Menter Thomas, Hirt-Minkowski Patricia, Hopfer Helmut
Universitätsspital Basel, Institut für Medizinische Genetik und Pathologie.
Universitätsspital Basel, Klinik für Transplantationsimmunologie und Nephrologie.
Ther Umsch. 2019;76(7):349-357. doi: 10.1024/0040-5930/a001109.
Kidney Biopsies - the Basics and Recent Developments Renal biopsies are taken to clarify the differential diagnosis of glomerular hematuria, proteinuria, and renal insufficiency. Nephropathology services are usually available at larger pathology units only because of the special equipment needed for light microscopy, immunohistology, and electron microscopy, the low number of biopsies processed compared to other fields, and the special expertise needed to read and sign out the cases. Biopsy diagnosis crucially contributes to the diagnostic workup and therapy of patients with kidney diseases. Increasingly, new immunohistochemical markers allow an etiological classification. We discuss paraprotein-associated kidney diseases in more detail because they are relatively common. Many of these patients do not fulfil the diagnostic criteria of plasma cell myeloma. Several years ago, the term «monoclonal gammopathy of renal significance» (MGRS) and a more aggressive therapeutic approach was introduced for these patients, with an improvement in mortality and morbidity. We also review the new group of complement C3-glomerulopathies. Although relatively rare, they have a very interesting pathophysiology and novel anti-complement therapies may provide new therapeutic approaches.
肾活检——基础与最新进展 肾活检用于明确肾小球性血尿、蛋白尿和肾功能不全的鉴别诊断。由于光镜检查、免疫组织化学检查和电子显微镜检查所需的特殊设备、与其他领域相比处理的活检数量较少以及解读和签发病例所需的特殊专业知识，肾病病理学服务通常仅在较大的病理科提供。活检诊断对肾脏疾病患者的诊断检查和治疗至关重要。越来越多的新免疫组化标志物有助于进行病因分类。我们将更详细地讨论副蛋白相关的肾脏疾病，因为它们相对常见。这些患者中的许多人不符合浆细胞骨髓瘤的诊断标准。几年前，针对这些患者引入了“具有肾脏意义的单克隆丙种球蛋白病”（MGRS）这一术语以及更积极的治疗方法，死亡率和发病率有所改善。我们还回顾了补体C3肾小球病这一新类别。虽然相对罕见，但它们具有非常有趣的病理生理学，新的抗补体疗法可能提供新的治疗方法。
