Indications for Renal Needle Biopsy and Histological Spectrum of Kidney Disease in Togo

Introduction: The frequent late-stage diagnosis of chronic kidney disease (CKD) constrains the treatment choices for nephrologists. Renal biopsy (RB) is crucial for accurately identifying renal lesions. This key nephrological procedure, however, is invasive and not without potential complications. The purpose of this study was to evaluate the indications, frequency, and histological lesion profiles of renal biopsies in Togo. Materials and Methods: We conducted a descriptive cross-sectional study encompassing all renal biopsies performed in Togo from the inception of nephrology services to the present. Data were compiled from the medical records of the patients. Results: From 2015 to 2023, 68 high-quality renal biopsies were executed in Togo. The patients had an average age of 30.6 years, with a predominance of males (69.1%). The most common indication was nephrotic syndrome, accounting for 66.2% of cases. Histologically, glomerulopathies were predominant, representing 61.8% of lesions, followed by vascular nephropathies (25%) and tubulointerstitial nephropathies (13.2%). The most frequently observed primary glomerulopathy was focal segmental glomerulosclerosis (FSGS). Gross hematuria was the sole complication, occurring in 1.4% of the cases. Conclusion: RB is an evolving practice in Togo. Glomerulopathies are the most commonly observed lesions. The histological categorization of renal lesions is vital for clinicians in their diagnostic reasoning and approach.

Exploring kidney biopsy findings in congenital heart diseases:Insights beyond cyanotic nephropathy

BACKGROUND The association between congenital heart disease and chronic kidney disease is well known.Various mechanisms of kidney damage associated with congenital heart disease have been established.The etiology of kidneydisease has commonly been considered to be secondary to focal segmental glomerulosclerosis(FSGS),however,this has only been demonstrated in case reports and not in observational or clinical trials.AIM To identify baseline and clinical characteristics,as well as the findings in kidney biopsies of patients with congenital heart disease in our hospital.METHODS This is a retrospective observational study conducted at the Nephrology Depart-ment of the National Institute of Cardiology“Ignacio Chávez”.All patients over 16 years old who underwent percutaneous kidney biopsy from January 2000 to January 2023 with congenital heart disease were included in the study.RESULTS Ten patients with congenital heart disease and kidney biopsy were found.The average age was 29.00 years±15.87 years with pre-biopsy proteinuria of 6193 mg/24 h±6165 mg/24 h.The most common congenital heart disease was Fallot’s tetralogy with 2 cases(20%)and ventricular septal defect with 2(20%)cases.Among the 10 cases,one case of IgA nephropathy and one case of membranoproliferative glomerulonephritis associated with immune complexes were found,receiving specific treatment after histopathological diagnosis,delaying the initiation of kidney replacement therapy.Among remaining 8 cases(80%),one case of FSGS with perihilar variety was found,while the other 7 cases were non-specific FSGS.CONCLUSION Determining the cause of chronic kidney disease can help in delaying the need for kidney replacement therapy.In 2 out of 10 patients in our study,interventions were performed,and initiation of kidney replacement therapy was delayed.Prospective studies are needed to determine the usefulness of kidney biopsy in patients with congenital heart disease.

Relationship between Renalase Expression and Kidney Disease： an Observational Study in 72 Patients Undergoing Renal Biopsy

The relationship between the levels of renalase and changes in proteinuria, hypertension, renal function, renal tubular epithelial cell apoptosis and B-cell lymphoma-2 （Bcl-2） expression was investigated in patients （chronic nephritis, primary nephrotic syndrome or other kidney disease） that underwent renal biopsy. The study group comprised 72 patients undergoing renal biopsy. Patient profiles and renal function were collected. Concentrations of renalase and Bcl-2 were measured by immunohistochemistry. Tubular injury was detected by periodic acid Schiff staining （PAS） and renal tubular epithelial cell apoptosis was assessed by TUNEL assay. The expression of renalase was significantly lower in renal biopsy specimens than in normal kidney tissues. There was a positive linear relationship between renalase and some serum and cardiac indices; a negative correlation was found between age, eGFR, Ccr and 24-h urinary protein. Renal tubule injury index and tubular epithelial cell apoptosis index showed a negative linear correlation with renalase. The results showed that renalase probably increased the expression of Bel-2. By two independent samples t-test, renalase levels were significantly increased in the non-hypertension group than in the hypertension group. One-way ANOVA showed that renalase expression was higher in samples with Lee＇s grade Ⅲ than in those with Lee＇s grade V. The expression of renalase was significantly decreased in patients who underwent renal biopsy, and was also associated with blood and renal function. The research proved that renalase may reduce renal tubular injury and apoptosis of renal tubular epithelial cells through the mitochondrial apoptosis pathway, finally achieving the purpose of delaying the progress of renal failure.

