Department of Biomedical Sciences and Human Oncology, University of Torino, Torino Italy.
Nephrol Dial Transplant. 2010 Oct;25(10):3401-8. doi: 10.1093/ndt/gfq166. Epub 2010 Mar 31.
Pre-transplant donor biopsy (PTDB) is a common practice in marginal donors, taking for granted that it represents the whole kidney state, but its reliability has not yet been thoroughly investigated. This prompted us to carry out a comparative study on a needle biopsy group (NBG) and a wedge biopsy group (WBG) and their corresponding untransplanted kidneys.
One hundred and fifty-four biopsies and matched kidneys were scored for four morphologic indexes, i.e. tubular atrophy, interstitial fibrosis, vascular damage and global glomerulosclerosis. Categorical indexes were statistically evaluated for concordance with the k index, and the percentage of sclerotic glomeruli with correlation and linear regression analysis.
Agreement between biopsies and kidneys was similar in both NBG and WBG with high scores for vascular damage (k 0.74 and 0.75) and intermediate ones for tubular atrophy (k 0.54 and 0.50). Agreement as to fibrosis and glomerular sclerosis was intermediate in the WBG (k 0.56 and 0.55) and poor in the NBG (k 0. 34 and 0.18). Vascular damage was underscored and glomerulosclerosis overscored in both groups, whereas interstitial fibrosis was underscored in the NBG and overscored in WBG. The agreement for the total score, i.e. the sum of the single indexes, was high in the NBG (k 0.73) and intermediate in WBG (k 0.57). Agreement for glomerulosclerosis and total score rose consistently in both groups along with the increasing number of biopsy glomeruli. There was an agreement as to biopsy and kidney evaluation for fitness for transplantation in 85% of NBG and 81% of WBG.
PTDB supplies reliable data on the actual kidney state, with better results for needle biopsy. Although the biopsy size plays a role, samples with over 10 glomeruli suffice for clinical purposes. Vascular damage is the most faithful single parameter, whereas global glomerulosclerosis estimation requires some caution.
移植前供体活检（PTDB）在边缘供体中是一种常见做法，默认其代表整个肾脏状态，但尚未对其可靠性进行彻底研究。这促使我们对针吸活检组（NBG）和楔形活检组（WBG）及其相应的未移植肾脏进行了比较研究。
对 154 例活检和匹配的肾脏进行了 4 种形态学指标（肾小管萎缩、间质纤维化、血管损伤和肾小球全球硬化）的评分。对分类指标进行了一致性的统计学评估，采用 k 指数、相关性和线性回归分析评估了硬化肾小球的百分比。
在 NBG 和 WBG 中，活检和肾脏之间的一致性相似，血管损伤的评分较高（k 值分别为 0.74 和 0.75），肾小管萎缩的评分中等（k 值分别为 0.54 和 0.50）。WBG 中纤维化和肾小球硬化的一致性中等（k 值分别为 0.56 和 0.55），而 NBG 中较差（k 值分别为 0.34 和 0.18）。两组中血管损伤均被低估，肾小球硬化均被高估，而间质纤维化在 NBG 中被低估，在 WBG 中被高估。在 NBG 中，总评分（即单个指标的总和）的一致性较高（k 值为 0.73），在 WBG 中为中等（k 值为 0.57）。随着活检肾小球数量的增加，两组的肾小球硬化和总评分的一致性也随之增加。在 85%的 NBG 和 81%的 WBG 中，活检和肾脏评估在适合移植方面具有一致性。
PTDB 提供了关于实际肾脏状态的可靠数据，针吸活检的结果更好。尽管活检大小起作用，但有 10 个以上肾小球的样本就足以满足临床需要。血管损伤是最忠实的单一参数，而肾小球硬化的评估需要谨慎。
