Common Indication For Biopsy Research Articles

CLINICO-PATHOLOGICAL SPECTRUM OF BIOPSY PROVEN NATIVE KIDNEY DISEASE IN A TERTIARY HOSPITAL IN NEPAL

Background: Kidney biopsy has been regarded as an important tool for the diagnosis, management and monitoring the prognosis of renal diseases. We conducted this study to find out the clinico-pathological spectrum by native kidney biopsy in a relatively large scale. Methods: This was a hospital based, prospective, observational study carried out in a tertiary hospital of Kathmandu from January 2022 to December 2023. The biopsy specimens were reported by nephropathologists on the basis of light microscopy, direct immunofluorescence for all samples and electron microscopic examination whenever indicated. The patient`s demographic profile, indication and histological findings of kidney biopsy were studied and analyzed using appropriate statistical tools. Results: A total of 610 kidney biopsies were performed during the study period, of which 24 samples did not meet the inclusion criteria and 586 patients were included in the final analysis. The mean age of the patients was 42.08 ±9.09 years and 59.03% of the patients were younger than 40 years. Females outnumbered the males with female to male ratio of 1.09. The most common presentation was limb swelling (81.22%) and nephrotic syndrome was the most common indication for the biopsy and the most common histological finding was lupus nephritis, followed by IgA nephropathy and FSGS. Non-diabetic kidney disease was found in 54.28% of diabetic patients who underwent biopsy. Conclusions: Nephrotic syndrome was the most common indication for kidney biopsy with lupus nephritis being the most common histological finding. Non diabetic kidney disease (NDKD) was found in more than half of the patients with diabetes mellitus.

Clinical and histopathological characteristics of primary focal segmental glomerulosclerosis in Turkish adults

The data regarding primary FSGS (pFSGS) from different parts of the world differ. While the prevalence of pFSGS has been increasing in Western countries like the USA, it follows an inconsistent trend in Europe and Asia and a decreasing trend in Far Eastern countries such as China in the last two decades. There are undetermined factors to explain those national and geographic discrepancies. Herein, we aimed to reveal the current prevalence with clinical and histopathological characteristics of pFSGS in Turkish adults. This study includes the biopsy-proven pFSGS patients data recorded between 2009 and 2019, obtained from the national multicenter primary glomerulonephritis registry system of the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database. 850 of the 3875 primer glomerulonephritis patients(21.9%) have pFSGS. The mean age is 40.5 ± 14.2 and 435 (51.2%) of patients are male. Nephrotic syndrome is the most common biopsy indication (59.2%). 32.6% of patients have hematuria, 15.2% have leukocyturia and 7.8% have both. Serum creatinine, albumin, and proteinuria are 1.0 mg/dL (IQR = 0.7–1.4) mg/dl, 3.4 ± 0.9 g/dl, 3400 mg/day(IQR, 1774–5740), respectively. Females have lower mean arterial pressure (− 2.2 mmHg), higher eGFR (+ 10.0 mL/min/1.73 m2), and BMI (+ 1.6 kg/m2) than males. Thickened basal membrane(76.6%) and mesangial proliferation (53.5%) on light microscopy are the major findings after segmental sclerosis. IgM (32.7%) and C3 (32.9%) depositions are the most common findings on immunofluorescence microscopy. IgM positivity is related to lower eGFR, serum albumin, and higher proteinuria. The prevalence of pFSGS is stable although slightly increasing in Turkish adults. The characteristics of the patients are similar to those seen in Western countries.

Bleeding complications after percutaneous kidney biopsies - nationwide experience from Brunei Darussalam.

Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions. Various studies have identified several risk factors associated with bleeding complications following the procedure, but these findings have shown inconsistency and variation. To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam. We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context. We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020. The outcomes of interest were post-biopsy bleeding and the need for blood transfusions. Demographics, clinical, laboratory and procedural-related data were collected. Logistic regression analysis was used to identify predictors of outcomes. A total of 255 kidney biopsies were included, with 11% being performed on transplanted kidneys. The majority of biopsies were done under ultrasound guidance (83.1%), with the rest under computer tomography guidance (16.9%). The most common indications for biopsy were chronic kidney disease of undefined cause (36.1%), nephrotic syndrome (24.3%) and acute kidney injury (11%). Rate of bleeding complication was 6.3% - 2% frank hematuria and 4.3% perinephric hematoma. Blood transfusion was required in 2.8% of patients. No patient lost a kidney or died because of the biopsy. Multivariate logistic regression identified baseline hemoglobin [odds ratio (OR): 4.11; 95% confidence interval (95%CI): 1.12-15.1; P = 0.03 for hemoglobin ≤ 11 g/dL vs. > 11 g/dL) and the presence of microscopic hematuria (OR: 5.24; 95%CI: 1.43-19.1; P = 0.01) as independent risk factors for post-biopsy bleeding. Furthermore, low baseline platelet count was identified as the dominant risk factor for requiring post-biopsy transfusions. Specifically, each 10 109/L decrease in baseline platelet count was associated with an 12% increase risk of needing transfusion (OR: 0.88; 95%CI: 0.79-0.98; P = 0.02). Kidney biopsies were generally well-tolerated. The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.

