Department of Nephrology, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, 390-8621, Japan.
Clin Exp Nephrol. 2022 May;26(5):424-434. doi: 10.1007/s10157-022-02179-z. Epub 2022 Feb 1.
On-site evaluation of fresh kidney biopsy (FKB) samples at the time of biopsy is useful to verify that adequate specimens are acquired. However, some cases present poor correlation between glomerular number in FKB samples and light microscopy (LM) samples. We examined the usefulness of such on-site evaluation.
We conducted a retrospective cross-sectional observational study (n = 129) to assess the correlation between glomerular number in FKB samples and LM samples and the associated factors hindering the evaluation.
There was a significant positive correlation between glomerular number in FKB samples and LM samples. The median ratio of glomerular number (LM samples/FKB samples) was 0.74. According to this ratio, cases were divided into three groups: reasonable estimation (65 cases), underestimation (32 cases), and overestimation (32 cases). Comparing the reasonable and underestimation groups, significant differences were detected in the extent of interstitial fibrosis and tubular atrophy (IFTA) and interstitial inflammation. Logistic regression analysis demonstrated that IFTA and interstitial inflammation were significantly associated with the underestimation. Moreover, the cortex length of FKB samples correlated with glomerular number in LM samples regardless of tubulointerstitial lesions.
Glomerular number determined during on-site evaluation can be a reference for the actual number of glomeruli in LM samples. Since tubulointerstitial lesions make it difficult to recognize glomeruli in FKB samples, the possibility of underestimation for cases with possibly severe tubulointerstitial lesions should be considered. In such cases, evaluation of cortex length of FKB samples may substitute for evaluating glomeruli on-site.
在活检时对新鲜肾活检（FKB）样本进行现场评估有助于验证是否获得了足够的标本。然而，有些情况下，FKB 样本中的肾小球数量与光镜（LM）样本之间相关性较差。我们检验了这种现场评估的有用性。
我们进行了一项回顾性横断面观察性研究（n=129），以评估 FKB 样本和 LM 样本中的肾小球数量之间的相关性及其阻碍评估的相关因素。
FKB 样本中的肾小球数量与 LM 样本之间存在显著正相关。FKB 样本中肾小球数量的中位数与 LM 样本的比值为 0.74。根据这个比值，病例被分为三组：合理估计（65 例）、低估（32 例）和高估（32 例）。比较合理和低估组，间质纤维化和肾小管萎缩（IFTA）和间质炎症的程度存在显著差异。Logistic 回归分析表明，IFTA 和间质炎症与低估显著相关。此外，FKB 样本的皮质长度与 LM 样本中的肾小球数量相关，而与肾小管间质病变无关。
现场评估确定的肾小球数量可以作为 LM 样本中实际肾小球数量的参考。由于肾小管间质病变使得 FKB 样本中的肾小球难以识别，对于可能存在严重肾小管间质病变的病例，低估的可能性应予以考虑。在这种情况下，评估 FKB 样本的皮质长度可以替代现场评估肾小球。
