Maixnerova Dita, Jancova Eva, Skibova Jelena, Rysava Romana, Rychlik Ivan, Viklicky Ondrej, Merta Miroslav, Kolsky Alexander, Reiterova Jana, Neprasova Michaela, Kidorova Jana, Honsova Eva, Tesar Vladimir
Department of Nephrology, 1st Faculty of Medicine, Charles University, U Nemocnice 2, 128 08, Prague 2, Czech Republic,
J Nephrol. 2015 Feb;28(1):39-49. doi: 10.1007/s40620-014-0090-z. Epub 2014 Apr 23.
We describe data on 10,472 renal biopsies gathered by the Czech Registry of Renal Biopsies over a period of 18 years.
We assessed the main demographic, clinical and histological data of individuals who underwent renal biopsies of native kidneys in 31 centers in the Czech Republic (population 10.3 million) during the period 1994-2011.
We evaluated 10,472 renal biopsies: males 57.8%, children (≤15 years) 13.6%, elderly (>60 years) 19.1%. The most frequent biopsy-proven diseases were primary (55.7%) and secondary (29.1%) glomerulonephritides (GN). Tubulointerstitial nephritis (TIN) was observed in 3.4 % and vascular diseases in 4.1%. The samples were non-diagnostic in 4.2%. Among primary GN the most frequent diagnoses were IgA nephropathy (IgAN) (37.4%), membranous GN (MGN) (13%) and focal segmental glomerulosclerosis (FSGS) (12.6%). Among secondary GN, systemic lupus erythematosus (SLE) represented 23.2%, hereditary diseases 19.8% and necrotizing vasculitis (NV) 19.4%. Among adults, mild renal insufficiency [serum creatinine (SCr) 111-200 μmol/l] was present in 24.7%, advanced renal insufficiency (SCr 201-400 μmol/l) in 15.3, and 12.3% of patients had SCr > 400 μmol/l. The most common diseases in patients with nephrotic proteinuria were minimal change disease (MCD) (39.7%) among children, IgAN (26.2%) in adults aged 16-60 years and amyloidosis (42.7%) among the elderly. The mean annual incidence (per million population) was: primary GN 30.9, secondary GN 18.1, IgAN 11.6, MGN 4.0, SLE 4.0, FSGS 3.9, MCD 3.4, NV 3.2, diabetic nephropathy 2.3, thin basement membrane glomerulopathy 2.0, mesangioproliferative GN 1.9, and TIN 1.9. Ultrasound needle guidance was used in 66.8%. The frequency of serious complications (symptomatic hematoma, gross hematuria, blood transfusion) was approximately 3.2%.
This report provides representative population-based data on native biopsy-proven renal diseases in the Czech Republic. Over the 18 years of nationwide biopsy survey, we noted an increase of the mean age of renal biopsy cases, an increasing proportion of elderly, and a cardinal change in biopsy technique towards ultrasonography needle guidance.
我们描述了捷克肾脏活检登记处18年间收集的10472例肾脏活检数据。
我们评估了1994年至2011年期间在捷克共和国（人口1030万）的31个中心接受自体肾活检的个体的主要人口统计学、临床和组织学数据。
我们评估了10472例肾脏活检：男性占57.8%，儿童（≤15岁）占13.6%，老年人（>60岁）占19.1%。活检确诊的最常见疾病是原发性（55.7%）和继发性（29.1%）肾小球肾炎（GN）。肾小管间质性肾炎（TIN）占3.4%，血管疾病占4.1%。样本无诊断价值的占4.2%。在原发性GN中，最常见的诊断是IgA肾病（IgAN）（37.4%）、膜性GN（MGN）（13%）和局灶节段性肾小球硬化（FSGS）（12.6%）。在继发性GN中，系统性红斑狼疮（SLE）占23.2%，遗传性疾病占19.8%，坏死性血管炎（NV）占19.4%。在成年人中，轻度肾功能不全[血清肌酐（SCr）111 - 200μmol/L]占24.7%，重度肾功能不全（SCr 201 - 4 hundred μmol/L）占15.3%，12.3%的患者SCr>400μmol/L。肾病性蛋白尿患者中最常见的疾病在儿童中是微小病变病（MCD）（39.7%），16 - 60岁成年人中是IgAN（26.2%），老年人中是淀粉样变性（42.7%）。年平均发病率（每百万人口）为：原发性GN 30.9，继发性GN 18.1，IgAN 11.6，MGN 4.0，SLE 4.0，FSGS 3.9，MCD 3.4，NV 3.2，糖尿病肾病2.3，薄基底膜肾小球病2.0，系膜增生性GN 1.9，TIN 1.9。66.8%的活检使用了超声引导穿刺。严重并发症（有症状的血肿、肉眼血尿、输血）的发生率约为3.2%。
本报告提供了捷克共和国基于人群的经活检确诊的自体肾疾病的代表性数据。在全国范围的18年活检调查中，我们注意到肾活检病例的平均年龄增加，老年人比例上升，并且活检技术向超声引导穿刺发生了根本性变化。