Diagnostic yield of endobronchial ultrasound and virtual CT navigational bronchoscopy for biopsy of pulmonary nodules, mediastinal lymph nodes, and thoracic tumors in children.

Endobronchial ultrasound-guided transbronchial biopsy and needle aspiration (EBUS-TBB/EBUS-TBNA) are first line investigative modalities for lung and mediastinal pathology in adults. We aimed to characterize and assess the diagnostic yield of EBUS and virtual CT navigation guided biopsies in children. This single center, retrospective cohort study included patients who underwent radial or linear EBUS procedures (+/- CT navigation) for biopsy of mediastinal lymph nodes, tumors, and pulmonary nodules. Demographic, procedural, and outcome were collected. Sixty procedures were performed in 56 patients aged 2-22 years of age between January 2015 and May 2023. The most common indications for biopsy were pulmonary nodules (45%) and hilar/mediastinal lymphadenopathy (33%). For cases in which a final diagnosis was ascertained by any means, the diagnostic yield for linear EBUS (mediastinal pathology) was 76% and the diagnostic yield from radial EBUS (pulmonary nodules and lung masses) was 85%. The most common diagnoses were infection (45%), malignancy (17%), and sarcoidosis (11%). Among patients in whom infection was the final diagnosis, a total of 31 pathogens were identified. Eighteen were identified on bronchoalveolar lavage and an additional 14 pathogens identified on EBUS-TBB, representing an increase of 77% (p < .005). The sensitivity, specificity, negative and positive predictive values for malignancy detection were 73%, 100%, 94%, and 100%, respectively. EBUS-TBB/TBNA is a safe and effective way to diagnose lung and mediastinal pathology in children. Pediatric interventional pulmonology is a growing field offering minimally-invasive diagnostic opportunities for children in whom more invasive procedures were previously the only option.

Exploring hospital practice types and their impact on glomerular pathologic patterns: Insights from the largest kidney biopsy cohort in Thailand.

This study aims to investigate the influence of different kidney biopsy practices on the prevalence of glomerular pathologic patterns in the largest kidney biopsy registry in Thailand. We conducted a retrospective review of kidney biopsy records from the period between 2000 and 2014. The records were obtained from 2 major institutions: King Chulalongkorn Memorial Hospital, a large university-based hospital, and the Kidney Center Bangkok Hospital, which provides pathology services to hospitals throughout Thailand. The study included native kidney biopsies from all provinces in Thailand, excluding paediatric patients, kidney transplant recipients, and cases of inadequate and repeated biopsies. Patient demographics, indications for biopsy, and final glomerular diagnoses were compared across different hospital practice settings: university (UVH), private (PVH) and public (PBH). A total of 5893 eligible native kidney biopsies were identified from a pool of 7005 biopsies conducted over a 15-year period in 25 provinces throughout Thailand. The 3 most common indications for biopsy were suspected kidney involvement in systemic lupus erythematosus (SLE) (29%), nephrotic syndrome (NS) (29%), and acute glomerulonephritis (AGN)/rapidly progressive glomerulonephritis (RPGN) (13%). The leading indication for biopsy differed across practice types, with suspected kidney involvement in SLE being the primary indication in UVH, while NS took precedence in both PBH and PVH practices. Notably, UVH performed fewer kidney biopsies for asymptomatic urinary abnormalities and diabetes-related indications compared with PVH and PBH. The leading glomerular diagnoses correlated with the biopsy indications, with lupus nephritis (LN) being the most common diagnosis in UVH and PBH practices, whiles immunoglobulin A nephropathy was the predominant diagnosis in PVH practice. Hospital practice types significantly impact the prevalence of glomerular pathologic diagnosis patterns in kidney biopsy data, highlighting the importance of considering this influence in epidemiological comparisons.

