Kidney Biopsy In Children Research Articles

Percutaneous kidney biopsies in children: a 24-year review in a tertiary center in northern Portugal

RESUMO Introdução: A biópsia renal (BR) percutânea é fundamental para diagnóstico e manejo de diversas patologias renais. Dados nacionais sobre BR nativa em pacientes pediátricos são escassos. Nosso objetivo foi revisar características demográficas, clínicas e padrões histopatológicos em crianças submetidas a BR percutânea nativa ao longo de 24 anos. Métodos: Estudo observacional retrospectivo de pacientes submetidos a BR percutâneas nativas em unidade de nefrologia pediátrica entre 1998 e 2021, comparando três períodos: período 1 (1998–2005), período 2 (2006–2013), período 3 (2014–2021). Resultados: Constatamos que foram realizadas 228 BR, 78 (34,2%) no período 1, 91 (39,9%) no período 2, 59 (25,9%) no período 3. A idade mediana na BR foi 11 (7–14) anos. As principais indicações para BR foram síndrome nefrótica (SN) (42,9%), hematúria e/ou proteinúria não nefrótica (35,5%), lesão renal aguda (13,2%). Glomerulopatias primárias foram mais frequentes (67,1%), principalmente doença de lesão mínima (DLM) (25,4%), nefropatia por IgA (12,7%), glomerulonefrite mesangioproliferativa (GN) (8,8%). Das glomerulopatias secundárias, nefrite lúpica (NL) foi a mais prevalente (11,8%). No grupo 1, hematúria e/ou a proteinúria não nefrótica foram os principais motivos para BR, ao contrário da SN nos grupos 2 e 3 (p < 0,01). A NL apresentou tendência crescente (período 1–3: 2,6%–5,3%) e a glomeruloesclerose segmentar focal (GESF) apresentou leve tendência decrescente (período 1–3: 3,1%–1,8%), sem significância estatística. Conclusões: A principal indicação para BR foi SN, que aumentou ao longo do tempo, justificando o achado de DLM como principal diagnóstico histológico. A NL apresentou aumento na incidência ao longo do tempo, enquanto os casos de GESF não aumentaram.

Kidney biopsy findings in children with diabetes mellitus

BackgroundDiabetic nephropathy may begin in childhood, but clinical kidney disease ascribable to this is uncommon in children with type 1 (insulin dependent) diabetes mellitus.MethodsWe reviewed our experience of kidney biopsies in children with type 1 diabetes mellitus.ResultsBetween 1995 and 2022, there were biopsies in 17 children, with various clinical indications for kidney biopsy, making this the largest series of biopsies in diabetic children with clinical kidney abnormalities. Four biopsies showed diabetic nephropathy, three showed the combination of diabetic nephropathy and IgA nephropathy, and ten showed a variety of conditions other than diabetic nephropathy: minimal change disease (2), membranous nephropathy (2), thin glomerular basement membrane lesion (2), non-glomerular chronic damage in Wolcott–Rallison syndrome (2), acute pauciimmune necrotizing crescentic glomerulonephritis (1) and IgA nephropathy (1). Clinical clues of something other than diabetic nephropathy included acute kidney injury, microscopic haematuria or chronic kidney impairment with little or no proteinuria and the nephrotic syndrome after a short duration of diabetes.ConclusionsWe confirm that changes better known in adults with either type 1 or type 2 diabetes mellitus can occur in children with type 1 diabetes mellitus: overt diabetic nephropathy either on its own or combined with other conditions and kidney disorders other than diabetic nephropathy.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Is kidney biopsy necessary in children with idiopathic nephrotic syndrome?

