Consecutive Renal Biopsies Research Articles

Comparison of Histopathological Findings with Clinical Response among Patients Undergoing Consecutive Renal Biopsy for Lupus Nephritis in 2008-2021

Comparison of Histopathological Findings with Clinical Response among Patients Undergoing Consecutive Renal Biopsy for Lupus Nephritis in 2008-2021

Clinical audit; freehand renal biopsy, still a suitable method?

Introduction: Freehand renal biopsy represents a valid alternative to the most widespread ultrasonography-guided technique, although some concerns can derive from the possible increased complication rate and lower adequacy rate. Objectives: In the present audit study, efficacy of freehand method have been established through the analysis of 328 consecutive renal biopsies in 322 patients, instead the safety of the procedure was assessed in 196 patients. Patients and Methods: We retrospectively reviewed hospital databases of all patients who underwent a percutaneous renal biopsy over an 18 years’ period at Santa Marta and Santa Venera hospital in Acireale. Results: The procedure led to a definitive diagnosis in the majority of cases (98.48%), being uninformative only in 5 out of 328 cases (1.52%). Comparing these results against a Proforma, resulting from analysis of best literature reports for the items studied, adverse event rates were similar. Conclusion: Freehand renal biopsy resulted a good option to obtain renal tissue, without serious side effects. We argue about safety and we prefer to reserve this invasive procedure to selected cases, avoiding renal biopsy if biochemical and instrumental data allow a definitive diagnosis as well as in high risk patients. Our policy protects patients from the adverse effects that can result from kidney biopsy.

Changes in the spectrum of kidney diseases: a survey of 2803 patients from 2010 to 2018 at a single center in southeastern China

Primary glomerular disease was the leading cause of chronic kidney disease (CKD) in China; however, changes in the economy and environment introduce variations in the spectrum of kidney diseases. This study aimed to analyze renal biopsy data to inform disease prevention and public health interventions. In this retrospective cohort study, data from 2,803 consecutive renal biopsies conducted at our center between January 2010 and December 2018 were analyzed. The sample was disaggregated by age and the date of biopsy to facilitate analysis. Primary glomerulonephritis (PGN) is the most frequent (81.84%) finding, followed by secondary glomerulonephritis (SGN; 15.38%), tubulointerstitial nephritis (15.38%), and others (1.57%). IgA nephropathy (IgAN), idiopathic membranous nephropathy (iMN), and minimal change disease were the primary causes of PGN. Among PGN cases, the incidence of iMN arose, especially among those aged ≥ 60 years old, during the observation period. Contrary to the case of iMN, the proportion of IgAN in PGN trended downward, continuously, and at length. Moreover, IgAN mainly affected those aged 25–44 years old and less so those aged ≥ 60 years old. Lupus nephritis, Henoch–Schönlein purpura nephritis, and diabetic nephropathy (DN) were key causes of SGN. A ratio reversal between infectious disease and chronic disease dramatically changed SGN patterns. In the past year, the incidence of hepatitis B–related nephritis has constantly declined; however, the proportion of DN among SGN had steadily increased. The incidence of iMN significantly increased during these years. Among SGN cases, the proportion of DN has increased.

A Case of TAFRO Syndrome with Two Consecutive Renal Biopsies Following the Pathological Course of the Kidney

A Case of TAFRO Syndrome with Two Consecutive Renal Biopsies Following the Pathological Course of the Kidney