Gastrointestinal amyloidosis: an often unexpected finding with systemic implications

The gastrointestinal (GI) tract is a common site of amyloidosis, but the incidence, clinicopathologic features, and systemic implications of different types of GI amyloidosis are not well understood. GI amyloid specimens (N = 2,511) typed using a proteomics-based method between 2008-2021 were identified. Clinical and morphologic features were reviewed in a subset of cases. Twelve amyloid types were identified, including AL (77.9%), ATTR (11.3%), AA (6.6%), AH (1.1%), AApoAIV (1.1%), AEFEMP1 (0.7%), ALys (0.4%), AApoAI (0.4%), ALECT2 (0.2%), Aβ2M (0.1%), AGel (0.1%), and AFib (<0.1%). Amino acid abnormalities indicative of known amyloidogenic mutations were detected in 24.4% ATTR cases. AL, ATTR, and AA types all commonly involved submucosal vessels. They also showed some characteristic patterns of involvement of more superficial anatomic compartments, although there was significant overlap. Common indications for biopsy were diarrhea, GI bleed, abdominal pain, or weight loss. Amyloidosis was usually an unexpected finding, but most AL and ATTR patients were ultimately found to have cardiac involvement (83.5% of AL; 100% of ATTR). Although most GI amyloid is of AL type, over 10% are ATTR, over 5% are AA, and twelve different types were identified in total. GI amyloid is often unexpected but usually signals systemic amyloidosis, thus there should be a low threshold to perform biopsy with Congo red stain in patients with unexplained GI symptoms. Clinical and histologic features are nonspecific, and typing should be performed via a robust method such as proteomics as treatment hinges on correctly identifying the amyloid type.

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy.

Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. In this observational study, we prospectively collected the data of kidney biopsies of patients aged ≥ 18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9 ± 11.5 years and 81% were males. The mean duration of DM was 6.4 ± 6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM.

Histopathological Evaluation of Endometrial Biopsies in Different Age Groups: A Tertiary Care Experience in Turkey

Background: An endometrial biopsy primarily aims to determine endometrial cancer and hyperplasia with atypia at an early stage. Objectives: This study aims to evaluate the indications, histopathological diagnoses, and the number of endometrial biopsies performed in our clinic, according to the age groups of patients, in light of the literature. Methods: A retrospective review was conducted on the file data of 4,965 patients who underwent endometrial biopsy for non-obstetric reasons between 2014-2021. The patients were divided into five groups, according to their age. Pathology diagnoses were classified as benign endometrial pathology, premalignant-malignant pathology, and insufficient for diagnosis. Results: The most common biopsy indication was abnormal uterine bleeding (61.9%), while the most common histopathological result was benign endometrial pathologies (75.3%). Endometrial cancer was also detected in 3% of the patients. The highest diagnosis of benign endometrial pathology among age groups was 96.6% in those below 35. The comparison of age groups in the diagnosis of premalignant-malignant pathology revealed that the highest diagnosis rate was 32.1% in those 65 years and over. Furthermore, the evaluation of the relationship between indications and material adequacy showed that the highest rate of insufficient for diagnosis pathology was in the postmenopausal patient group (34.0%). Moreover, insufficient for diagnosis and endometrial surface epithelium results were highest in patients over 65 (46.7%). Conclusion: Patients aged 55-64 and those over 65 had the highest rate of endometrial cancer and insufficient for diagnosis biopsy results. Therefore, dilation and curettage may be recommended while taking a biopsy from patients in this age group.

Patterns of Glomerular Disease at a Large Urban Public Hospital in South Africa- Impact of HIV Infection

Abstract Introduction Glomerular disease is an important cause of renal failure. We sought to describe the patterns of glomerular disease in patients undergoing native kidney biopsy at a large urban public hospital in South Africa during the period 2001–2010. Methods We retrospectively reviewed all native kidney biopsies undertaken during the study period. We further characterised and compared clinical, laboratory and demographic data between glomerular pathologies. Results The majority of patients undergoing biopsy were young (median age 34 years) and of Black African descent (83%). Proteinuria was the most common indication for biopsy. Secondary glomerular disease was more common than primary glomerular disease. HIV-associated glomerular diseases were the most common secondary glomerulopathies Focal segmental glomerulosclerosis (FSGS) was the most frequent primary glomerulopathy. Minimal change nephropathy (MCN) was more frequent in younger patients and membranous nephropathy (MN) more common in older patients. Renal function was poorer in FSGS and membranoproliferative glomerular disease. Conclusions HIV is an important contributor to the high rates of secondary glomerular disease. Primary glomerulopathy demonstrates geographic variation in South Africa with FSGS being dominant in Johannesburg. Although clinical parameters may suggest underlying glomerulopathy, an accurate diagnosis to facilitate directed treatment and prevent progression to renal failure requires a renal biopsy.

