Peters Björn, Stegmayr Bernd, Andersson Yvonne, Hadimeri Henrik, Mölne Johan
Department of Nephrology, Skaraborgs Hospital, 541 85, Skövde, Sweden.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Clin Exp Nephrol. 2015 Dec;19(6):1135-41. doi: 10.1007/s10157-015-1121-3. Epub 2015 May 8.
The aim of this study was to investigate if specific clinical and histological findings can be related to biopsy complications to enable more closely monitoring patients at high risk.
Results from 1081 biopsies (994 patients, median age 54.5 years; 896 native and 185 transplant kidney biopsies) were included. Diagnostic quality, morphology, clinical data and complications were prospectively registered.
In native kidney biopsies, the most common diagnosis was IgA-nephritis, while in transplant kidney biopsies it was rejection. Patients with IgA-nephritis had a higher risk of major complications (11.7 versus 6.4 %, Odds Ratio (OR) 1.8, Confidence Interval (CI) 1.1-3.2) when compared to patients with other diseases. In native kidney biopsies, patients who experienced major complications had higher degrees of glomerulosclerosis (31 versus 20 %, p = 0.008), whereas in transplant kidney biopsies, patients had higher degrees of interstitial fibrosis (82 versus 33 %, p < 0.001) when compared to patients without major complications. IgA-nephritis-patients had a higher risk of re-biopsies (4.7 versus 1.3 %, OR 4, CI 1.5-11) than patients with other diseases. Patients with native kidneys who needed re-biopsies were younger (42.6 versus 52.3 years, p = 0.031) and had a higher degree of interstitial fibrosis (63 versus 34 %, p = 0.046).
Patients with IgA-nephritis have an increased risk of major biopsy complications. The risk of re-biopsies was higher in younger individuals and in patients with IgA-nephritis.
本研究的目的是调查特定的临床和组织学发现是否与活检并发症相关，以便更密切地监测高危患者。
纳入了1081例活检结果（994例患者，中位年龄54.5岁；896例自体肾活检和185例移植肾活检）。前瞻性记录诊断质量、形态、临床数据和并发症。
在自体肾活检中，最常见的诊断是IgA肾病，而在移植肾活检中是排斥反应。与其他疾病患者相比，IgA肾病患者发生严重并发症的风险更高（11.7%对6.4%，比值比（OR）1.8，置信区间（CI）1.1 - 3.2）。在自体肾活检中，发生严重并发症的患者肾小球硬化程度更高（31%对20%，p = 0.008），而在移植肾活检中，与无严重并发症的患者相比，患者的间质纤维化程度更高（82%对33%，p < 0.001）。IgA肾病患者再次活检的风险高于其他疾病患者（4.7%对1.3%，OR 4，CI 1.5 - 11）。需要再次活检的自体肾患者更年轻（42.6岁对52.3岁，p = 0.031），且间质纤维化程度更高（63%对34%，p = 0.046）。
IgA肾病患者发生活检严重并发症的风险增加。年轻个体和IgA肾病患者再次活检的风险更高。