POS-415 ELECTRON MICROSCOPY: THE GOLDEN WEAPON FOR GLOMERULAR DISORDERS

Worldwide glomerular disorders (GD) constitute one of the major causes of end-stage renal disease (ESRD). Its spectrum varies in comparison to developing countries compared to developed countries. The definitive diagnosis of requires histopathological evaluation of renal biopsy by light microscopy (LM), immunofluorescence (IF), and electron microscopy (EM). Nowadays, EM has become the standard of care practice for the evaluation of GD. The objective of this study was to analyze the role of EM for an accurate diagnosis. This was a cross-sectional study conducted in patients of age group 18-65 years presenting at a tertiary care center in North India from August 2018 to January 2020. A total of 200 consecutive renal biopsies were performed and were subjected to LM, IF, and EM. IF was performed in 100% cases and EM done in 75.5% cases. The most common indication of kidney biopsy was nephrotic syndrome (44%). Primary glomerular disorder (PGD) observed in 62% of cases. The most common PGD was IgA nephropathy [IgAN (18.5%)], followed by focal segmental glomerulosclerosis [FSGS (16%)], membranous nephropathy [MN (10%)], minimal change disease [MCD (5%)], membranoproliferative glomerulonephritis [MPGN I (2.5%)], C3 glomerulonephritis [C3GN (4%)], Crescentic GN (2.5%), diffuse proliferative GN [DPGN (2%)], IgM nephropathy [IgMN (0.5%)] and miscellaneous (1%). Secondary glomerular disorders (SGD) accounted for 21% of cases. Lupus nephritis was the most common SGD. Vascular (5.5%), tubulointerstitial disorders (9%), and ESRD (5%) were less prevalent. MCD was the most common GD in patients less than 20 years, while IgAN was most common in patients 21-50 years, followed by FSGS. Above 51 years, FSGS was the most common GD, followed by MN. In 62% of cases, the diagnosis of glomerular disease was based on LM and IF findings alone. Discrepant IF findings were obtained in 5.5% cases. In 9% of cases, EM contributed to the diagnosis. EM was essential for the final diagnosis in 23.5% of the cases. Table 1: Case series evaluation based on EM Tabled 1CategoriesLM + IFDiscrepant IFUseful EMEssential EMTotal(A). PGD124MCD2-810FSGS18111232MN1323220DPGN1-214MPGN (MPGN I / C3GN/ DDD)2/2/-1/-/--/2/-2/4/-5/8/0CresGN5---5IgAN2362637IgMN1---1Miscellaneous1--12(B). SGD42LN812415DN8-2414AA10-1-11MM2---2HSP----0(C). Vascular Nephropathy11HUS----0TMA1-214HN1-124CAN3---3(D). Tubulo-interstitial nephritis (TIN)18Acute TIN10---10Chronic TIN5---5ATN3---3(E). ESRD5---5TOTAL (%)124 (62%)11 (5.5%)18 (9%)47 (23.5%)200 Open table in a new tab The incidence of IgAN and FSGS has increased significantly over the last decade, especially in developing countries. This study has provided comprehensive information about the changing spectrum of GD in adults with a focus on EM as a routine standard of care practice.

A Novel Standardized Method of Renal Biopsy in Mice

Introduction: In animal models, it can be difficult to confirm therapeutic effects due to technical inconsistencies and other reasons. Although renal biopsy is widely used in clinical diagnosis, it is rarely used in animal experimental models, especially in mice, because the problems of surgery-induced renal injury and bleeding have not been solved. Methods: We developed an easy-to-use method of renal biopsy in mice and evaluated whether 3 consecutive renal biopsies can be performed in the same kidney in a standardized manner. This method was verified using 2 mouse models, a healthy mouse model and a unilateral ureteral obstruction (UUO) mouse model, and evaluated based on renal function and histological changes. Results: There were no perioperative complications in any of the model mice. There was no significant difference in serum Cr, 24-h urine protein, or kidney/body weight ratio between the biopsy and control groups. Each biopsy sample contained sufficient renal tissue. The damage to the operated tissue was limited to the tissue near the biopsy site. Compared with renal tissues in the corresponding control group, the renal tissues obtained from the 3 biopsies (healthy model days 0, 4, and 7 and UUO model days 3, 7, and 10) and the remnant renal tissues after the biopsy showed no significant difference in the glomerular sclerosis index, degree of renal tubular damage, inflammatory response and renal fibrosis in these 2 models. Conclusions: Our new standardized method of renal biopsy in mice is a safe and cost-saving approach that allows repeated renal biopsies and ensures minimal trauma and sufficient sample size to quality in experimental disease models.

Renal Allograft Biopsies with Polyomavirus BK Nephropathy: Turin Transplant Center, 2015-19.