To investigate the need, in the Northern European setting, to perform kidney biopsy in children with steroid-sensitive nephrotic syndrome. In this retrospective study 124 individuals aged 1-18 years with idiopathic nephrotic syndrome, followed in the paediatric hospitals in southern Sweden from 1999 to 2018, were included. There was a median follow-up time of 6.5 (0.2-16.8) years. The majority (92%) of children were steroid-sensitive and of them, 60.5% were frequently relapsing or steroid-dependent. Microscopic haematuria was found at onset in 81.1% and hypertension in 8.7%. At least one kidney biopsy was performed in 93 (75%). The most common indication was a steroid-dependent or relapsing course (58.4%). One of 79 steroid-sensitive children had another histological diagnosis than minimal change nephropathy 1.3%, 95% confidence interval (0.002, 0.068). Bleeding occurred after eight biopsies (6.6%). Twenty individuals (30.7%) were transferred to adult units, 18 still on immunosuppression. We have in our cohort of unselected children with idiopathic nephrotic syndrome confirmed that a kidney biopsy rarely gives important medical information in steroid-sensitive children without any other complicating factor and that the liberal policy of kidney biopsy in the Nordic countries safely can be changed.

Complications of ultrasound-guided percutaneous native kidney biopsies in children: A single center experience

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them. Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors. Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022). Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

How to define and assess the clinically significant causes of hematuria in childhood

Given the wide diversity of causes of hematuria, ranging from simple urinary tract infections with rapid recovery to severe glomerulonephritis with fast decline in kidney function, it is essential to recognize the underlying disease. The first objective of the assessment is to determine whether the cause of the hematuria is medically significant. The combination of hematuria with proteinuria, the presence of hypertension, or worsening kidney function can represent signs of progressive kidney disease. Differentiating the various causes of hematuria is often simple and obvious based on the clinical signs and gross appearance of the urine. However, in some instances, additional non-invasive investigations, such as ultrasound imaging, urinary red cell morphology, measurement of calcium and other solutes in the urine, evaluation of kidney function, and protein excretion, are needed to elucidate the nature of the hematuria. Taking a detailed family history can help in establishing the underlying cause in cases of familial hematuria. On the other hand, the decision to perform a kidney biopsy in children with asymptomatic hematuria remains a challenging issue for clinicians. Ultimately, the frequency of diagnosis of glomerular involvement causing hematuria may depend on the threshold for performing a kidney biopsy. The following review will focus on the diagnostics of hematuria, starting with difficulties regarding its definition, followed by various means to differentiate between urinary, glomerular, and other causes, and finally reviewing the most common diseases that, due to their frequency or their effect on kidney function, present a diagnostic challenge in everyday practice.

Complications of Ultrasonography Guided Percutaneous Renal Biopsy in Children: A Retrospective Study in a Tertiary Hospital in Nepal

Introduction: Percutaneous renal biopsy is done under ultrasonographic guidance in recent times due to which the diagnostic yield has increased and complications have been severely curtailed. We aimed to retrospectively evaluate the complications following kidney biopsy in children. Methods: After obtaining ethical clearance, retrospective evaluation of sixty pediatric renal biopsies done in BPKIHS from October 1, 2018, to September 30, 2020, were included in the study. Biopsies were done by 18G biopsy guns under ultrasound guidance and the complications were evaluated. Results: Of sixty patients, 13.33% had gross hematuria, 3.33% had a perirenal hematoma and the biopsy failure rate was 3.3%. None of the patients required blood transfusion and had major complications requiring further intervention. Conclusions: Percutaneous renal biopsy under ultrasonographic guidance is a safe procedure with a better success rate.

Ураження нирок при геморагічному васкуліті Шенлейна — Геноха, що почався в дитячому і дорослому віці