Clinical and histopathological study of renal biopsy in Nepalese children: A single center experience.

BackgroundGlomerular diseases are important causes of morbidity and mortality among children in developing countries. Renal biopsy is the gold standard for determining histological diagnosis, prognosis, and therapy options. This study aimed to investigate the clinical, histopathological, and direct immunofluorescence findings of renal biopsy results in Nepalese children under 18 years old.MethodsIn this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2016 and the end of 2020 were evaluated. Demographic data, indications of biopsy, histopathologic findings, and direct immunofluorescence findings were collected and presented.ResultsThe mean age of the patients was 12.14 ± 4.07 years. Male/female ratio was 1:1. The majority of biopsy cases were aged between 11–15 years of age. The most common indication for biopsy in children was nephrotic syndrome (68.25%). Lupus nephritis with 28 cases (22.22%) had the highest frequency in overall renal biopsies. Minimal change disease (MCD) with 22 cases (17.46%) followed by Ig A nephropathy with 16 cases (12.69%) were the most frequent primary glomerulonephritis. Lupus nephritis showed full house positivity, and MCD showed full house negativity in all Direct immunofluorescence (DIF) parameters, whereas immunoglobulin A nephropathy showed 100% positivity in Ig A in DIF.ConclusionsNephrotic syndrome was the most common indication for renal biopsy. The most common primary glomerulonephritis was MCD, while secondary glomerulonephritis was lupus nephritis. Clinical data, light microscopy, and direct DIF played an integral role in the overall final diagnosis.

Clinicopathological evaluation of our patients with ultrasound assisted percutaneous kidney biopsy

Aim: This study aims to determine the frequency of kidney diseases based on histological diagnosis and to evaluate the relationship between clinical and histopathological findings in patients undergoing percutaneous kidney biopsy for various indications. Material and Method: In this cross-sectional study, demographic, anthropometric and laboratory data of the patients were obtained retrospectively from medical files and computer records. Biopsy indications and histopathological diagnoses (primary glomerular diseases, secondary glomerular diseases, tubulointerstitial diseases and other causes) of the patients were examined. Results: Of 103 patients, 57 (55.3%) were male and 46 (44.7%) were female. The mean age of the patients was 44.67±15.29 years. The most common biopsy indication was hematuria+proteinuria+renal dysfunction (n=28, 27.2%). The most common pathology in histopathological diagnoses was primary glomerular diseases (56.3%), the most common diagnosis was IgAN (n=16, 15.5%). Tubulointerstitial diseases were seen more frequently in the 60 years and older group. (n=4, 25%). The most common cause of secondary glomerulonephritis was AA amyloidosis. The number of tubular disorders increased with advanced age. Conclusion: In our center, renal biopsy was performed most frequently with the combination of proteinuria, hematuria, and renal dysfunction. The most common histopathological result was primary glomerulonephritis, in which IgAN took the first place.

The spectrum of renal diseases with lupus-like features: a single-center study

Background A subset of patients without overt systemic lupus erythematosus (SLE) present with biopsy findings typically seen in lupus nephritis (LN). Although a minority eventually develops SLE, many do not. It remains unclear how to classify or treat these patients. Our study attempted to further understand the clinical and pathological characteristics of cases with lupus-like nephritis (LLN). Methods Among 2700 native kidney biopsies interpreted at University of Rochester Medical Center (URMC) from 2010 to 2019, we identified 27 patients with biopsies showing lupus-like features (LL-fx) and 96 with LN. Of those with LL-fx, 17 were idiopathic LLN and 10 were associated with a secondary etiology (e.g., infection/drugs). Results At the time of biopsy, the LLN-group tended to be slightly older (44 vs. 35), male (58.8 vs. 17.7%, p = .041), and Caucasian (47.0 vs. 28.1%, p = .005). Chronic kidney disease was the most common biopsy indication in LLN (21.4 vs. 2.8%, p = .001). Both LN and LLN presented with nephrotic-range proteinuria (mean 5.73 vs. 4.40 g/d), and elevated serum creatinine (mean 1.66 vs. 1.47 mg/dL). Tubuloreticular inclusions (TRIs; p < .001) and fibrous crescents (p = .04) were more often seen in LN, while more tubulointerstitial scarring was seen in LLN (p = .011). At mean follow-up of 1684 d (range: 31–4323), none of the LLN patients developed ESRD. A subset of both LN and cases with LL-fx overlapped with other autoimmune diseases. Conclusions Lupus-like pathologic features are seen in a wide array of disease processes. The findings suggest that LLN may be a manifestation of an autoimmune process that overlaps with SLE.

