Gerth J, Busch M, Illner N, Traut M, Gröne H-J, Wolf G
Department of Internal Medicine III, University of Jena, Germany.
Clin Nephrol. 2010 Oct;74(4):258-65. doi: 10.5414/cnp74258.
An accurate histological diagnosis is of fundamental importance for the therapy and prognosis of many kidney diseases. However, it remains unclear whether a single biopsy is representative of changes in the whole kidney.
To compare the quantity and quality of renal biopsy material taken from two separate areas from one kidney, we prospectively biopsied the renal cortex at the central third and at one of the kidney poles of 103 consecutive 61 native and 42 transplanted kidneys. With two biopsy cores from each kidney we sampled 14.5 ± 8.5 glomeruli/procedure.
The length of the biopsy core, the number of glomeruli/core and the markers of chronic renal damage (degree of interstitial fibrosis, proportion of global or segmental scared glomeruli) were not influenced by biopsy location (pole compared with central third locations). Moreover, there was no significant difference in the number of arteries in biopsies obtained from the two different biopsy areas. The percentage between renal cortex and medulla was not influenced by the biopsy area in all kidneys, but transplanted kidney biopsies contained more medulla than specimens from native kidneys. In patients with native kidneys and lower estimated creatinine clearances, there was a nonsignificant trend towards higher variations in the degree of interstitial fibrosis between the two cores, but a coincidence cannot be excluded. There was no significant difference in global sclerotic glomeruli in regard to the biopsy location.
We conclude that a renal biopsy composed of two cores from different areas of the kidney provides enough material for histological diagnosis. However, despite the variety of different renal diseases, sampling errors are minimal and obtaining two biopsies from different areas of the kidney does not lead to clinically useful information which would alter the management of patients.
准确的组织学诊断对于许多肾脏疾病的治疗和预后至关重要。然而，单次活检是否能代表整个肾脏的变化仍不清楚。
为了比较从一个肾脏的两个不同区域获取的肾活检材料的数量和质量，我们前瞻性地对103例连续患者（61例为自体肾，42例为移植肾）肾脏中央三分之一处的肾皮质和一个肾极进行了活检。每次活检从每个肾脏获取两个活检样本，每个样本平均含有14.5±8.5个肾小球。
活检样本的长度、每个样本中的肾小球数量以及慢性肾损伤标志物（间质纤维化程度、全球性或节段性硬化肾小球的比例）不受活检部位（肾极与中央三分之一处）的影响。此外，从两个不同活检区域获取的活检样本中的动脉数量没有显著差异。所有肾脏中，肾皮质与髓质的比例不受活检区域的影响，但移植肾活检样本中的髓质含量高于自体肾样本。在自体肾且估计肌酐清除率较低的患者中，两个样本间间质纤维化程度的差异有升高趋势，但不能排除巧合因素。活检部位对全球性硬化肾小球数量没有显著影响。
我们得出结论，由来自肾脏不同区域的两个样本组成的肾活检能够提供足够的组织学诊断材料。然而，尽管存在多种不同的肾脏疾病，采样误差极小，从肾脏不同区域获取两个活检样本并不能提供可改变患者治疗管理的临床有用信息。