Метою роботи стала порівняльна оцінка клініко-лабораторних і морфологічних проявів ниркової патології при геморагічному васкуліті Шенлейна — Геноха, що почався в дитячому та дорослому віці. Ураження нирок відзначено у 71 % від числа хворих (незалежно від віку пацієнтів у дебюті хвороби нефропатія зустрічалася з однаковою частотою), серед яких нефротичний синдром сформувався у 4 % випадків, хронічна хвороба нирок II, III, IV i V стадій — у 28 % спостережень (співвідношення 10 : 5 : 1 : 1), причому, за даними нефробіоптатів, у пацієнтів із трансформацією хвороби з ювенільної виявилися меншими ступені ураження ниркових артеріол, клубочків, канальців й строми, нижчими темпи прогресування ниркової недостатності, рівні артеріального тиску та периферійного судинного опору, а в цілому дебютний вік хворих впливає на подальшу частоту IV, V і VI класів генохівського гломерулонефриту, визначає рівень лімфогістіоцитарної інфільтрації судинних стінок й депозицій імуноглобулінів в клубочках та судинах.

Value of electron microscopy in the pathological diagnosis of native kidney biopsies in children.

Pediatric native kidney diseases are common worldwide. The pathological diagnosis of kidney lesions is crucial for clinical treatment and prognosis. The aim of the current study was therefore to evaluate the value of electron microscopy (EM) to the final diagnosis of native kidney biopsies in children. A retrospective evaluation of 855 pediatric kidney biopsies obtained from the Department of Pediatrics in Peking University First Hospital between November 2010 and December 2017 was performed to assess the contribution of EM to the final diagnosis. The role of EM in the final diagnosis was determined to be crucial in 300 cases (35.1%), important in 280 cases (32.7%), and auxiliary in 275 cases (32.2%). EM is considered most valuable in a large percentage of glomerular diseases, mainly including minimal change disease, early-stage membranous nephropathy, postinfectious glomerulonephritis, Alport syndrome, thin basement membrane nephropathy, and thrombotic microangiopathy. EM also provided helpful diagnostic information in cases of focal segmental glomerulosclerosis, lupus nephritis, IgA nephropathy, and IgA vasculitis (Henoch-Schonlein purpura nephritis). Additionally, EM was crucial in 90.0% of cases of subtle pathological changes observed with light microscopy (LM) and immunofluorescence (IF) and in 69.3% of the IF-negative specimens. Patients with nephrotic syndrome or hematuria also benefit from ultrastructural examination. The present study demonstrated the crucial or important role of EM in the diagnosis of a majority of native kidney biopsies in children. The application of EM should be integrated together with LM and IF as a routine method of assessing pediatric kidney specimens. Graphical abstract.

Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome.

The aim of this study was to investigate the histopathological findings in kidney biopsies in children with atypical hemolytic uremic syndrome (aHUS) and to determine whether specific pathological findings in aHUS have a prognostic value. Renal biopsy specimens of 29 patients who were recorded in the national Turkish aHUS registry database were available for review. Histopathological findings were compared with the clinical and laboratory features at the presentation and the final outcome. The mean age at presentation and follow-up period was 4.9 ± 3.9 and 3.9 ± 3.0 years, respectively. The median time interval from the first symptom to biopsy was 10 days. Vascular thrombosis and interstitial fibrosis were significantly related to chronic kidney disease (CKD) requiring dialysis or kidney transplantation during follow-up (5.6-fold, for both). Glomerular necrosis, cortical necrosis, and glomerular sclerosis were markedly associated with CKD without dialysis (6.2-fold, 13.3-fold, and 8.8-fold, respectively). However, presence of endothelial swelling, subendothelial widening, and fragmented erythrocytes was found to be correlated with a favorable final outcome. Presence of vascular thrombosis, cortical necrosis, and glomerular sclerosis in histopathological evaluation correlated with developing CKD. Chronic changes in the interstitial compartment were also related to poor prognosis, a finding that has been shown for the first time in pediatric aHUS cases.