Trends of primary glomerular disease in Turkey: TSN-GOLD registry report.

Although several renal biopsy registry reports have been published worldwide, there are no data on primary glomerular disease trends in Turkey. Three thousand eight-hundred fifty-eight native kidney biopsy records were assessed in the Turkish Society of Nephrology Primary Glomerulopathy Working Group (TSN-GOLD) Registry. Secondary disease and transplant biopsies were not recorded in the registry. These records were divided into four periods, before 2009, 2009 to 2013, 2013-2017, and 2017-current. A total of 3858 patients (43.6% female, 6.8% elderly) were examined. Nephrotic syndrome was the most common biopsy indication in all periods (58.6%, 53%, 44.1%, 51.6%, respectively). In the whole cohort, IgA nephropathy (IgAN) (25.7%) was the most common PGN with male predominance (62.7%), and IgAN frequency steadily increased through the periods (× 2 = 198, p < 0.001). MGN was the most common nephropathy in the elderly (> 65years), and there was no trend in this age group. An increasing trend was seen in the frequency of overweight patients (× 2 = 37, p < 0.0001). Although the biopsy rate performed with interventional radiology gradually increased, the mean glomeruli count in the samples did not change over the periods. In Turkey, IgAN is the most common primary glomerulonephritis, and the frequency of this is increasing.

Role of Renal Biopsy in Managing Paediatric Renal Disease in a Tertiary Care Setting

Introduction: The contribution of renal biopsy is of major importance in many paediatrics renal diseases. This prospective study analysed the clinic-pathological spectrum of the biopsied cases, complications related to renal biopsy and its effect on management. Methods: USG guided percutaneous renal biopsy was performed in indicated children. Laboratory findings, complications of the procedure, histological diagnosis and its effect on management were obtained from all patients who underwent renal biopsy from April 2019 to March 2020. The data were finally analysed using descriptive statistics. Results: Total 50 cases were enrolled during the study period. There were 24 males and 26 females with age range from two to 16 years. The common indications for biopsy were acute nephritic syndrome (25 cases), including both primary glomerulonephritis (11 cases) and secondary glomerulonephritis (14 cases), of which lupus nephritis contributed (11/25) cases, followed by atypical/ steroid resistant or dependent nephrotic syndrome (18 cases). Among primary glomerulonephritis, diffuse proliferative glomerulonephritis was most common pathological finding (11/25). One had crescentric glomerulonephritis. Lupus nephritis predominantly had Class IV/V pathology (6/11). Of 18 nephrotic syndrome cases, nine had minimal-change-disease and five had focal-segmental-glomerulosclerosis. The complications associated with procedure were self-resolving gross hematuria in eight cases, perirenal hematoma requiring plasma transfusion in one case. Adequate renal tissue sample was obtained in 47 of the renal biopsies. Three cases underwent repeat biopsy. Immunosuppressive therapy was altered as per the biopsy report among 18 cases. Conclusions: Our study showed that renal biopsy is a safe, reliable and effective technique in children. It resolutes many diagnostic dilemma and helps in effective management.

Fine needle aspiration and core needle biopsy of the spleen: A case series illustrating current practices and challenges.