The Spectrum of Kidney Disease in Type Two Diabetic Patients: A Single-Center Study

Background: Diabetic nephropathy (DN) is the dominant reason for end-stage kidney disease linked with a rise in cardiovascular mortality rate. However, besides DN, type 2 diabetic patients may also suffer from various non-diabetic renal diseases (NDRD). Aim: The objective of the current research was to assess the occurrence and type of NDRD diagnosed by kidney biopsy in type 2 diabetic subjects, evaluate the association of various clinical and laboratory characteristics with histopathology findings, and identify essential predictors of NDRD. Methods: Retrospective analysis has been performed through medical record revision of 101 patients with type 2 diabetes undergoing percutaneous renal biopsy at Qilu Hospital of Shandong University (Jinan, China) between January 2015 and December 2020. Results: Renal biopsy results showed that NDRD was found in 59 patients (58.42%), while DN existed in 32 patients (31.68%) and 10 patients (9.90%) showed DN complicated with NDRD. Membranous nephropathy was prevailing NDRD (42%), followed by focal segmental glomerulosclerosis (11.6%) and IgA nephropathy (10.1%). In univariate analysis, patients with NDRD had older age (p Conclusions: Clinical parameters such as short duration of diabetes, older age, higher hemoglobin level, and lower proteinuria might be associated with NDRD in type 2 diabetic patients. An early diagnosis of NDRD poses a favorable renal prognosis because it requires a different approach than DN, further larger multicenter randomized prospective investigations focused on identifying possible risk markers of NDRD are still in priority.

Diabetic nephropathy:Is it time yet for routine kidney biopsy?

Diabetic nephropathy(DN)is one of the most important long-term complications of diabetes.Patients with diabetes and chronic kidney disease have an increased risk of all-cause mortality,cardiovascular mortality,and kidney failure.The clinical diagnosis of DN depends on the detection of microalbuminuria.This usually occurs after the first five years from the onset of diabetes,and predictors of DN development and progression are being studied but are not yet implemented into clinical practice.Diagnostic tests are useful tools to recognize onset,progression and response to therapeutic interventions.Microalbuminuria is an indicator of DN,and it is considered the only noninvasive marker of early onset.However,up to now there is no diagnostic tool that can predict which patients will develop DN before any damage is present.Pathological renal injury is hard to predict only with clinical and laboratory findings.An accurate estimate of damage in DN can only be achieved by the histological analysis of tissue samples.At the present time,renal biopsy is indicated on patients with diabetes under the suspicion of the presence of nephropathies other than DN.Results from renal biopsies in patients with diabetes had made possible the classification of renal biopsies in three major groups associated with different prognostic features:diabetic nephropathy,non-diabetic renal disease(NDRD),and a superimposed non-diabetic condition on underlying diabetic nephropathy.In patients with type 2 diabetes with a higher degree of suspicion for NDRD,it is granted the need of a renal biopsy.It is important to identify and differentiate these pathologies at an early stage in order to prevent progression and potential complications.Therefore,a more extensive use of biopsy is advisable.

Indications and Results of Kidney Biopsies in Patients over 65 Years Old

Normal kidney aging is related to tissue and functional changes that make older patients very vulnerable to environmental modifications. Numerous factors can accelerate the impairment of renal function during aging. It was a single-center retrospective study extending over a period of 30 years from 1984 to 2014 and includes patients older than 65 years, hospitalized for nephropathy requiring renal biopsy and monitored in our service. There were 6 men and 7 women with an average age of 69.38 ± 4.5 years. Mean serum creatinine was 267.15 ± 124 mmol/l. Eleven patients had renal failure. Histological lesions were: Extramembranous glomerulonephritis (EMGN): 1 case, focal segmental glomerular sclerosis (FSGS): 3 cases, membranoproliferative glomerulonephritis (MPGN): 1 case, IgA nephropathy: 1 case, glomerulonephritis with IgG4 fibrillar deposits (GN IgG4): 1 case, diabetic nephropathy: 2 cases, myeloma-associated tubulopathy: 1 case, acute tubular necrosis: 1 case, acute interstitial nephritis: 1 case, vascular nephropathy: 1 case. Kidney disease will increasingly become a geriatric illness. Nephrologists are encountering a growing group of elderly patients with diminished equation for estimated glomerular filtration rate (eGFR) that require evaluation and management.