Clinicopathological Assessment of Kidney Biopsies in Children with Familial Mediterranean Fever: A Single-Center Experience

Objectives: Familial Mediterranean fever (FMF) is a monogenic auto-inflammatory disease which might rarely cause glomerulopathy in patients. The aim of this study was to determine the clinical, demographic, and genetic characteristics and type of glomerular lesions in pediatric FMF patients who underwent kidney biopsy. Methods: The data of 30 pediatric FMF patients with biopsy-proven glomerulopathy were retrospectively reviewed. Patients were grouped into 2 categories as amyloid nephropathy (AN, n = 16) and non-amyloid nephropathy (N-AN, n = 14). Results: The mean age at FMF diagnosis was 7.2 ± 3.0 years. The AN group showed higher rates of hypertension, higher levels of 24-h protein excretion and serum creatinine, and lower estimated glomerular filtration rate at the time of kidney biopsy. The rate of ESRD was found to be higher in the AN group (p = 0.011). Mesangioproliferative glomerulonephritis was the most common pathology in the N-AN group (21.4%). The frequency of amyloidosis was significantly higher in patients with homozygous p.M694V mutations than non-homozygous p.M694V mutations (p = 0.039). Conclusions: In children with FMF, nephropathy is rare. To our knowledge, this is the first study performed in pediatric FMF patients exploring amyloid and non-amyloid glomerulopathies. Patients with AN had higher rates of proteinuria, lower estimated glomerular filtration rate levels, and higher blood pressure than N-AN patients at the time of biopsy.

SUN-467 CLINICOPATHOLOGICAL SPECTRUM OF RENAL BIOPSIES IN UNIVERSITY CHILDREN’S HOSPITAL IN DAMASCUS

Renal biopsy is an important tool for establishing the histological diagnosis and prognosis, as well as guiding therapy of renal disease in children and adults. There is great variation in epidemiology of renal histopathology all over the world, due to differences in race, socioeconomical difference and policy of performing kidney biopsy in children. There are very few renal pathology studies available in the literature from developing world, so we performed this study to identify the distribution of histopathological types of renal diseases in patients in Children’s Hospital in Damascus, and describe the clinicopathological correlation, and its effect on the choice of treatment, for establishing the important indications for renal biopsy. A Descriptive retrospective study carried out in Children’s Hospital in Damascus, included all patients admitted and had percutaneous kidney biopsy, in a period of 6 years, from January 2011 to December 2016. A sample was considered adequate if more than ten glomeruli were present. The specimen was examined only under light microscopy and immunofluorescence, as electron microscopy is not available at our center. We collected the data, which were discussed and compared with similar studies in the literature. The study includes 105 patients had kidney biopsy, with slight male dominance (52%) and median age 6 years, ranged from 40 days to 14 years. All patients tolerated the biopsy well, without important complications. Nephrotic Syndrome was the most common indication for kidney biopsy (62%), followed by Persistent Isolated Glomerular Hematuria (13%) and Systemic Lupus Erythematosus (12.5%) and Acute Nephritic Syndrome (8.5%). Steroid-resistant Nephrotic Syndrome was the commonest indication for biopsy in Nephrotic Syndrome patients (51%). Focal Segmental Glomerulosclerosis was the commonest histopathological diagnosis in Nephrotic Syndrome patients (45%), then Minimal Change Disease (32%). In Persistent Isolated Glomerular Hematuria patients (14 cases), the biopsy was normal in (50%), and revealed IgA Nephropathy in (29%). In Systemic Lupus Erythematosus patients (13 cases), the most common histopathological type was Lupus Nephritis type IV (38%). Renal biopsy is a safe procedure in children and occupies a fundamental position in the management of kidney diseases. The most common indication for the renal biopsy in children remains Nephrotic Syndrome, mainly Steroid-resistant Nephrotic Syndrome, and the commonest histopathological diagnosis in Nephrotic Syndrome patients who had kidney biopsy is Focal Segmental Glomerulosclerosis. Biopsy had no therapeutic effect in Persistent Isolated Glomerular Hematuria, so it is not urgent procedure in these cases. It is important to do renal biopsy in Systemic Lupus Erythematosus cases in children, which help in guiding therapy and follow it.

MeSsAGe risk score: tool for renal biopsy decision in steroid-dependent nephrotic syndrome.

