Department of Internal Medicine, Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Nephrol Dial Transplant. 2019 Feb 1;34(2):193-199. doi: 10.1093/ndt/gfy220.
A kidney biopsy is done to determine the etiology of the glomerulonephritis (GN) and the severity of the lesion, to identify whether other lesions, related to or not related to the GN, are present on the kidney biopsy and finally to ascertain the extent of chronicity of the GN. The etiology of GN is based on the classification of GN into five groups: immune complex-mediated GN, antineutrophil cytoplasmic antibody (ANCA)-associated GN, anti-glomerular basement membrane (GBM) GN, monoclonal immunoglobulin-mediated GN and C3 glomerulopathy. Immune complex GN includes multiple specific diseases such as lupus nephritis, IgA nephropathy, infection-related GN and fibrillary GN. ANCA GN, anti-GBM GN and C3 glomerulopathy are specific diseases in themselves, while monoclonal Ig GN includes proliferative GN with monoclonal Ig deposits and monoclonal Ig deposition disease. Thus identification of the class of GN and within it the specific disease determines the etiology of GN. Ancillary studies may be required to confirm the etiology of GN. The severity of the GN is revealed by the pattern of injury, such as crescentic, necrotizing, diffuse proliferative, exudative, membranoproliferative, mesangial proliferative or a sclerosing GN. Secondary diagnosis either related or unrelated to the GN, such as diabetic glomerulosclerosis, acute tubular necrosis or thrombotic microangiopathy, may also be present. The secondary diagnosis may sometimes be the reason for the kidney biopsy. The chronicity of GN is determined by evaluating the extent of glomerulosclerosis, tubular atrophy and interstitial fibrosis and vascular sclerosis present on the biopsy. This review summarizes the approach to standardizing a kidney biopsy report that includes these components in a logical and sequential manner.
肾活检的目的是确定肾小球肾炎（GN）的病因和病变严重程度，确定肾活检是否存在其他与 GN 相关或不相关的病变，最终确定 GN 的慢性程度。GN 的病因基于 GN 分为五类：免疫复合物介导的 GN、抗中性粒细胞胞质抗体（ANCA）相关的 GN、抗肾小球基底膜（GBM）GN、单克隆免疫球蛋白介导的 GN 和 C3 肾小球病。免疫复合物 GN 包括多种特定疾病，如狼疮性肾炎、IgA 肾病、感染相关 GN 和纤维状 GN。ANCA GN、抗 GBM GN 和 C3 肾小球病本身就是特定的疾病，而单克隆 Ig GN 包括伴有单克隆 Ig 沉积的增生性 GN 和单克隆 Ig 沉积病。因此，确定 GN 的类别以及其中的特定疾病可以确定 GN 的病因。可能需要辅助研究来确认 GN 的病因。GN 的严重程度通过损伤模式揭示，如新月体性、坏死性、弥漫性增生性、渗出性、膜增生性、系膜增生性或硬化性 GN。继发性诊断与 GN 相关或不相关，如糖尿病肾小球硬化、急性肾小管坏死或血栓性微血管病，也可能存在。继发性诊断有时可能是进行肾活检的原因。GN 的慢性程度通过评估活检中肾小球硬化、肾小管萎缩和间质纤维化以及血管硬化的程度来确定。本综述总结了以逻辑和顺序的方式标准化肾活检报告的方法，其中包括这些成分。