Background: In kidney transplant patients, polyomavirus-associated nephropathy (PVAN) represents a serious complication; the key factor for the development of PVAN is immunosuppression level and modulation of anti-rejection treatment represents the first line of intervention. Allograft biopsy and histology remain the criterion standard for diagnosing PVAN. Methods: All consecutive renal biopsies with the diagnosis of PVAN carried out at the University Hospital City of Health and Science of Turin over a five-years period were studied. Renal allograft biopsy was performed due to renal function alterations associated to medium-high polyomavirus BK (BKV)-DNA levels on plasma specimen. Results: A total of 21 patients underwent a first biopsy to diagnose a possible BKV nephropathy, in 18, a second biopsy was made, in eight, a third biopsy, and finally, three underwent the fourth renal biopsy; following the results of each biopsies, immunosuppressant agents dosages were modified in order to reduce the effect of PVAN. Conclusions: In this study, the clinical and histological features of 21 kidney transplant recipients with BKV reactivation and development of PVAN are described. To date, the only treatment for PVAN consists in the reduction of immunosuppressive agents, constantly monitoring viral load.

P0127ROUTINE USE OF COMBINATION CD3/PAS STAIN IN EVALUATING RENAL ALLOGRAFT BIOPSIES FOR REJECTION RESULTS IN MORE ACCURATE BANFF SCORES FOR TUBULITIS

Abstract Background and Aims The BANFF Classification of renal allograft rejection consists of scores for cellular rejection which rely primarily on the evaluation of lymphocytic infiltration into tubules (t), non-atrophic interstitial inflammation (i), total inflammation (ti), and endotheliatis (v.) CD3/PAS is a combination stain that highlights T lymphocytes (CD3) and basement membrane (PAS). The original BANFF scoring was developed using a hematoxylin and eosin (H&E) stain only. This study compares scores for (t) using H&E versus CD3/PAS. Method 50 consecutive renal allograft biopsies were retrieved and on each case H&E and CD3/PAS combination stains (Ventana/Roche tissue Diagnostics Clone 2GV6 for CD3) were performed. One blinded group of matching CD3/PAS and H&E slides were evaluated and reviewed independently by two renal pathologists (Reviewer 1 and 2). Each case was graded in an identical manner following criteria designated for (t) as previously described in the Banff Classification for Renal Allograft Biopsies. Briefly (t)=0 no lymphocytes in 10 tubule cross section (tcx), (t)=1 between 1-4 lymphocytes per tcx, (t)=2 5-10 lymphocytes per tcx and (t)=3 greater than 10 lymphocytes per tcx. Cases were not graded for (v) as there were too few cases with endotheliatis to allow for statistical evaluation. The difference between CD3/PAS versus H&E scores were tested for significance using the Wilcoxon Signed Rank test. All p values were two-tailed and values of <0.05 were considered statistically significant. Results Mean age was 44 years with a range of 9 -75 years. Standard deviation (SD) for age was 18 years. Gender distribution was 20% female and 80% male. 28 cases were graded as (t) = 0 in H&E versus 18 in the CD3/PAS group (59% versus 36%). 17 cases were graded as (t)=1 in H&E group versus 19 in the CD3/PAS group (36% versus 38% respectively). 2 cases were graded (t)=>2 in H&E versus 12 cases in CD3/PAS groups (4% versus 24% respectively). In all categories of (t) there was a higher (t) score when using a CD3/PAS with 42% showing a one digit score increase and 8% showing a 2 digit increase. The difference in scoring for (t) between the H&E set versus the CD3/PAS set for both Reviewers 1 and 2 were statistically significant (p<0.0001). Conclusion This study showed statistically significant higher tubulitis scores when using a CD3/PAS combination stain to grade allograft biopsies. Since (t) scores directly affect the diagnosis of cellular rejection, we propose routine use of CD3/PAS in addition to H&E when reviewing renal allograft biopsies. Compared with H&E, CD3/PAS makes recognition and quantification of lymphocytes crossing the tubular basement membrane easier to detect and therefore more accurate.