A lack of consensus exists as to the timing of kidney biopsy in children with steroid-dependent nephrotic syndrome (SDNS) where minimal change disease (MCD) predominates. This study aimed at examining the applicability of a biomarker-assisted risk score model to select SDNS patients at high risk of focal segmental glomerulosclerosis (FSGS) for biopsy. Fifty-five patients with SDNS and biopsy-proven MCD (n = 40) or FSGS (n = 15) were studied. A risk score model was developed with variables consisting of age, sex, eGFR, suPAR levels and percentage of CD8+ memory T cells. Following multivariate regression analysis, total risk score was calculated as sum of the products of odds ratios and corresponding variables. Predictive cut-off point was determined using receiver operator characteristics (ROC) curve analysis. Plasma suPAR levels in FSGS patients were significantly higher, while percentage of CD45RO+CD8+CD3+ was significantly lower than in MCD patients and controls. ROC analysis suggests the risk score model with threshold score of 16.7 (AUC 0.84, 95% CI 0.72-0.96) was a good predictor of FSGS on biopsy. The 100% PPV cut-off was >24.0, while the 100% NPV was <13.3. A suPAR and CD8+ memory T cell percentage-based risk score model was developed to stratify SDNS patients for biopsy and for predicting FSGS.

Clinical parameters, LysoGb3, podocyturia, and kidney biopsy in children with Fabry disease: is a correlation possible?

Fabry disease is an X-linked lysosomal storage disorder caused by α-galactosidase enzyme deficiency. We present clinical, biochemical, and histologic findings in children with classical phenotypic presentation of Fabry disease. A retrospective analysis was performed using charts from 14 children with confirmed diagnosis. Clinical parameters were evaluated. Globotriaosylsphingosine -lysoGb3- detection in plasma, podocyturia, and kidney biopsy were carried out in all cases. All patients except one demonstrated at least one symptom of Fabry disease. LysoGb3 levels were above the normal range in all patients. Podocyturia was documented in all patients. Kidney biopsy revealed glomerular, interstitial, vascular, and tubular changes on light microscopy in nearly all patients. Electron microscopy showed podocyte inclusions in all patients. No difference in symptomatology was discernible between boys and girls. Podocyturia was detectable in children serving as a possible early marker of kidney injury. LysoGb3 was elevated in all cases, emphasizing the importance for diagnosis especially in female patients with normal αGal A activity. A possible association between lysoGb3 and symptom severity and histological involvement in kidney biopsy should be assessed in prospective studies with enough statistical power to determine if lysoGb3 can be used to predict nephropathy in children with Fabry disease.

The Spectrum of Biopsy-Proven Glomerular Diseases among Children in China: A National, Cross-Sectional Survey.

High-quality epidemiologic data on the spectrum of biopsy-proven glomerular diseases among children are limited. This study aimed to determine the profile of and temporal change in biopsy-proven pediatric glomerular diseases in China. We previously conducted a nationwide kidney biopsy survey including 71,151 patients over an 11-year period from January 2004 to December 2014. A total of 7962 children younger than 18 years old from 115 hospitals across China with biopsy-proven glomerular diseases were included in this study. The demographic and clinical variables were extracted from referral records and pathology reports. The composition of pediatric glomerular diseases and clinicopathologic correlations in different sexes, age groups, and regions were assessed. The changing patterns of common glomerulopathies over the study period were examined. Nephrotic syndrome (50%) was the most frequent indication for kidney biopsy in children. Minimal change disease was the most common primary glomerular disease (29%) followed by IgA nephropathy (17%). Henoch-Schonlein purpura nephritis (13%) and lupus nephritis (9%) were the most common secondary glomerular diseases. The proportion of minimal change disease was significant higher in boys (38%) than in girls (13%), whereas lupus nephritis was more prevalent in girls (20%) than in boys (3%). Purpura nephritis (23%) was the major pathologic pattern in younger children (0-12 years old), whereas minimal change disease (33%) was the most common glomerulopathy in adolescents (13-18 years old). The clinicopathologic correlations were slightly different between sexes and age groups. We observed increases in the proportions of minimal change disease, purpura nephritis, and membranous nephropathy over the study period that were contemporaneous with a fall in the proportion of FSGS. The spectrum of glomerular diseases among children varied across sexes, age groups, and regions and changed substantially from 2004 to 2014 in China.

