Changing trends in pediatric renal biopsies: analysis of pediatric renal biopsies in national nephrology registry data

Abstract

Renal biopsy is the gold standard method for determining the diagnosis, treatment, and prognosis in children with renal disease. This study aims to evaluate the histopathological features of pediatric renal biopsies obtained from the national nephrology registry in the last two decades. Data recorded in the Turkish Society of Nephrology Registry System (TSNRS) in 1991 as well as in between 2001 and 2010 were analyzed. A total of 3892 biopsies were recorded; with the least number in 1991 (total 103 biopsies from 17 centers) and the highest number in 2008 (total 654 biopsies from 23 centers). Glomerular diseases constituted the main group in the registry (62.64%), followed by systemic diseases (20.06%). Focal and segmental glomerulosclerosis (FSGS) and Henoch-Schönlein purpura (HSP) nephritis (IgA vasculitis) were the most common glomerular and systemic diseases, respectively. Overall prevalence of renal amyloidosis and membranous nephropathy (MN) was quite low (1.87% and 1.56%, respectively) in all periods. Compared to 1991, there was an increasing trend in the frequencies of certain disorders including hemolytic uremic syndrome (HUS), IgA nephropathy, and HSP nephritis; and there was a decrease in acute proliferative glomerulonephritis (GN) in 2008. As well as demonstrating the etiologies of renal diseases which can only be identified by renal biopsies, this study provides important information regarding the changing patterns of histopathological findings due to better management of pediatric renal diseases over the years in Turkey.

Epidemiology of 10-year paediatric renal biopsies in the region of southern Croatia

“…Our comparative study of PHD-s of all biopsies showed significant increase of IgAN from 13.8% in our previous study to 24.7% in this study [2]. Similar results were noticed in some other comparative studies as well [3,12]. Those findings might be the result of higher numbers of biopsied patients with isolated hematuria and changes in classification of IgAN.…”

“…In accordance with the inclusion criteria, among the total number of patients with glomerular and tubulointerstitial diseases admitted to our Department during the investigated period, renal biopsy was performed in 23.4% of cases. Contrary to our results, the study by Fidan et al reported kidney biopsy in about 10% of patients with renal diseases [3]. This difference might be attributed to still unclear/different inclusion criteria.…”

“…The reason for this finding might by extensive indications for renal biopsy in NS in cimparison to our Hospital. FSGS was the most frequent PHD in Turkey, Greece and Serbia, probably due to stricter renal biopsy indications in NS patients in those countries [3,16,18]. In addition, biopsy practice in England showed that HSPN was the most common PHD (15.9%) [10], while MesPGN was the most frequent PHD in Southern Croatia in the period from 1995 to 2005 [9].…”

“…Renal diseases are very important as they significantly contribute to morbidity of children. National registries of renal biopsies showed a variety of renal diseases and different epidemiology worldwide [1][2][3][4][5][6]. Renal biopsies are still very important for renal diseases management in children [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Results of native and transplant kidney biopsies of children in a single center over a 15 years period

“…Although a renal biopsy is difficult in children because of variable sizes of kidneys and different levels of cooperation, especially with the possibility of ultrasound-guided biopsy enhanced with the latest technologies, clinicians can make a choice about biopsies undoubtedly [2]. The main indications for a renal biopsy in children include persistent microscopic hematuria with or without proteinuria, recurrent gross hematuria, steroid-dependent and steroid resistant nephrotic syndrome (NS), distinction of nephrotic syndrome/nephritic syndrome, persistently low C3 in acute post-streptococcal GN, acute renal failure of unknown etiology, cyclosporine protocol biopsy, renal involvement in systemic lupus erythematosus (SLE) and lastly, staging of HSP nephritis [3][4][5]. Although macroscopic hematuria has been described as the most common complication, the biopsy protocols and instruments used are not same in many publications to determine the complications and rates [2,6,7].…”