Kidney transplantation in Indonesia: An update

Objective:Indonesia has overcome several barriers to the growth of kidney transplantation within the past decade.Currently,the procedure is increasingly performed in several centers across the country.However there are limited publications on kidney transplantation from Indonesia,especially from centers outside Jakarta.This study aims to give a brief overview on transplantation performed,discuss current efforts and progresses of transplantation in Indonesia and chiefly Semarang.Methods:Retrospective analysis of 20 transplant cases in Semarang during 2014e2018 was performed.Information from other transplant centers was acquired through formal correspondences with 11 central teaching hospitals in Jakarta,Surabaya,Yogyakarta,Malang,Bali,Solo,Palembang,Aceh,Medan,Bandung,and Padang.Results:There were 629 recorded kidney transplantations performed in 12 centers,and we report on 245 cases with viable data.The average age of kidney recipients were younger(35.4 years old)compared to the donors(41.3 years old).Approximately half of the kidneys were obtained from related donors(49.0%)and there was only one case of cadaveric donor.The three leading etiologies of end-stage renal disease were hypertension(37.4%),diabetes mellitus(26.1%),and autoimmune disease(11.3%).There is only one center that has performed more than 100 kidney transplants in Indonesia.Conclusion:Indonesia has successfully overcome several major hurdles that had previously hindered the growth of transplantation.Further improvement should concentrate on the development of integrated organ transplant infrastructure,decentralization of transplant professionals,establishment of National kidney transplant database and changing the Nation’s paradigm on cadaveric organ donor through public education.

Epidemiology of biopsy-proven glomerular diseases in Chinese children: A scoping review

Background: Glomerular disease is the leading cause of chronic kidney disease globally. No scoping review reports have focused on China’’s spectrum of glomerular diseases in children. This study aimed to systematically identify and describe retrospective studies on pediatric glomerular disease based on available data on sex, age, study period, and region.Methods: Six databases were systematically searched for relevant studies from initiation to December 2021 in PubMed, Embase, Web of Science, Global Health Library, Wangfang Database, and CNKI.Results: Thirty-four studies were identified in the scoping review, including 40,430 patients with biopsy-proven diagnoses. The proportion of boys was significantly higher than that of girls. In this study, 28,280 (70%) cases were primary glomerular disease, 10,547 (26.1%) cases were diagnosed as secondary glomerular disease, and 1146 (2.8%) cases were hereditary glomerular disease. Minimal change disease is the most common glomerular disease among children in China, followed by mesangial proliferative glomerulonephritis, IgA nephropathy, and purpura nephritis. We observed increments in glomerular diseases in periods 2 (2001–2010) and 3 (2011–2021). The proportion of major glomerular diseases varies significantly in the different regions of China.Conclusion: The spectrum of pediatric glomerular diseases varied across sex, age groups, study periods, and regions, and has changed considerably over the past 30 years.

Biopsy-proven acute phosphate nephropathy:A case report

BACKGROUND Acute phosphate nephropathy(APN)is a disease that can occur when exposed to high doses of phosphate.The most common cause of APN is the use of oral sodium phosphate for bowel cleansing preparations.However,there are other less commonly known sources of phosphate that are equally important.To date,our literature search did not identify any report of excessive dietary phosphate as a cause of APN.CASE SUMMARY We report an unusual case of a 39-year-old diabetic male who presented with epigastric pain and oliguria.Work-up showed elevated serum creatinine,potassium,and calcium-phosphate product,and metabolic acidosis.The patient was admitted in the intensive care unit and received emergent renal replacement therapy.Kidney biopsy revealed tubular cell injury with transparent crystal casts positive for Von Kossa staining,which established the diagnosis of APN.CONCLUSION This case confirmed that APN may occur with other sources of phosphorus,highlighting the importance of good history taking and kidney biopsy in patients with predisposing factors for APN.Raising awareness on the possibility of APN and its timely recognition and management is imperative so that appropriate measures can be instituted to prevent or delay its progression to end stage renal disease.