P1759NEPHROTOXICITY OF CALCINEURIN INHIBITORS AS A RISK FACTOR FOR BK VIRUS REPLICATION AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims BK virus nephropathy (BKVN) represents a serious complication of kidney transplantation and is responsible for significant percentage of transplanted kidneys prematurely terminating their function. Its occurrence is considered a complication of immunosuppressive therapy and is closely related to its intensity. The aim of our prospective study was to evaluate the incidence of subclinical and clinically manifest nephrotoxicity of calcineurin inhibitors (CI) in repeated protocol kidney graft biopsies as a manifestation of excessive immunosuppression and to evaluate its relationship to the PCR confirmed active BKV replication and bioptically proven BKVN during the first year after transplantation. Method In a group of 161 newly transplanted patients we prospectively evaluated 457 consecutive protocol renal biopsies performed within the first year after transplantation. Using the CI nephrotoxicity score, the incidence of nephrotoxicity was monitored. Findings were correlated with laboratory (PCR) and histological evidence of active BK virus (BKV) replication and BKVN. Results When compared to the normal histology, nephrotoxicity was associated with more frequent significant BKV viraemia and viruria (P = 0.02 and P = 0.01, respectively) and more common occurrence of BKVN. The persistence of toxicity in the subsequent biopsy proved to be a negative risk factor of significant BKV viraemia and viruria (P = 0.03 and P = 0.01, respectively), independently of the initial BKV status of the monitored groups. Toxicity could also be used as a predictor of significant viraemia and viruria (P = 0.02 and P = 0.01, respectively) even in the absence of viral replication at the time of initial biopsy. Conclusion Early histological detection of CI nephrotoxicity followed by pre-emptive CI dose reduction might prevent significant BKV reactivation in the risky first posttransplant year. The evaluation whether a regression of histological signs of nephrotoxicity after a CI dose reduction leads to a reduction in BKV replication, and whether a more frequent occurrence of rejection does not complicate further posttransplant course, will be the subject of our further investigation. Supported by grant of Ministry of Health, Czech Republic DRO (FNOL 00098892) – 87-68.

P0093IMPROVED INTEROBSERVER AGREEMENT IN BANFF SCORING OF RENAL ALLOGRAFT BIOPSIES WHEN ROUTINELY USING CD3/PAS STAIN

Abstract Background and Aims The BANFF Classification of renal allograft rejection consists of scores for cellular and antibody mediated rejection. The scores for tubulitis (t), interstitial inflammation (i), glomerulitis (g), total inflammation (ti), and endotheliatis (v) have direct prognostic and therapeutic significance as they contribute to a diagnosis of renal allograft rejection. The original BANFF scoring was developed using hematoxylin and eosin (H&E) stain only. This study examines the level of interobserver agreement using H&E and a combination CD3/PAS stain that highlights T lymphocytes and basement membranes. Method 50 consecutive renal allograft biopsies were retrieved and on each case H&E and CD3/PAS stains (Ventana/Roche Tissue Diagnostics clone 2GV6 for CD3) were performed. CD3/PAS and H&E slides were matched and blinded for two reviewers [reviewer (R1) and reviewer 2 (R2)]. Each case was graded in an identical manner following criteria designated for (t),(i),(g) and (ti) as previously described in the Banff Classification for Renal Allograft Biopsies. Cases were not graded for (v) as there were too few cases with endothelialitis to allow for statistical evaluation. The matched scores were analyzed using weighted Kappa statistics for interobserver agreement within each group. Agreement levels were characterized using Landis and Koch descriptions for level of agreement. All p values were two-tailed, values of <0.05 were considered statistically significant. Statistical analyses was performed using SAS Version 9.4, Cary NC. Results Mean age was 44 years with a range of 9 -75 years. Standard deviation (SD) for age was 18 years. Gender distribution was 20% female and 80% male. Agreement between R1 and R2 for (t) scores was moderate (Weighted Kappa 0.5276) as opposed to fair for H&E group (Weighted Kappa 0.4189). Similarly, interobserver agreement was moderate for scores of (i) and (ti) in the CD3/PAS group and fair in the H&E group. For both CD3/PAS and H&E interrater evaluations, agreement was fair to poor for (g) with weighted Kappa of 0.3928 and 0.3559 respectively. Conclusion This study showed increased levels of interobserver agreement when using a CD3/PAS combination stain to score allograft biopsies for (t), (i) and (ti). Since (t), (i) and (ti) scores directly affect a diagnosis of rejection, we propose routine use of CD3/PAS in addition to H&E when reviewing renal allograft biopsies. Glomerulitis (g) shows poor interobserver agreement regardless of the stain used and further studies to refine the criteria for (g) in Banff revisions of the classification may be of value.

