Unit of Pediatric Nephrology and Dialysis, Pediatric Hospital "Giovanni XXIII", Bari, Italy.
Clinical Pathology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
World J Pediatr. 2018 Apr;14(2):127-133. doi: 10.1007/s12519-018-0147-5. Epub 2018 Mar 22.
This study was conducted to investigate retrospectively the indications for renal biopsy (RB) in native kidneys and to analyze pathological findings in a single tertiary pediatric hospital in Southern Italy for the last 36 years.
All patients who underwent RB at our hospital from 1979 to 2014 were included. All renal tissue specimens were studied under light and immunofluorescent microscopy, while electron microscopy was performed only for specific clinical indications.
The study group included 213 patients (female 43.2%) who underwent 225 percutaneous native kidney biopsies. Median age was 10.4 years (range 0.6-24 years). The most frequent indication for RB was nephrotic syndrome (44.4%), followed by proteinuria (27.6%), asymptomatic hematuria (17.3%) and acute kidney injury (9.8%). Gross hematuria appeared after biopsy in less than 5% of the patients, but none of them needed blood transfusion. Adequate renal tissue sample was obtained in 95.5% of the renal biopsies. Primary glomerulonephritis (GN) was the most common finding (61.4%), followed by secondary GN (21.4%), tubulointerstitial diseases (3.7%) and hereditary nephropathy (2.8%), while in 10.7% of the cases, normal renal tissues were found. According to histopathological diagnosis, the most common causes of primary GN were IgA nephropathy (20.9%), followed by minimal change disease (18.1%) and focal segmental glomerulosclerosis (11.6%).
The epidemiology of glomerular disease in our single-center cohort is similar to that shown in other national and international reports. Moreover, our study shows that percutaneous ultrasound-guided RB is a safe, reliable and effective technique in children.
本研究旨在回顾性调查意大利南部一家三级儿科医院过去 36 年来的原发性肾脏活检（RB）适应证，并分析其病理发现。
纳入我院 1979 年至 2014 年期间行 RB 的所有患者。所有肾脏组织标本均行光镜和免疫荧光显微镜检查，仅对特定的临床适应证行电镜检查。
研究组包括 213 例（女 43.2%）患者，共行 225 例经皮原发性肾脏活检。中位年龄为 10.4 岁（范围 0.6-24 岁）。RB 的最常见适应证是肾病综合征（44.4%），其次是蛋白尿（27.6%）、无症状性血尿（17.3%）和急性肾损伤（9.8%）。活检后不到 5%的患者出现肉眼血尿，但均无需输血。95.5%的肾脏活检获得了足够的肾组织样本。原发性肾小球肾炎（GN）是最常见的发现（61.4%），其次是继发性 GN（21.4%）、肾小管间质疾病（3.7%）和遗传性肾病（2.8%），而 10.7%的病例发现正常肾组织。根据组织病理学诊断，原发性 GN 最常见的病因是 IgA 肾病（20.9%），其次是微小病变性肾病（18.1%）和局灶节段性肾小球硬化（11.6%）。
本单中心队列的肾小球疾病流行病学与其他国家和国际报道相似。此外，本研究表明，经皮超声引导 RB 是一种安全、可靠且有效的儿童技术。
