Biopsy Vs New Biopsy in Adult Nephrotics - An Eternal Controversy

Abstract

In children, since 80% cases of nephrotic syndrome are minimal change Glomerulonephritis and respond to steroids, treatment with a course of Prednisolone in given after preliminary investigations. Further investigations including kidney biopsy are undertaken only if the child is ‘steroid resistant’, ‘steroid dependent’ or a ‘frequent relapser’ in whom more powerful immuno suppressive treatment is contemplated. The situation in adults is different since a wide range of primary or secondary glomerular diseases present with nephrotic syndrome. Identification of the cause helps in choosing the appropriate specific treatment from early stages. There was a time when people believed that careful ‘urine examination’ as equivalent to a non invasive kidney biopsy. Although the value of careful urine examination is not questioned, it cannot replace renal biopsy which has become safer and is not associated with pain or morbidity. The ultrasound guidance and use of biopsy ‘guns’ have made the procedure less traumatic and safe. Most centers perform renal biopsy as an outpatient procedure. Keywords: Nephrotic syndrome, Biopsy, Controversies in need for renal biopsy