ESPN 51th Annual Meeting

ESPN 2018


 
Percutaneous Native Kidney Biopsy: Experiences of a Pediatric Nephrologist Over a 22-Year-Period
ZELAL EKINCI 1

1- GROUP FLORENCE NIGHTINGALE HOSPITALS
 
Introduction:

The present retrospective study aims to determine the histopathological spectrum of renal diseases and to evaluate the indications, safety and efficacy of percutaneous native kidney biopsies (PNKB) performed by a single pediatric nephrologist during a 22-year-period, in different regions of Turkey.

Material and methods:

The nephrologist worked in Dicle University Hospital (Diyarbakır) from January 1994 to September 1998, Lütfi Kırdar Training and Research Hospital (İstanbul) from October 1998 to April 2002, and Kocaeli University Hospital (Kocaeli) from April 2002 to September 2016. Copies of reports of the PNKB performed by the nephrologist were kept in a personal file with special notes about indications and complications to follow her self-improvement. A total of 312 biopsy reports were filed. Eleven of these did not include sufficient renal tissue. The PNKB efficacy rate was 96.5%. Analyses were done with the remaining 301 biopsy reports. Age, gender, year, place, indications, complications, number of glomeruli, light, immunofluorescence and electron microscopic findings, and final histopathological diagnoses were recorded and evaluated by SPSS 17.0.

Results:

171 patients were male and 130 were female, with ages ranging from one month to 19 years (mean 8.98±4.49). Transient gross hematuria was seen in 21 patients, 7 (major complication: 0.2%) required blood transfusion and of these seven, one anuric patient required urologic intervention because of clot retention in the bladder. The most frequent indications and histopathologic diagnoses recorded in the study according to professional periods are shown in the table. 

The most frequent indications and histopathologic diagnoses recorded according to professional periods
 

Diyarbakır

n=57

İstanbul

n=47

Kocaeli

n=197

Overall

n=301

Number of Glomeruli(median)  24  31  22  24

INDICATION n(%)

       
Steroid Dependent Nephrotic Syndrome  15(26.3)  3(6.4)  12(6.1)  30(10.0)
Steroid Resistant Nephrotic Syndrome   4(7.0)  8(17.0)  23(11.7)  35(11.6)
Atypical Presentation of Nephrotic Syndrome  9(15.8)  15(31.9)  48(24.4)  72(23.9)
Unresolved or Progressive Glomerulonephritis  19(33.3)  12(25.5)  51(25.9)  82(27.2)
HISTOPATHOLOGY n(%)        
Mesangioproliferative Glomerulonephritis  20(35.1)  19(40.4)  30(15.8)  69(22.9)
FSGS  5(8.8)  7(14.9)  35(17.8)  47(15.6)
Membranoproliferative Glomerulonephritis  8(14.0)  6(12.8)  11(5.6) 25(8.3) 

 

Conclusions:

This report documents the indications and patterns of histopathologic findings of patients followed by a single pediatric nephrologist. Evolution in indications and change in histopathologic findings are remarkable with decreasing rate of steroid dependency as an indication and increasing rate of FSGS as histopathologic diagnosis (Kruskal-Wallis p<0.005). PNKB is a safe and efficient diagnostic procedure for pediatric nephrologists and should be encouraged during pediatric nephrology training.