Abstract
This report analyses data on 177 renal biopsies (RB) performed in 174 children in the East Bohemian region throughout 1997-2008. The primary aim was to evaluate the diagnostic benefit of the procedure, the secondary aim was to assess the safety of RB and prevalence of clinical complications. The patients' mean age at the time of RB was 12.77 +/- 4.17 years; range 1 to 19 years; male to female ratio 1.17:1. Haematuria was the most common indication for RB. All RBs were performed by a single consultant nephrologist. 27 biopsies in 27 patients (15.3 %) in 1997 were performed under X-ray control, the remaining 150 RB (84.7 %) under ultrasound guidance. The mean annual number of RBs performed in 1997-2001 was significantly higher than in the 2003-2008 period (21.6 +/- 5.5 versus 9.9 +/- 1.2; p=0.0003). All samples were diagnostic. The mean number of glomeruli was 23.5 +/- 11.4 (range 4-55) per sample. The RB resulted in information yielding a definite diagnosis and/or prognosis in 173 children (99.4 %). The most frequent diagnoses were IgA nephropathy (n=41; 23.5 %), mesangioproliferative glomerulonephritis (n=31; 17.8 %) and thin basement membrane glomerulopathy (n=22; 12.6 %). No major complications were encountered and only minor complications occurred in 43 cases (24.2 %), not requiring medical intervention. In conclusion, the present practice of RB in children is safe, with high clinical benefit.
Highlights
Renal biopsy (RB) is a decisive diagnostic procedure in patients with renal disease
The primary aim was to evaluate the diagnostic benefit of the procedure, the secondary aim was to assess the safety of RB and prevalence of clinical complications, and the changes in diagnostic distribution and RB indications throughout one decade
The largest amount of biopsies was performed in children aged 12–17 years (Fig. 1) especially in 1997–1998, while a decline in the number of achieved biopsies has been observed since the year 2002 (Fig. 2)
Summary
Renal biopsy (RB) is a decisive diagnostic procedure in patients with renal disease. The indications for RB have changed over the years. There are five categories of indications [7, 9,10, 12, 16,17,18, 26, 27, 32, 33, 35]: glomerular hematuria; non-nephrotic range protenuria; nephrotic syndrome; acute nephritic syndrome; acute or subacute renal failure of undetermined origin In paediatric patients these indications further include: persistent hematuria of unknown origin; persistent proteinuria of unknown origin; steroid-resistant nephrotic syndrome; acute renal failure of unknown origin; familial nephritis; rapidly progressive glomerulonephritis; “atypical“ acute glomerulonephritis; suspected tubulointerstitial nephritis; nephropathies in systemic diseases (Lupus erythematosus, Henoch-Schoenlein purpura) [7, 12, 18, 19, 26, 27, 35]. In paediatric nephrotic syndrome (NS) the indications are: congenital NS (occurring under 6 months of age); corticoresistant NS; corticodependent NS prior to cyclosporine A therapy; NS patients
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