López-Gómez Juan M, Rivera Francisco
Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, Spain.
Clin J Am Soc Nephrol. 2008 May;3(3):674-81. doi: 10.2215/CJN.04441007. Epub 2008 Mar 19.
Renal biopsy in acute renal failure of unknown origin provides irreplaceable information for diagnosis, treatment, and prognosis. This study analyzed the frequency and clinicopathologic correlations of renal native biopsied acute renal failure in Spain during the period 1994 through 2006.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Acute renal failure was defined as a rapid deterioration of glomerular filtration rate, with or without oligoanuria or rapidly progressive renal insufficiency, including acute-on-chronic renal failure. Patients who were younger than 15 yr were considered children, those between 15 and 65 yr adults, and those >65 elderly.
Between 1994 and 2006, data on 14,190 native renal biopsies were collected from 112 renal units in Spain. Of these, 16.1% (2281 biopsies) were diagnosed with acute renal failure. The prevalence of the main clinical syndromes was different in the three age groups: Biopsy-confirmed acute renal failure in children was 5.7%, in adults was 12.5%, and in elderly increased significantly to 32.9%. The prevalence of biopsy-confirmed acute renal failure according to cause was as follows: Vasculitis, 23.3%; acute tubulointerstitial nephritis, 11.3%; and crescentic glomerulonephritis types 1 and 2, 10.1%. The prevalence of the different causes differed significantly according to age group.
The Spanish Registry of Glomerulonephritis provides useful information about renal histopathology in biopsy-confirmed acute renal failure. The prevalence of vasculitis and crescentic glomerulonephritis is high, especially in elderly patients. These data obtained from a national large registry highlight the value of renal biopsy in undetermined acute renal failure.
对于病因不明的急性肾衰竭患者，肾活检可为诊断、治疗及预后提供不可替代的信息。本研究分析了1994年至2006年期间西班牙肾活检确诊的急性肾衰竭的发生率及其临床病理相关性。
设计、研究地点、参与者及检测指标：急性肾衰竭定义为肾小球滤过率迅速下降，伴或不伴有少尿或无尿，或快速进展性肾功能不全，包括急性慢性肾衰竭。年龄小于15岁的患者为儿童，15至65岁为成年人，大于65岁为老年人。
1994年至2006年期间，从西班牙112个肾脏单位收集了14190例肾活检数据。其中，16.1%（2281例活检）被诊断为急性肾衰竭。三个年龄组主要临床综合征的患病率不同：儿童活检确诊的急性肾衰竭患病率为5.7%，成人为12.5%，老年人显著增至32.9%。根据病因，活检确诊的急性肾衰竭患病率如下：血管炎为23.3%；急性肾小管间质性肾炎为11.3%；1型和2型新月体性肾小球肾炎为10.1%。不同病因的患病率在不同年龄组间差异显著。
西班牙肾小球肾炎登记处提供了关于活检确诊急性肾衰竭肾组织病理学的有用信息。血管炎和新月体性肾小球肾炎的患病率较高，尤其是在老年患者中。这些来自全国大型登记处的数据凸显了肾活检在不明原因急性肾衰竭中的价值。
