Spectrum of renal pathology: a 7-year review of renal biopsy database

A kidney biopsy is the "gold standard" for the diagnosis of kidney diseases and a mandatory diagnostic procedure for suspected glomerular pathology. The aim of this study is a retrospective analysis of the renal biopsy register data, performed over 7 years, with an assessment of the pathology structure depending on the indications for biopsy and the age of the patients. Material and methods: a retrospective study based on the results of 6387 biopsies of native kidneys performed from 2013 to 2020 at the Moscow City Nephrology Center. Results: the most common indications for kidney biopsy were isolated urinary syndrome, the nephrotic syndrome and renal failure (33%, 32.5% and 27% of cases). Less biopsy was performed at acute nephritic syndrome (3.5%) and for evaluating the morphological picture already diagnosed systemic disease (4%). The main causes of the nephrotic syndrome were membranous nephropathy (MN) - 27%, focal segmental glomerulosclerosis (FSGS) - 22%, minimal change disease (MCD) - 21%, amyloidosis - 13%, and diabetic nephropathy (DN) - 6%. In children, the majority of cases were presented by MCD (59%) and FSGS (30%), and in persons over 65 years of age, the main causes of the nephrotic syndrome were MN (30%) and amyloidosis (28%). Renal failure was most often caused by nephrosclerosis of various nature (including the outcome of IgA nephropathy), which prevailed in children (48%) and middle-aged patients (39%), as well as crescentic glomerulonephritis, which was the main cause of renal failure in patients over 65 years of age (33%). The rate of thrombotic microangiopathy (TMA) decreased from 14% in children to 8% and 1% in middle-aged and older patients. In middle-aged patients with the isolated urinary syndrome, IgA nephropathy was the main cause (58%), but in children, hereditary nephritis (42%) prevailed, while in patients over 65 years old it was secondary forms of FSGS (23%). In acute nephritic syndrome, cases of IgA nephropathy also prevailed (38%), but in half of cases, various forms of proliferative and membranoproliferative glomerulonephritis were detected. Their nature at the time of biopsy could not always be verified. Among the biopsies performed to precise the morphological pattern of an already diagnosed systemic disease, in most cases, it was systemic lupus erythematosus (76%), followed by Schönlein-Henoch purpura (10%), amyloidosis (2.3%) ANCA-vasculitis (2%), cryoglobulinemic nephritis (3%) and TMA (1.6%). In 4.7% of cases, the morphological examination did not allow us to confirm the initial diagnosis. Conclusion: renal pathology includes a wide spectrum of diseases, which differ significantly depending on the indications for the biopsy and the age of the patient.

почечная патология, биопсия почки, гломерулярные заболевания, регистр, glomerulonephritis, kidney biopsy. registry, nephropathies

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