Splenic fine needle aspiration (FNA) and core needle biopsies (CNB) are rare specimen types, potentially avoided due to clinical concern for hemorrhagic complications. The safety and utility of splenic FNA, the role of rapid onsite evaluation (ROSE), as well as the diagnostic utility of CNB versus FNA have not been recently reviewed. A 10-year retrospective review was performed of percutaneous image-guided FNA and CNB of the spleen. Clinical indications, outcomes, ROSE findings, and final diagnoses were reviewed and correlated. Forty-four specimens from 39 patients were identified. The commonest indication for biopsy was a radiographic mass found during assessment for patient complaint (45%, 20/44), evaluation for malignancy (primary or metastatic) (39%, 17/44), and incidentally (16%, 7/44). Malignant diagnoses were rendered in 10 cases, 80% hematolymphoid and 20% nonhematolymphoid. Thirty-one cases were nonneoplastic and identified as infectious/inflammatory processes 39%, cysts 10%, vascular lesions 13%, benign splenic elements 22%, accessory or atrophic spleen 10%, and extramedullary hematopoiesis 6%. The nondiagnostic rate was 7%. Cases with subsequent splenectomy showed 100% specificity and 86% sensitivity. The concordance of ROSE and final interpretation was 90% within the neoplastic category. Finally, the significant complication rate was 6.8% with no bias to occurrence following FNA or CNB. This series affirms the safety and efficacy of splenic FNA and CNB by complication rates comparable to prior studies and high rate of concordance. The diagnostic accuracy may be further improved by ROSE, and CNB in cases reliant on staining and tissue architecture.

Polyvinylpyrrolidone deposition disease in patients with intravenous opioid use: a case series

The polymer polyvinylpyrrolidone (PVP) is an excipient widely used in prescription drugs. Depending on the molecular weight (MW), parenterally administered PVP may accumulate in various tissues. Consequently, moderate and high MW PVP have only been used in oral preparations since the late 1970s. Surprisingly, starting in 2009, pathology departments in Norway received biopsies revealing PVP deposition, all from patients with a history of intravenous drug use. We identified 13 patients with PVP deposition and re-evaluated 31 biopsies and two autopsies. Common indications for biopsy were renal insufficiency, anemia, pathological fractures, and abdominal complaints. We observed PVP deposits in all biopsies (kidney, hematopoietic bone marrow, bone, gastrointestinal tract, lymph node, and skin) and all sampled tissue from the autopsies. Overall, the clinical findings could be related to PVP deposits in the biopsies. In the most seriously affected patients, PVP deposition caused severe organ dysfunction and contributed to the fatal outcomes of two patients. All patients except for one were prescribed opioid substitution drugs (OSDs), and most of the patients admitted to having injected such medications. Several OSDs contain PVP. One methadone formulation that was marketed in Norway from 2007 to 2014 contained large amounts of very high MW PVP, making it the most likely source of PVP deposition. Although the presumed source of PVP in these patients has now been withdrawn from the market, pathologists should be aware of PVP deposits when evaluating biopsies from this patient group.

Comparative analysis of blind vs real-time ultrasound-guided pediatric renal biopsies: A cross-sectional study

BackgroundRenal biopsy has a definite role in the management of pediatric kidney diseases. Most centers have given up the earlier practice of performing blind biopsy using Tru-Cut needle and started doing real time ultrasound-guided renal biopsy with an automated spring-loaded gun, which has become standard of care in the last decade or so. MethodsWe performed a cross-sectional analysis of the pediatric biopsies conducted at our center over the years by both methods to evaluate whether ultrasound-guided renal biopsy with a disposable automated spring-loaded gun was superior to blind biopsy with a disposable needle of the same size in terms of reduction of complications and improving the yield. We also reviewed the indications and the histopathological diagnosis of pediatric renal biopsies at our center. ResultsA total of 45 native kidney biopsies were performed blind and 48 ultrasound-guided biopsies using the curvilinear probe (frequency 3-5 Hz) of GE Logiq P3 ultrasound machine with disposable spring-loaded automated guns. There was a significant increase in the yield of biopsy in terms of the number of glomeruli per pass. A significant increase in the mean number of glomeruli was noted when a biopsy was performed under ultrasound guidance (P < 0.0001). Gross hematuria was significantly reduced as compared to the earlier biopsies done blind i.e., without ultrasound (P ¼ 0.03). Nephrotic syndrome was the commonest indication for biopsy in our patients during both time periods studied. The most common histopathological diagnosis was MesPGN among the children who underwent kidney biopsy from 2005 to 2007, while Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) were most frequently reported. ConclusionUltrasound guided kidney biopsies in pediatric age group have significant reduction in incidence of post gross hematuria and significant increase in the mean number of glomeruli per pass.

Epidemiology of Pediatric Renal Diseases and its Histopathological Spectrum - A Single-Center Experience from India.