Analysis of Pathological data of renal biopsy at one single center in China from 1987 to 2012

Background In China,the prevalence of chronic kidney disease has increased significantly.Many studies shows that the spectrum of kidney disease had changed in recent years.We retrospectively analyzed the pathological types of renal biopsy and its spectrum change at the General Hospital of the Chinese People＇s Liberation Army from December 1987 to December 2012,in order to offer new supporting evidences for further specifying the distribution of renal pathological types in China.Methods According to the ＂Revised Protocol for the Histological Typing of Glomerulopathy＂ （WHO,1995）,pathological diagnosis of renal biopsy was classified,detection rate of each pathological type was summarized （i.e.,percentage of total renal biopsy cases）,study period was divided at an interval of 5 years,and age-stratified distribution change of main pathological types was analyzed.Results The proportion of pathological types in 11 618 cases of renal biopsy was as follows：primary glomerulonephritis （PGN,70.7％）,secondary glomerulonephritis （SGN,20.7％）,tubular-interstitial nephropathy （4.0％）,hereditary/rare nephropathy （0.3％）,end-stage renal disease （0.9％）,and unclassified renal disease （3.3％）.Among PGN,there was IgA nephropathy （IgAN,37.0％）,membranous nephropathy （MN,11.8％）,mesangial proliferative glomerulonephritis （MsPGN,8.9％）,minimal change disease （MCD,6.6％）,and focal segmental glomerulosclerosis （3.9％）.Among SGN there was lupus nephritis （LN,5.5％）,Henoch-Sch（o）nlein purpura glomerulonephritis （5.3％）,hepatitis B virus-associated nephritis （HBVAN,3.03％）,diabetic nephropathy （2.2％）,and hypertension/malignant hypertension-associated renal damage （1.9％）.Pathological data were analyzed from 1987-1992 to 2008-2012 （after age adjustment）.Detection rate of IgAN tended to rise （P ＜0.001）.Detection rates of MN and MCD rose significantly （P ＜0.001）,but detection rate of MsPGN dropped significantly （P ＜0.001）.Among SGN,detection rate of HBVAN tended to drop （P ＜0.001）.Conclusion In China,PGN was the most common glomerulopathy （mostly IgAN）,LN was the most common SGN,and detection rate of MN and MCD rose significantly.

Relative performance of two equations for estimation of glomerular filtration rate in a Chinese population having chronic kidney disease

Background The new Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation was developed to address the systematic underestimation of glomerular filtration rate （GFR） by the Modification of Diet in Renal Disease （MDRD） Study equation in patients with relatively well-preserved kidney function.Performance of the new equation in the Chinese population is unknown.The goal of the present study was to compare performance of these two equations in Chinese patients with chronic kidney disease （CKD）.Methods We enrolled 450 Chinese patients （239 women and 211 men） with CKD in the present study.The renal dynamic imaging method was used to measure the referenced standard GFR （rGFR） for comparison with estimations using the two equations.Their overall performance was assessed with the Bland-Altman method and receiver-operating characteristics （ROC） analysis.Performance of the two equations in lower and higher estimated GFR （eGFR） subgroups was further investigated.Results Both eGFRs correlated well with rGFR （r=0.88,0.81,P〈0.05）.In overall performance,the CKD-EPI equation showed less bias,higher precision and improved accuracy,and was better for detecting CKD.In the higher-eGFR subgroup,the CKD-EPI equation corrected the underestimation of GFR by the abbreviated MDRD equation.Conclusions The CKD-EPI equation outperformed the abbreviated MDRD equation not only in overall performance but also in the subgroups studied.For the present,the CKD-EPI equation appears to be the first-choice prediction equation for estimating GFR.

