biopsies from blind percutaneous renal biopsy obtained inadequate tissue. The overall bleeding complications were not statistically different. We found being female, lower eGFR and lower hematocrit were associated with bleeding complications.
Conclusion:
In comparison with blind percutaneous renal biopsy, real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissue and number of glomeruli. While the complications of both were comparable. We encourage to practice and perform real-time ultrasound-guided percutaneous renal biopsy in resource constraint countries.
We present a consensus report pertaining to the improved clarity of definitions and classification of glomerular lesions in lupus nephritis that derived from a meeting of 18 members of an ...international nephropathology working group in Leiden, Netherlands, in 2016. Here we report detailed recommendations on issues for which we can propose adjustments based on existing evidence and current consensus opinion (phase 1). New definitions are provided for mesangial hypercellularity and for cellular, fibrocellular, and fibrous crescents. The term “endocapillary proliferation” is eliminated and the definition of endocapillary hypercellularity considered in some detail. We also eliminate the class IV-S and IV-G subdivisions of class IV lupus nephritis. The active and chronic designations for class III/IV lesions are replaced by a proposal for activity and chronicity indices that should be applied to all classes. In the activity index, we include fibrinoid necrosis as a specific descriptor. We also make recommendations on issues for which there are limited data at present and that can best be addressed in future studies (phase 2). We propose to proceed to these investigations, with clinicopathologic studies and tests of interobserver reproducibility to evaluate the applications of the proposed definitions and to classify lupus nephritis lesions.
The application of deep learning for automated segmentation (delineation of boundaries) of histologic primitives (structures) from whole slide images can facilitate the establishment of novel ...protocols for kidney biopsy assessment. Here, we developed and validated deep learning networks for the segmentation of histologic structures on kidney biopsies and nephrectomies. For development, we examined 125 biopsies for Minimal Change Disease collected across 29 NEPTUNE enrolling centers along with 459 whole slide images stained with Hematoxylin & Eosin (125), Periodic Acid Schiff (125), Silver (102), and Trichrome (107) divided into training, validation and testing sets (ratio 6:1:3). Histologic structures were manually segmented (30048 total annotations) by five nephropathologists. Twenty deep learning models were trained with optimal digital magnification across the structures and stains. Periodic Acid Schiff-stained whole slide images yielded the best concordance between pathologists and deep learning segmentation across all structures (F-scores: 0.93 for glomerular tufts, 0.94 for glomerular tuft plus Bowman’s capsule, 0.91 for proximal tubules, 0.93 for distal tubular segments, 0.81 for peritubular capillaries, and 0.85 for arteries and afferent arterioles). Optimal digital magnifications were 5X for glomerular tuft/tuft plus Bowman’s capsule, 10X for proximal/distal tubule, arteries and afferent arterioles, and 40X for peritubular capillaries. Silver stained whole slide images yielded the worst deep learning performance. Thus, this largest study to date adapted deep learning for the segmentation of kidney histologic structures across multiple stains and pathology laboratories. All data used for training and testing and a detailed online tutorial will be publicly available.
Display omitted
Abstract
Background:
Despite the increasing proportion of the elderly population, renal biopsies are restricted to few centers. We studied the elderly renal biopsy data from a tertiary care center in ...South India.
Materials and Methods:
A retrospective observational study was done in patients more than 60 years of age who underwent native kidney biopsy for various clinical indications from January 2014 to June 2022 and was compared with the renal pathology data of adults 18–60 years of age who underwent native kidney biopsy for various indications during the same study.
Results:
Hundred and five (
n
= 105) elderly biopsies were included in the study. The mean age was 65.7 years (interquartile range: 60–85 years). Forty-two (40%) were type 2 diabetics. Infection-related glomerulonephritis (IRGN) (20, 19.04%), acute tubular necrosis (ATN) (15, 14.28%), membranous nephropathy (11, 10.47%), and acute interstitial nephritis (10, 9.52%) were the common pathologies observed in the elderly. The most common indication for renal biopsy was rapidly progressive renal failure (RPRF) (
n
= 28, 26.6%) and IRGN was the most common cause of RPRF. 76.2% of diabetics had nondiabetic renal disease, the most common being IRGN (8, 25%). Crescentic glomerulonephritis (GN), ATN, and cast nephropathy were observed significantly more frequent in the elderly than in those 18–60 years of age. IRGN and pauci-immune vasculitis were the causes of crescentic GN in the elderly.
Conclusion:
Our study highlights the importance of IRGN as the most frequent pathology in the South Indian elderly population both in diabetics and nondiabetics.
PDF