Clinico-pathological Profile and Outcome of C-3 Glomerulopathy in Indian Children.

Introduction:There is paucity of data of C3 glomerulopathy in Indian children.Methods:First Indian pediatric case series where consecutive renal biopsies done over a period of ten years were reviewed to identify those patients who had isolated or predominant C3 deposits on immunofluorescent microscopy, fulfilling the criteria for C-3 glomerulopathy. The clinical, biochemical, serological, histopathological profile, eGFR and the need for renal replacement therapy was analyzed.Results:Eighteen patients, comprising 5.3% (18/298) of all renal biopsies, had C3 glomerulopathy, four with Dense Deposit Disease (DDD) and fourteen with C3 Glomerulonephritis (C3GN) with a median follow-up of 38.2 months. Median age of presentation was 7.45±3.03 years (2.5yrs- 13.5yrs) with nine boys and nine girls. Presentation was nephrotic syndrome in seven (39%), acute nephritic syndrome in three (16.7%), hematuria in five (27.7%) and acute kidney injury in three (16.7%). Median eGFR was 69 ml/min/1.73m2 (8.2-107 ml/min/1.73m2). Hematuria was seen in 16 (88%), proteinuria in 18 (100%) and low C3 in 16 (88%) at the time of presentation. Mesangioproliferative glomerulonephritis was the predominant pattern in DDD while C3GN showed a mix of mesangioproliferative, membranoproliferative, endocapillary and crescentic GN (p = 0.43).Complete or partial remission was seen in seven patients who received long term alternate day steroids alone or with added mycophenolate mofetil. The cumulative patient survival was 70.8%. Kaplan Meir analyses for renal survival without progression to ESRD was 60.2% at one year and 48.1% at five and ten years.Conclusion:Interstitial fibrosis and tubular atrophy on renal biopsy was an independent predictor of adverse renal outcome in the cohort (p = 0.013, HR8.1;95% CI -1.6-42).

Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy

Introduction The risk of bleeding has led to screening of the primary hemostasis before renal biopsy. A bleeding time test (BT) is considered standard practice, but reliance on this test is controversial and its benefits remain questionable. A possible alternative is thromboelastography (TEG). However, data regarding TEG in patients with renal dysfunction is limited. Objectives To determine TEG abnormalities and their consequences in patients who underwent a native kidney biopsy. Methods A retrospective study of 417 consecutive percutaneous native renal biopsies performed in our Center. If serum creatinine >1.5 mg/dL, the patient underwent either a BT test (period A, January 2015–31 December 2016) or TEG (period B, January 2017–August 2018). In patients with prolonged BT, or an abnormal low maximal amplitude (MA) parameter of TEG, or suspected clinical uremic thrombopathy, the use of desmopressin acetate (DDAVP) was considered. Results Most biopsies (90.6%) were done by the same dedicated radiologist. Fifty-one patients had a BT test, which was normal in all tested patients. Seventy-one patients underwent TEG, and it was abnormal in 34 of them, most patients had combined abnormalities. The only parameter related to abnormal TEG was older age (Odds Ratio 1.21 [95% CI 1.09–2.38] p = 0.04 for abnormal Kinetics; OR 1.37 (1.05–1.96) p = 0.037 for abnormal MA). Twenty-six patients (6.23%) had bleeding complications. Risk of bleeding was significantly related to age (1.4 [1.11–7.48] p = 0.04), systolic blood pressure (1.85 [1.258–9.65] p = 0.02), and serum creatinine (1.21 [1.06–3.134] p = 0.048). Conclusions TEG abnormalities in patients with renal dysfunction are variable and fail to predict bleeding during kidney biopsy. The decision to administer DDAVP as a preventive measure during these procedures should be based on clinical judgment only.

A Comparison between Kidney Allograft Biopsies Performed by Nephrologists and Surgeons Versus Interventional Radiologists.