Analysis of chronic kidney disease staging with different estimated glomerular filtration rate equations in Chinese centenarians

Background: Accurate estimation of the glomerular filtration rate (GFR) and staging of chronic kidney disease (CKD) are important. Currently, there is no research on the differences in several estimated GFR equations for staging CKD in a large sample of centenarians. Thus, this study aimed to investigate the differences in CKD staging with the most commonly used equations and to analyze sources of discrepancy. Methods: A total of 966 centenarians were enrolled in this study from June 2014 to December 2016 in Hainan province, China. The GFR with the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study 1 (BIS1) equations were estimated. Agreement between these equations was investigated with the k statistic and Bland-Altman plots. Sources of discrepancy were investigated by partial correlation analysis. Results: The k values of the MDRD and CKD-EPI equations, MDRD and BIS1 equations, and CKD-EPI and BIS1 equations were 0.610, 0.253, and 0.381, respectively. Serum creatinine (Scr) explained 10.96%, 41.60% and 17.06% of the variability in these three comparisons, respectively. Serum uric acid (SUA) explained 3.65% and 5.43% of the variability in the first 2 comparisons, respectively. Gender was associated with significant differences in these 3 comparisons (P<0.001). Conclusions: The strengths of agreement between the MDRD and CKD-EPI equations were substantial, but those between the MDRD and BIS 1 equations and the CKD-EPI and BIS 1 equations were fair. The difference in CKD staging of the first 2 comparisons strongly depended on Scr, SUA and gender, and that of CKD-EPI and BIS1 equations strongly depended on Scr and gender. The incidence at various stages of CKD staging was quite different. Thus, a new equation that is more suitable for the elderly needs to be built in the future.

Indications and results of renal biopsy in children:a 36-year experience

Background This study was conducted to investigate retrospectively the indications for renal biopsy(RB)in native kidneys and to analyze pathological findings in a single tertiary pediatric hospital in Southern Italy for the last 36 years.Methods All patients who underwent RB at our hospital from 1979 to 2014 were included.All renal tissue specimens were studied under light and immunofluorescent microscopy,while electron microscopy was performed only for specific clinical indications.Results The study group included 213 patients(female 43.2%)who underwent 225 percutaneous native kidney biopsies.Median age was 10.4 years(range 0.6-24 years).The most frequent indication for RB was nephrotic syndrome(44.4%),fol-lowed by proteinuria(27.6%),asymptomatic hematuria(17.3%)and acute kidney injury(9.8%).Gross hematuria appeared after biopsy in less than 5%of the patients,but none of them needed blood transfusion.Adequate renal tissue sample was obtained in 95.5%of the renal biopsies.Primary glomerulonephritis(GN)was the most common finding(61.4%),followed by secondary GN(21.4%),tubulointerstitial diseases(3.7%)and hereditary nephropathy(2.8%),while in 10.7%of the cases,normal renal tissues were found.According to histopathological diagnosis,the most common causes of primary GN were IgA nephropathy(20.9%),followed by minimal change disease(18.1%)and focal segmental glomerulosclerosis(11.6%).Conclusions The epidemiology of glomerular disease in our single-center cohort is similar to that shown in other national and international reports.Moreover,our study shows that percutaneous ultrasound-guided RB is a safe,reliable and effec-tive technique in children.

肾脏疾病谱的变迁:基于2003～2014年中国单中心40759例肾活检病理诊断分析

目的:分析近12年来肾脏疾病谱的构成特征及其变化。方法:本研究纳入南京总医院国家肾脏疾病临床医学研究中心肾活检注册登记系统中2003-01-01至2014-12-31行肾穿刺活检病例,分析肾脏疾病类型的分布特征,并与1979~2002年的研究数据进行比较。结果:研究共纳入肾穿刺活检病例40 759例,≥60岁肾活检比例从5.60%增至9.89%。与1979~2002年肾脏疾病谱相比,原发性肾小球肾炎(PGN)比例下降,继发性肾小球肾炎(SGN)比例上升。PGN中以IgA肾病(IgAN)最常见;膜性肾病(MN)比例较1979~2002年增长近1倍,且2003~2014年间14~24岁年龄段增幅最大。SGN主要包括免疫介导疾病(59.20%)和肿瘤代谢性疾病(37.09%),糖尿病肾病(DN)、肾淀粉样变性、高血压肾损害和单克隆免疫球蛋白沉积病(MIDD)等肿瘤代谢性疾病的比例呈明显上升趋势。结论:PGN仍是我国肾脏疾病的主体,以IgAN最常见,MN比例明显升高,在青少年患者中增幅最大。DN、高血压肾损害、肾淀粉样变性和MIDD等肿瘤代谢性SGN均有增长趋势。肾脏疾病谱的这些变化特点将为临床诊断、预防及流行病学研究提供参考依据。