Pediatric renal biopsy is an uncommon event, and the spectrum of the disease is evaluated and managed mostly on the clinical grounds. Compared to adults, the indications for renal biopsy in pediatric population are very few. We reviewed the pediatric renal biopsies received at our tertiary center in Mumbai, India, over a period of six years to study the incidence of various medical renal diseases, their spectrum on histology and its correlation with electron microscopy (EM). A total of 65 pediatric renal biopsies in the age group of 0-12 years were evaluated over a period of six years. The mean age of our patients was 7.9 years, with a median of 8.8 years with a male-to-female ratio of 1.3:1. The overall most common indication for biopsy was nephrotic syndrome (NS) including steroid-resistant NS, followed by proteinuria and nephritic syndrome. Majority of the lesions included in the study were primary glomerular disease (71%) while secondary glomerular disease amounted to 18%. The spectrum of disease includes minimal-change disease (MCD) (27.7%), followed by membranoproliferative glomerulonephritis (MPGN) (15.38%), focal segmental glomerulosclerosis (FSGS) (9.23%), lupus nephritis (7.7%), hemolytic uremic syndrome (7.7%), MPGN (6.15%), advanced renal disease (6.15%), membranous glomerulonephritis (3.07%), and crescentic glomerulonephritis (3.07%). This study is an important contribution to the epidemiology of pediatric renal disease spectrum in the Indian population. We conclude that MCD is the most common pathology seen in pediatric age group, with NS as the most common indication for biopsy. There is a steady increase in the incidence of FSGS in the pediatric population with frequent relapses and an increase in the incidence of steroid resistance. However, with the use of immunofluorescence and EM, an accurate diagnosis is possible, so an early renal biopsy should be planned in nonresponding cases and at times even before starting the treatment for appropriate treatment.

Histopathological evaluation of percutaneous renal biopsies: A single center experience

Aim: The aim of this study was to examine the indications, demographic features and histopathological diagnosis category of renal biopsies evaluated at the Pathology Laboratory of the University of Health Sciences Diyarbakir Gazi Yasargil Training and Research Hospital. Materials and Methods: The information of 190 patients who underwent percutaneous renal needle biopsy between July 2017 and February 2020 was obtained from the approved final pathology reports. Results: 190 biopsies were performed. 60% (n=114) and 40% (n=76) of the biopsies were native and transplant, respectively. 59.5% of the patients were male. Four of the patients were under 18 years. The mean ages of the native and transplant biopsy groupes were 37±14, and 34±14, respectively. Proteinuria was the most common biopsy indication (79.5%).Nonspecific changes were the most common diagnosis of the native biopsies. It was followed by focal segmental glomerulonephritis (FSGS), membranous glomerulonephritis (MGN), and IgA nephritis (IgAN). The most common secondary cause of glomerulonephritis was lupus nephritis. Acute cellular rejection was the most common diagnosis of the transplant renal biopsies. Conclusion: Proteinuria was identified as the most common indication for biopsy. In the present study, the primary glomerular disease was FSGS while the secondary was lupus nephritis. With electron microscopic examination, it might be possible to decrease the number of patients who cannot be definitively diagnosed histomorphologically.

A pediatric nephrologist’s experience on real-time ultrasound-guided kidney biopsy

Aim: Kidney biopsy is crucial in management of renal diseases. Biopsies in children have added difficulties. The aim of this study is to investigate our 5-year experience of real-time ultrasound (USG)-guided percutaneous renal biopsy (PRB). Methods: Institutional database of children who underwent PRB in a tertiary hospital between January 2015 and March 2020 were evaluated retrospectively. A single pediatric nephrologist performed all the biopsies using an automated spring-loaded biopsy gun under real-time USG guidance. Results: Thirty-two biopsies were performed in 17 males (53.1%) and 15 females (46.9%), and the median age of the children was 14.5 years. The most common indication for biopsy was nephrotic syndrome in 13 /32 children (40.6%). Median number of glomeruli obtained from biopsy specimens was 18 (min-max=7-54 glomeruli). A diagnosis was achieved in all cases (100%) by a histopathologist. The only complication observed in a 16-year-old boy was a self-limited gross hematuria (3.1%) episode with subcapsular hematoma. Conclusion: Real-time USG-guided PRB with an automated biopsy gun is an effective and safe technique, providing superior yield when performed by a pediatric nephrologist. Performing kidney biopsy is an essential tool in a nephrologist’s workshop.