Introduction: Renal biopsy is an integral part of clinical nephrology practice that helps in the diagnosis of various renal diseases. Across the globe, it is performed by nephrologists and/or surgeons under ultrasound guidance. Lately, this novel procedure has been performed more frequently by the interventional radiologist (IR) as compared to nephrologists and surgeons.Methods: We completed a retrospective review of 378 consecutive renal biopsies performed at our university hospital in the city center of Philadelphia, Pennsylvania, between September 2008 and June 2011 for various indications. Baseline characteristics were comparable except systolic blood pressure (SBP), prothrombin time (PT), and international normalized ratio (INR) which was higher. Hemoglobin was lower in patients who underwent biopsy by the IR compared to those who were biopsied by nephrologists and/or surgeons.Results: The primary outcome showed the average number of glomeruli obtained with each biopsy was significantly lower by nephrology or surgical teams, 9.09 ± 5.17 vs. 19.17 ± 11.11 obtained by the interventional radiology team, p-value <0.0001. The number of cores obtained with each biopsy was significantly lower by nephrologist or surgeon at the bedside, 1.57 ± 1.05 vs. 2.42 ± 1.26, p-value <0.0001. The average number of attempts to obtain one core was 2.00 ± 1.10 vs. 2.60 ± 1.17 by nephrologist and surgeon vs. IR, respectively, p-value <0.0001.Conclusion: Our study clearly shows the superior success of renal biopsy by the IR as compared to the nephrology and surgical teams. This calls for more robust training of nephrology fellows and surgery residents to obtain the renal biopsy to prevent the loss of this unique procedure skill by non-radiology clinicians.

Membranoproliferative glomerulonephritis with deposition of monoclonal IgG evolved from polyclonal IgG: a case report with two consecutive renal biopsies

BackgroundProliferative glomerulonephritis with monoclonal Immunoglobulin (G) deposits (PGNMID) is a rare kind of MGRS with intact monoclonal IgG deposition. Seventy percent of PGNMID patients were negative for M-spike.Case presentationA 51-year-old Chinese woman presented with 16-month history of chronic nephritic syndrome. Her first biopsy showed a MPGN pattern, and the IF showed polyclonal IgG deposition but with IgG3λ dominance, MGRS was highly suspected. But the serum/urine IFE and bone marrow examination was negative for monoclonal gammopathy. She was treated with RAS inhibitors, and monitored carefully in the outpatient clinic. When the proteinuria was not controlled by RAS inhibitors, immunosuppressive agents were initiated. The second biopsy was done due to her acute kidney injury 9 months later, showing a MPGN pattern with acute tubulointerstitial disease, but the IF showed monoclonal IgG3λ deposition. The κ light chain, IgG1, IgG2 and IgG4 were absent. Electron microscopic examination revealed electron-dense deposits in the mesangial, subendothelial and subepithelial area which is the same as the first renal biopsy. The final diagnose of this patient was PGNMID (IgG3λ) with non-organized deposits. Repeated serum/urine IFE and free light chain still failed to identify monoclonal gammopathy. The patient was treated with steroid and cyclophosphamide, and her serum creatinine decreased.ConclusionsSome of the PGNMID patients may be derived from polyclonal immune complex mediated glomerulonephritis.

Consecutive renal biopsy in a cohort of patients with lupus nephritis of the Colombian Caribbean

Background: Renal biopsy is the gold standard for the diagnosis and classification of lupus nephritis (LN). However, a consecutive biopsy can predict the clinical course and optimize the therapeutic strategies. Objectives: To compare the histopathological findings with clinical responses. Patients and Methods: Thirty patients with active LN were included. Renal biopsies were performed at the time of diagnosis and subsequently under clinical criteria according to consensus of Spanish Society of Nephrology. The response to treatment was defined as complete response, partial responder or non-responder. The histological change in second biopsy towards LN classes I, II or III/IV-C was defined as histological response (HR). Results: In initial renal biopsy, 28 (93%) patients showed proliferative LN; III-A or A/C (n; 7), IV-A or A/C (n: 19) and mixed; III+IV/V (n; 2). LN class V was presented in two cases. The clinical response was; complete response (10%), partial response (20%), and non-response (70%). HR was manifested in 37% and non-histologic response in 63% of patients. Around 33% of patients with complete response/partial response showed active lesions in the consecutive renal biopsy. Conclusions: In Colombian Caribbean, LN is aggressive and refractory to treatment. The consecutive renal biopsy allowed to demonstrate the persistence of the activity of the lesion in almost half of the patients, which may provide additional information to create better response criteria. The consecutive renal biopsy is a tool that allows improving the evaluation of the response to treatment in the LN.

