The value of renal biopsy.

Abstract

THE VALUE of the renal biopsy has recently been questioned, especially in the American scientific literature, and several groups of established clinicians in the U. S. regard renal biopsy as a hazardous and unnecessary luxury . This has led several renal pathologists to critically reexamine their own activity. From an experience based on the examination of 8000 renal biopsies between January 1964 and August 1981, I have obviously a biased point of view, as it is humiliating to find out that one's permanent activity has mainly been devoted to a useless hobby. I will however try to review briefly the implications of following renal patients with and without a renal biopsy. The use of renal biopsies requires a very close cooperation and understanding between renal clinicians and pathologists . These latter should sometimes remember that the aim of pathology is to communicate in an understandable and easy manner what they have seen through a microscope. The replacement of some simple words in a conclusion by numbers and subgroups may lead to terrible confusion . For instance the recommendations of WHO to assess a renal biopsy may lead to the following type of reports: patient Mr Smith is II a, i b 34, and if I were a clinician I would prefer to read Mr. S . has a focal glomerulonephritis involving 1,4 of the glomeruli, with lesions of moderate severity and little damage of tubes, interstitium and vessels. There are some circumstances in which renal biopsy should be performed rapidly and the result used for therapeutic purposes, and I will briefly review these in this article. On the other hand, while some biopsies are probably of no practical immediate use to the patient, they add to the general knowledge, and contribute to the advancement of nephrology in general. For the present article I will only review the use of renal biopsies in a population of adult patients. Although needle