431例肾活检病理类型及流行病学特点

目的通过对浙江省衢州市431例肾病患者的肾活检病理资料进行总结分析,并探讨其在衢州市的分布情况,以推测其流行病学的地方特点。方法回顾性分析我院2012年1月~2014年12月期间收治的431例肾病患者的流行病学特点,并分析其病理类型的分布情况及流行病学特点。结果成功穿刺431例肾标本,其中男181例（42.0%）,女250例（58.0%）,男/女=1∶1.38。从疾病临床分型看,肾病综合征（NS）最多为178例（41.3%）,第2位是慢性肾小球肾炎（CGN）为l42例（32.9%）。从病因分类看431例患者中原发性肾小球肾炎（PGN）最多为342例（79.3%）,继发性肾小球肾炎（SGN）77例（17.9%）,小管-间质疾病（TID）11例（2.6%）,移植肾疾病1例（0.2%）。原发性肾小球炎（PGN）中Ig A肾病（Ig AN）和膜性肾病（MN）所占比例较高,分别占32.7%和24.5%。继发性肾小球肾炎（SGN）中狼疮性肾炎（LN）占比最高,为40.2%;过敏性紫癜性肾炎（HSPGN）为18.2%,乙型肝炎病毒相关性肾炎（HBVGN）占13.0%。结论 PGN是肾穿刺活检中最常见的病因,其中大多数属Ig AN和MN;SGN中LN最多见,HSPGN及HBVGN也较多。在本地区肾病防治工作中,青壮年发病率较高,需重点关注Ig AN和MN,还有LN。

温州市成人原发性肾小球疾病病理类型构成比20年演变

目的:探讨温州市成人原发性肾小球疾病(PGD),包括原发性肾病综合征(PNS)病理类型分布的流行病学特征。方法:回顾性分析我院肾内科病理室2000-2013年14年间经肾活检诊断的成人(≥18岁)PGD患者3 392例(资料完整)的流行病学特点,并与1993-1999年我院肾活检诊断的553例PGD作比较。结果:12000-2013年间肾活检诊断PGD共3 392例,中位年龄为37(29,48)岁,男女比例为1:1。PGD以Ig A肾病(Ig AN)最多,占59.5%,其次分别为膜性肾病(MN)和微小病变型肾小球疾病(MCD),分别占16.5%和12.4%。Ig AN在青年组、中年组分别占47.6%和41.2%;老年前期组和老年组合计以MN最常见,占46.6%。2与1993-1999年肾活检病例比较,2000-2013年PGD中最显著的改变是MN的比率明显提高(从7.2%提高到16.5%)。1 067例PNS以MN最常见,占38.7%,其次分别为MCD(占38.3%)、Ig AN(占13.0%)和局灶性节段性肾小球硬化症(FSGS)(占6.2%)。结论:近14年来PGD仍以Ig AN居首,但MN的比率有明显上升趋势,后者已成为成人PNS最常见的病理类型。在前后两个时期肾活检指征基本未变的情况下,肾活检PGD构成比的演变可能与实际发病率的改变有关。

黑龙江省单中心785例儿童肾活检病理分析(2002年~2019年)

目的:从肾活检病理角度分析哈尔滨医科大学附属第二医院儿科近18年间儿童肾脏疾病肾组织病理学诊断的构成特征及其变化。方法:回顾性收集并分析2002年~2019年在我院行肾活检病理检查的肾脏疾病患儿资料,并将研究对象按时间先后分为第一阶段(2002年~2010年)和第二阶段(2011年~2019年)进行横断面对比分析。结果:(1)一般情况:研究共纳入肾活检患儿785例,男女比例为1.43∶1,0~6岁、7~12岁和13~18岁患儿所占肾活检患儿比例分别为68例(8.66%)、262例(33.38%)、455例(57.96%)。(2)病理类型:原发性肾小球疾病占76.94%,继发性肾小球疾病占21.14%,遗传性及先天性肾脏疾病占0.76%,肾小管间质疾病占1.15%。(3)病理谱变迁:轻微病变性肾小球肾炎是第一阶段最常见原发性肾小球疾病,IgA肾病是第二阶段最常见原发性肾小球疾病。狼疮性肾炎和紫癜性肾炎的构成比分别从第一阶段的0.86%和4.31%显著增加到第二阶段的7.59%和18.44%。结论:原发性肾小球疾病仍是影响我国儿童健康的主要肾脏疾病,近年来IgA肾病明显增加,是本组患儿最常见原发性肾小球疾病。紫癜性肾炎和狼疮性肾炎是最常见的继发性肾小球疾病。