Association of CD147 renal expression with morphologic lesions of Oxford classification in IgA nephropathy patients

Introduction: Nephropathy of immunoglobulin A (IgA), is the most frequent glomerulonephritis worldwide. Nephropathy of IgA, has a highly variable course, either clinically or pathologically. Objectives: The aim of this study was to assess CD147 expression with four morphological lesions of Oxford classification in IgA nephropathy patients. Patients and Methods: The characterization of IgA nephropathy necessitated the existence of diffuse and global mesangial IgA deposition with weak C1q deposition. The kidney biopsies with the diagnosis of IgA nephropathy were included in the study. After the diagnosis of IgA nephropathy, four pathologic variables, of the Oxford classification of IgA nephropathy were assessed. For immunohistochemical staining, 4-μm-thick sections were stained with anti-human CD147 antibody. The intensity of CD147 staining on tubules, Bowman’s capsules, vessels and tuft of glomeruli was expressed as percentage of involvement. Results: In this study, 48 consecutive renal biopsies documented for IgA nephropathy were selected. Mean age of patients was 38.4±12.6 years. The average of proteinuria and serum creatinine were 1620.33± 720 mg/d and 1.33±0.54 mg/dL, respectively. We found vessels had the least and tubules had the highest mean of intensity of CD147 staining. This study showed that the intensity of CD147 staining in glomeruli was much higher among women than men. In addition, the association of T1 and T2 as the morphologic variables of Oxford classification with CD147 intensity staining on tubules was significant (P=0.032). Conclusion: IgA nephropathy is common in various parts of the world. Beyond the Oxford classification, further work is still needed, to find other parameters having prognostic implication. Our study revealed some correlations of CD147; however, larger investigations are needed on this aspect of IgA nephropathy

Tubuloreticular inclusions in peritubular capillaries of renal allografts

BackgroundTubuloreticular inclusions (TRIs) are anastomosing networks of microtubules that are frequently found in autoimmune diseases and viral infections. In renal allografts, TRIs have been reported in glomerular endothelial cells in association with viral infections and donor specific antibodies (DSAs), but their presence in peritubular capillaries has not been explored. MethodsWe collected seven cases with TRIs out of 148 consecutive renal allograft biopsies taken from Dec. 2015 to Dec. 2016. ResultsTRIs were present in peritubular capillaries in seven cases and were concomitantly present in glomerular endothelial cells in two cases. The diagnoses included polyomavirus nephropathy (n=2), acute T cell-mediated rejection (ACR) (n=1), combined ACR and antibody-mediated rejection (AMR) (n=1), suspicious for ACR (n=1), chronic active AMR (n=1), and moderate tubular atrophy and interstitial fibrosis (n=1). Six patients had recent or current viral infections (BK polyomavirus, hepatitis B virus, herpes simplex virus, and cytomegalovirus in two, two, one, and one case, respectively). DSA was positive in one case. Five cases had moderate to severe interstitial inflammation and four cases had peritubular capillaritis. ConclusionTRIs are not rare in peritubular capillaries. They are associated with various viral infections and their appearance seems to be related to peritubular capillary injury.

