Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, No. 8. Xishiku Street, Xi Cheng District, Beijing, 100034, China.
Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
Pediatr Nephrol. 2020 Dec;35(12):2285-2295. doi: 10.1007/s00467-020-04681-6. Epub 2020 Jul 3.
Pediatric native kidney diseases are common worldwide. The pathological diagnosis of kidney lesions is crucial for clinical treatment and prognosis. The aim of the current study was therefore to evaluate the value of electron microscopy (EM) to the final diagnosis of native kidney biopsies in children.
A retrospective evaluation of 855 pediatric kidney biopsies obtained from the Department of Pediatrics in Peking University First Hospital between November 2010 and December 2017 was performed to assess the contribution of EM to the final diagnosis.
The role of EM in the final diagnosis was determined to be crucial in 300 cases (35.1%), important in 280 cases (32.7%), and auxiliary in 275 cases (32.2%). EM is considered most valuable in a large percentage of glomerular diseases, mainly including minimal change disease, early-stage membranous nephropathy, postinfectious glomerulonephritis, Alport syndrome, thin basement membrane nephropathy, and thrombotic microangiopathy. EM also provided helpful diagnostic information in cases of focal segmental glomerulosclerosis, lupus nephritis, IgA nephropathy, and IgA vasculitis (Henoch-Schonlein purpura nephritis). Additionally, EM was crucial in 90.0% of cases of subtle pathological changes observed with light microscopy (LM) and immunofluorescence (IF) and in 69.3% of the IF-negative specimens. Patients with nephrotic syndrome or hematuria also benefit from ultrastructural examination.
The present study demonstrated the crucial or important role of EM in the diagnosis of a majority of native kidney biopsies in children. The application of EM should be integrated together with LM and IF as a routine method of assessing pediatric kidney specimens. Graphical abstract.
儿科原发性肾脏疾病在全球范围内较为常见。肾脏病变的病理诊断对临床治疗和预后至关重要。因此，本研究旨在评估电子显微镜（EM）对儿童原发性肾脏活检的最终诊断价值。
回顾性分析 2010 年 11 月至 2017 年 12 月北京大学第一医院儿科获取的 855 例儿童肾脏活检，评估 EM 对最终诊断的贡献。
EM 在 300 例（35.1%）中对最终诊断具有关键作用，在 280 例（32.7%）中具有重要作用，在 275 例（32.2%）中具有辅助作用。EM 在肾小球疾病中具有较高的价值，主要包括微小病变性肾病、早期膜性肾病、感染后肾小球肾炎、Alport 综合征、薄基底膜肾病和血栓性微血管病。EM 在局灶节段性肾小球硬化症、狼疮性肾炎、IgA 肾病和 IgA 血管炎（过敏性紫癜性肾炎）中也提供了有价值的诊断信息。此外，EM 在光镜（LM）和免疫荧光（IF）观察到的细微病理变化的 90.0%病例中和 IF 阴性标本的 69.3%病例中具有关键作用。肾病综合征或血尿患者也受益于超微结构检查。
本研究表明 EM 在诊断大多数儿科原发性肾脏活检中具有关键或重要作用。EM 的应用应与 LM 和 IF 一起作为评估儿科肾脏标本的常规方法。