Proteinuria persistente en pacientes pediátricos, caracterización histopatológica y su influencia en la progresión de la enfermedad renal crónica

Objective: To describe the histopathological findings and their progression of chronic kidney disease in pediatric patients who underwent kidney biopsy due to persistent proteinuria during 2005-2015 at a high-complexity hospital in Medellin, Colombia. Methods: A retrospective, cohort study was carried out; the medical records of children under 18 with diagnosis of persistent proteinuria were reviewed. Sociodemographic, clinical, and histopathological variables were analyzed. Results: A total of 71 patients were included. The mean age at the diagnosis of persistent proteinuria was 10.07 years old. 69.1% and 20.6% of the patients had hematuria and hypertension, respectively. Overall, the predominant pathological diagnosis in the current study was IgA nephropathy (21.13%) followed by lupus nephropathy (18.31%). 69.0% of the patients received angiotensin-converting enzyme inhibitors. At the last follow-up, 15.9% presented impaired renal function. Conclusion: In our cohort, the prevalence of glomerulopathies in children with persistent proteinuria was high. We recommended performing kidney biopsy in children with persistent proteinuria. This allows early detection of primary or secondary glomerulopathies to retard progression of renal damage.

Fifteen years of kidney biopsies in children: a single center in Egypt.

This study retrospectively investigates the indications and results of renal biopsy in children to determine the patterns of childhood kidney disease in a single tertiary children's hospital in Egypt. We included all the patients who underwent ultrasound-guided renal biopsy from 1998 to 2012. All the kidney biopsies were studied under light microscopy, while immunofluorescence and electron microscopy were performed when indicated. A total of 1246 renal biopsies were performed over 15 years, on 1096 patients. The mean age of the patients at the time of biopsy was 9.2±3.7 years. The main indication for a biopsy was the steroid-resistant nephrotic syndrome (n=354, 28.4%), followed by the atypical nephrotic syndrome (n=250, 20.1%), and renal abnormalities in the systemic diseases (n=228, 18.3 %). In the 1226 pathologically diagnosed specimens, primary glomerulonephritis was the most common finding (n=826, 67.4%), followed by secondary glomerulonephritis (n=238, 19.4%). The most common causes of primary glomerulonephritis were Minimal Change Disease (MCD) (n=267, 21.8%), diffuse proliferative glomerulonephritis (n=188, 15. 3%), and focal proliferative glomerulonephritis (n=164, 13.3%). Lupus nephritis (n=209, 17%) was the most common cause of secondary glomerulonephritis. We conclude that the steroid-resistant nephrotic syndrome was the most frequent indication for biopsy and minimal change disease was the most common histopathological finding in our population.