广西桂北地区单中心1703例肾活检患者的病理分析及疾病谱变化

目的分析2005至2019年桂林医学院附属医院肾活检患者病理类型的分布特点及疾病谱的变迁。方法收集桂林医学院附属医院2005年1月至2019年12月共计1703例肾活检患者的临床病理资料,对肾脏疾病的临床病理特征进行回顾性分析。结果研究共纳入1703例肾穿刺活检病例,男女比例为1∶1.03,年龄(39.04±15.04)岁。病理类型组成为原发性肾小球肾炎(81.27%),继发性肾小球肾炎(17.91%),肾小管间质疾病(0.82%)。原发性肾小球肾炎最常见的病理类型是IgA肾病(29.93%)和膜性肾病(28.92%),膜性肾病占比从2005至2007年的4.35%上升到2017至2019年的39.27%,呈明显上升趋势。在继发性肾小球肾炎中,狼疮肾炎(40.20%)最为常见,其次是乙型肝炎病毒相关性肾炎(26.47%)、过敏性紫癜性肾炎(12.42%)、糖尿病肾脏疾病(6.54%)。结论原发性肾小球肾炎仍然是肾活检患者最主要的病理类型,IgA肾病和狼疮肾炎分别是最常见的原发性和继发性肾小球肾炎,膜性肾病有逐年增长趋势。

617例肾活检病理资料回顾性分析

目的:分析肾活检的病理类型,研究不同时期肾活检病理的形态学特征及变化,以便指导临床诊治。方法:标本取自2013~2018年蚌埠医学院第一附属医院肾病科住院行肾活检患者,统计患者的年龄、性别、肾活检时间及病理类型,时间为2013~2014年、2015~2016年、2017~2018年,年龄分别为≤20岁、21~40岁、41~60岁及>60岁,在此基础上观察肾小球肾炎的病理形态学特征及变化。结果:共纳入617例肾活检病例,原发性肾小球肾炎511例(82.82%),其中膜性肾病258例(50.49%)为最常见;继发性肾小球肾炎96例(15.56%),其中狼疮性肾炎54例(56.25%)为最常见;其他病理类型10例(1.62%)。按时间段分组统计,疾病构成比发生变化,其中原发性肾小球肾炎中膜性肾病占比由33.64%(2013~2014年)升至50.00%(2017~2018年);按不同年龄段统计,膜性肾病在>20岁患者中所占比例均最高。结论:膜性肾病是原发性肾小球肾炎中最常见的病理类型,膜性肾病在>20岁患者中所占比例最高,且所占比例逐年增加。

近十年温州地区肾脏疾病谱的变迁-基于5114例肾活检病理资料分析

目的:分析温州地区近十年肾脏疾病谱的构成特征和流行病学趋势。方法:选取2009年10月至2019年9月在温州医科大学附属第一医院行肾脏病理检查的患者,按照时间分布分为2个阶段,即2009年10月至2014年9月为第一阶段(组1),2014年10月至2019年9月为第二阶段(组2),分析肾脏疾病的构成和演变。结果:本研究共纳入肾穿刺活检标本5114例,肾活检患者平均年龄随时间变化逐渐升高,老年患者肾活检比例由7.70%升至20.36%。与组1相比,组2膜性肾病比例明显升高(24.3%vs.36.8%,P<0.001),其中以45~59岁年龄段增长幅度最显著。继发性肾小球疾病主要包括免疫介导性疾病(55.0%)、肿瘤代谢性疾病(33.8%)和感染相关性肾病(3.7%),两组相比,组2中肿瘤代谢性疾病比例升高近1倍(24.0%vs.44.4%,P<0.001)。结论:在过去的10年中,温州地区的肾脏疾病谱中原发性肾小球疾病中膜性肾病比例明显升高,是中老年患者最常见的原发性肾小球疾病。在继发性肾小球疾病中,糖尿病肾病、肾淀粉样变性等肿瘤代谢性疾病比例明显升高。