Kidney biopsy in patients with glomerulonephritis: is the earlier the better?

Abstract

BackgroundInterventional diagnostic procedures are established for several diseases in medicine. Despite the KDOQI guideline recommendation for histological diagnosis of kidney disease to enable risk stratification, its optimal time point has not been evaluated. We have therefore analyzed whether histological diagnosis of glomerulonephritis (GN) at an early stage of chronic kidney disease (CKD) is associated with different outcome compared to diagnosis at a more advanced stage.MethodsA cohort of 424 consecutive patients with histological diagnosis of GN were included in a retrospective data analysis. Kidney function was assessed by glomerular filtration rate (GFR) estimation at the time point of kidney biopsy and after consecutive immunosuppressive therapy. Censored events were death, initiation of dialysis or kidney transplantation, or progression of disease, defined as deterioration of CKD stage ≥1 from kidney biopsy to last available kidney function measurement.ResultsOccurrence of death, dialysis/transplantation or progression of disease were associated with GFR and CKD stage at the time of kidney biopsy (p < 0.001 for all). Patients with CKD stage 1 and 2 at kidney biopsy had fewer endpoints compared to patients with a GFR of <60 ml/min (p < 0.001).ConclusionKidney function at the time point of histological GN diagnosis is associated with clinical outcome, likely due to early initiation of specific drug treatment. This suggests that selection of therapy yields greatest benefit before renal function is impaired in GN.

Relationship between renal biopsy and renal survival in elderly patients with chronic kidney disease: A propensity score matching approach

“…A previous study 15 showed that early guidance of renal biopsy may confer significant benefits in preserving renal function in patients. Compared with other patients, patients with CKD stages 1 and 2…”

Haematuria on the Spanish Registry of Glomerulonephritis

“…Although is commonly accepted that glomerular haematuria indicates GFB dysfunction, its usefulness as glomerular injury marker is not properly established and so it is not formally included as a biopsy criterion in the KDIGO Clinical Practice Guidelines 20 . Similarly, although it has been suggested that early identification of glomerular disease optimizes treatment and may be beneficial on early CKD stages there is no consensus on whether biopsy should be performed in patients with haematuric glomerular diseases 21 22 . Recent evidences reported that persistent isolated haematuria increased 18-fold the risk of ESRD 9 , mainly due to primary glomerular diseases, pointing that persistent mH could be an early feature of glomerulonephritis.…”

Etiopathogenetic, Morphological, Diagnostic and Therapeutic Aspects of Acute Glomerulonephritis: Current Status

“…Согласно клиническим и практическим рекомендациям Научного общества нефрологов России (НОНР) морфологическая диагностика ОГН базируется на данных световой и электронной микроскопии, а также иммунофлюоресцентного исследования биоптата почек [17,18,48]. При световой микроскопии отмечается увеличение клубочков, сужение их просвета за счет пролиферации мезангиальных клеток, увеличение толщины мезангиального матрикса, большое число нейтрофильных лейкоцитов, сужение просвета капилляров клубочков [48,49]. Для ОПСГН характерна картина эндокапиллярного пролиферативного гломерулонефрита [47,50].…”

“…При электронной микроскопии можно обнаружить субэпителиальные депозиты (иммунные комплексы) по типу «горбов». Формирование полулуний при ОГН считается прогностически неблагоприятным вариантом заболевания [49,50]. При иммунофлюоресцентном исследовании типичным признаком является обнаружение гранулированных депозитов иммуноглобулина G и C3-комплемента в мезангии и стенках капилляров клубочков [49,50].…”

“…Формирование полулуний при ОГН считается прогностически неблагоприятным вариантом заболевания [49,50]. При иммунофлюоресцентном исследовании типичным признаком является обнаружение гранулированных депозитов иммуноглобулина G и C3-комплемента в мезангии и стенках капилляров клубочков [49,50]. Определена прямая корреляция между тяжестью гистологических изменений и клиническими проявлениями ОГН и, возможно, прогнозом [49,50].…”