Audit on the practice of kidney biopsies in children

<h3>Introduction</h3> Practice of diagnostic percutaneous renal biopsy in children has considerable variation in different centres in UK. We reviewed our practice and compared it against the standards recommended by the British Association of Paediatric Nephrologists (BAPN). <h3>Methods</h3> We retrospectively analysed the medical case notes and hospital pathology web browser to collect data of all patients who had kidney biopsies performed in our unit over a 2 years period starting from Jan 2008 until Dec 2009. <h3>Results</h3> Out of total 31 biopsies performed in 28 patients, 21 were of native kidneys and rest consisted of renal transplants. All the biopsies were done by consultant nephrologists with real time ultrasound guidance except in one patient needing assistance from the consultant radiologist. Biopsies were performed as a day case procedure in 84% of patients. 64% of biopsies were done under sedation, 13% using local anaesthesia and 23% under general anaesthesia. The common complications noted in our audit were macroscopic haematuria (6.4%) and readmission (3.2%). The most common indication for biopsy in the native kidney was proteinuria in 47.6% patients and suspected drug toxicity in 23.8%. Suspected rejection was the main indication for transplanted kidneys. The commonest biopsy finding in nephrotic syndrome was minimal change disease (38.1%). Among the patients with glomerulonephritic picture, the most common primary cause was membrano-proliferative type and henoch-schoenlein purpura was the commonest secondary cause. The standard for the number of needle passes for native kidneys (≤3 in 80%) was achieved in 86% and for transplants (≤2 passes) in 80%. Adequate tissue was obtained for diagnosis in 97% (standard &gt;95%) and the major complications rate was only 3.2% (standard ≤5%). <h3>Conclusion</h3> The study showed that the standards for renal biopsy as recommended by BAPN were achieved in the unit. We recommended that in day cases, intravenous hydration was not mandatory and it was safe to discharge after at least 6-8 hours of observation following biopsy. We also suggested improving our documentation in inpatient notes and including a renal biopsy check list.

Renal function in the long term after pediatric liver transplantation: is there a need for protocol kidney biopsies?

With improving survival rates following solid organ transplantation, assessment of its success has broadened with a focus on long-term outcomes, including nongraft-related medical outcomes and family and patient perceptions of quality of life. Posttransplant renal dysfunction contributes to long-term morbidity and mortality following pediatric liver transplantation. In this review, we provide an overview of our understanding and approach to managing posttransplant renal dysfunction and highlight the existing gaps in knowledge in this area. The literature regarding renal dysfunction following liver transplant primarily focuses on the experience in the adult population. Studies on children are limited by small numbers and varying definitions of outcomes. Thus, lessons in the current literature must be closely examined before they can be extrapolated and applied to children. The current literature validates that posttransplant renal dysfunction is a frequent and important outcome for adults and children. Although the characteristics of children at high risk are less clear, calcineurin inhibitor minimization is considered a viable strategy for preserving renal function. The risk-benefit ratio of kidney biopsy in children and the possibility of renal preservation via immunosuppression withdrawal are intriguing concepts that remain to be defined.

腎生検ガイドブック: 第VIII章 小児における腎生検

腎生検ガイドブック: 第VIII章 小児における腎生検

Spectrum of childhood nephrotic syndrome in Iran: A single center study

Sir, We read with interest the article by Safaei et al. on “Spectrum of childhood nephrotic syndrome in Iran: A single center study”.[1] We appreciate the work done by the authors. However, we have a few queries which we would like to be clarified. The first indication for kidney biopsy mentioned in the study, i.e., age of onset between zero and 14 years will include all children in the study group. However, kidney biopsy was performed by the authors only in 17 children. We would like the authors to quote a reference supporting this indication for kidney biopsy. The Indian Pediatric Nephrology group and standard pediatric textbooks recommend that kidney biopsy in nephrotic syndrome should be done in children with age of onset 8 years.[2,3] The authors have also performed kidney biopsy in children with microscopic hematuria. Transient microscopic hematuria is found in 20–23% of steroid-sensitive nephrotic syndrome and usually does not warrant a kidney biopsy.[4] Various studies and standard textbooks recommend that kidney biopsy in nephrotic syndrome should be done in children with gross hematuria and/or persistent microscopic hematuria.[2–4] The definition of steroid dependent nephrotic syndrome (SDNS) in the article is incorrect. As per the authors, SDNS is defined as recurrence of nephrosis when the dose of corticosteroids is reduced or within 2 months after the discontinuation of therapy. The reference quoted is from the 18th edition of Nelson Textbook of pediatrics. We would like to bring to the notice of the authors and our readers that the correct definition mentioned in the textbook is “recurrence of nephrosis when the dose of corticosteroids is reduced or within one month after the discontinuation of therapy”.[2]