Spectrum of Renal Parenchymal Diseases: An Eleven Year Retrospective Review of Renal Biopsy Data from a Tertiary Care Hospital in Pakistan

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;To report our experience with renal biopsy and histopathological pattern of renal disease in a tertiary care hospital in Pakistan over 11 years period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;All the kidney biopsies performed in our unit from Jan 2001 to Dec 2011 were retrospectively reviewed. We recorded the following data for each patient: name, age, sex, indications for renal biopsy, histopathological diagnosis and lab investigations such as Serum Creatinine, 24 hour urinary protein, urine microscopy, virology (Hbs Ag, Anti HCV) and serology (antids DNA, ANA, C3, C4, C-ANCA and p-ANCA) when indicated. Histopathological examination included Light Microscopy (LM) and Immunofluorescence Microscopy (IF). For LM, six sections were taken and stained with Haemotoxilin and Eosin, and special stains included Periodic acid-Schiff (PAS), Trichome and Grocott’ Smethanamine Silver Stain (GMS). IF study was done using polyclonal antisera against human IgG, IgM, IgA, C3 and Cq. The renal biopsies were performed by a trained Nephrologist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;A total of 329 consecutive percutaneous renal biopsies of native kidneys were reviewed. A total of thirteen specimens were unsatisfactory. Nineteen cases had incomplete data, therefore were excluded. There were 159 males (53.3%) and 138 females (46.46%). Age distribution showed a total no. of 34 (11.44%) of paediatric cases, 238 (80.13%) adult cases and 25 (10.5 %) elderly cases. The most common clinical indication for renal biopsy was unexplained renal failure (n = 116 39%) followed by nephrotic syndrome (n = 83 27.9%). Of the total biopsies included 248 (82.82%) had glomerular disease and 49 (16.49%) had non glomerular disease. The most frequently found primary glomerular lesion was membranous nephropathy (n = 51 17%) followed by focal segmental glomerulosclerosis (n = 26 8.7%). Amongst the non-glomerular lesions, CIN (chronic interstitial nephritis) was the most frequently found lesion (n = 24 8.08%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Membranous Nephropathy followed by Focal Segmental Glomerulosclerosis were the most frequently found renal lesion.&lt;/p&gt;

Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts

Background: The extent of interstitial fibrosis on kidney biopsy is regarded as a prognostic indicator and guide to treatment. Patients with extensive fibrosis are assigned to supportive treatments with the expectation that they have advanced beyond the point at which immunosuppressive or other disease-modifying therapies would be of benefit. Our study highlights some of the limitations of using interstitial fibrosis to predict who will develop end-stage renal disease (ESRD). Methods: Analysis of 434 consecutive renal biopsies performed between 2001 and 2012 at a single center. We assessed the influence of various clinical factors along with fibrosis as predictors of ESRD and dialysis-free survival in various patient groups. Results: Interstitial fibrosis performed well overall as a predictor of progression to dialysis. On average, patients with >50% fibrosis progressed more rapidly than those with either 25-49 or 0-24% fibrosis with a median time to dialysis of 1.2, 6.5 and >10 years, respectively. In contrast, interstitial fibrosis was of less value as a predictor of disease progression in a subset of cases that included patients over the age of 70 and those with diabetic nephropathy on biopsy. Surprisingly, 13.9% of patients with normal renal function had 25-49% fibrosis and 5% had more than 50% fibrosis on biopsy, and 5 years after undergoing biopsy 21% of patients with >50% fibrosis still remained dialysis free. Conclusion: Renal fibrosis is an imperfect prognostic indicator for the development of ESRD and caution should be exercised in applying it too rigidly, especially in elderly or diabetic patients.

A prospective audit of complications in 100 consecutive pediatric percutaneous renal biopsies done under real-time ultrasound guidance.

Despite being a common procedure, percutaneous renal biopsy (PRB) carries the potential for complications. The British Association of Paediatric Nephrologist (BAPN) has published standards for pediatric PRB. As Indian data are scarce, we conducted a prospective audit of 100 consecutive pediatric renal biopsies (60% males) under real-time ultrasound guidance. Nephrotic syndrome was the most common indication for PRB (68%) with minimal change disease (30%) and focal segmental glomerulosclerosis (25%) being the most common histopathological lesions. Gross hematuria was observed in six cases. Major complications was noted in one case, who needed longer hospital stay. The result of the audit demonstrated achievability of BAPN standards. In addition, we also show the usefulness of 16 gauge biopsy needle over 18 gauge biopsy needles (median number of glomeruli 25, range 3–90 vs 13, range 6–46, P = 0.001) without any increase in complications. Being a single center study, we do hope that our results will encourage a wider survey on the current state of pediatric PRB.