Analysis Of Complication And Pathology Of 420 Cases With Renal Biopsy

Background and ObjectiveRenal disease is common in China that each year hundreds of people per million population for various reasons of kidney diseases progress to end-stage renal disease (ESRD).Lileishi and the other reports that in China glomerular disease are dominant.So,identifying etiologies of the renal diseases and delaying renal diseases developing to ESRD is critical.Glomerular diseases have different pathological types and different types of treatment methods are not identical, While renal biopsy can identify pathology types of renal diseases . Renal biopsy,first used by Alwallin 1944, was popularized and spread in the 50 's. In the late 1950s this technology was spread in China and literatures reported series of cases mortality before the 1970s was 0.07%-0.17%.but as the improvement of renal biopsy, the mortality number of renal biopsy has declined a lot. There are many reported common complications after renal biopsy such as hematuria,low back pain, renal week hematoma, abdominal distension and urinary retention, such as common complications, while strictly control of renal Biopsy indications, preoperative preparation fully and good cooperation during the operations can reduces the complications of renal biopsy.This research retrospective analysis Clinical data,complications and pathological types of 420 cases with renal biopsy ,trying to discuss the contact between them ,so that drawing lessons as to better apply renal Biopsy .Besides,this research want to discuss the significance of Renal Biopsy in renal disease diagnosis.MethodsCollecting 434 cases with renal biopsy in the second affiliated hospital of Jilin university during January 2002 and April 2007.14 cases with renal biopsy removed for information is incomplete, the last 420 cases include various types of primary and secondary Glomerular Disease, renal tubules and tubulointerstitial disease and other causes of renal disease. Clinical and laboratory data, also,pathology types were collected, including preoperative and postoperative blood routine test, such as, red blood cell ( RBC ), white blood cell (WBC) , hemoglobin values (HGB), clotting time(CT),platelet (PLT),plasma albumin (ALB),Serum creatinine values (Scr), alanine aminotransferase (ALT),aspartate aminotransferase (AST), blood ion, hepatitis antibody(Ab) and antigen(Ag),syphilis Ab and AIDS, renal ultrasonography for renal size. All biopsies were performed under ultra-sound guidance using an automated springloaded gun device.Renal biopsies specimens were processed for light and immunofluorescence microscopy in all and for electron microscopy in some specimens. In all cases, sections were stained with Hematoxylin and Eosin stain (H and E), Masson's trichrome stain, periodic acid-Schiff(PAS), and Silver Jone's stain. Then, pathological diagnosis were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995The qualitative data of clinical and laboratory examination present as the number of case (percentage), and the quantitative data present as mean±standard deviation(±s).The count data used analysis of variance and chisquaretest, and measurement data by t-test, P<0.05 defined as a statistically significant difference. .Results420 renal specimens were gotten for 420 cases with renal biopsy, 100% success rate. A total of 120 cases have complications after renal biopsy,that 67 cases were male and the other 53 cases were female. one kind of complication appear on 104 cases ,While more than two kinds of complications emerged on the other16 cases. Complications were divided into 81 cases of low back pain, 31 cases of microscopic hematuria, 13 cases of gross hematuria, 8 cases of urinary retention ,5 cases of perirenal hematoma. Clinical manifestations of 420 cases with renal biopsy were composed of glomerular diseases, a total of 315 cases of primary Glomerular Disease, occupy 75% by the total number, followed by the 98cases of secondary glomerular diseases (21.2%), 7cases of renal tubules and tubulointerstitial disease (3.8%)。Pathology types of 315 Primary glomerular disease cases divided: IGA nephropathy(IgAN)120 cases (38.1%), mesangial proliferative Glomerulonephritis (MsPGN)75 cases(23.8%), membranous nephropathy(MN) 45 cases (14.3%), Sclerosing nephritis 42 cases (13.3), minimal change disease (MCD) in 13 cases(4.1%), Focal Segmental Glomerulosclerosis (FsGs) 8 cases (2.5%), proliferative nephritis (MPGN) of 7 cases (2.2%), capillaries in proliferative nephritis (EnPGN) 5 cases (1.6%). Pathology types of 89 secondary glomerular disease cases divided: lupus nephritis 34 patients (38.2%), purpuric nephritis 32 patients (35.9%), 11 cases of diabetic nephropathy (12.4%), 8 cases of hepatitis associated Glomerulonephritis (9.0%), Amyloidosis 4 patients(4.5%). 16 cases of tubulointerstitial Disease Pathology: Hypertensive renal damage in 8 patients(50%), acute tubular necrosis in 6 patients (37.5%), 2 cases of chronic interstitial nephritis(12.5%).The reseach have shown that in this group IgA nephropathy most manifest clinical type of chronic glomerulonephritis(58.3%) and latent glomerulonephritis (35%), Mesangial proliferative glomerulonephritis most manifest clinical type of nephrotic syndrome(62.7%) and chronic Glomerulonephritis(14.7%), and membranous nephropathy most manifest clinical type of nephrotic syndrome (53.3%) and chronic Glomerulonephritis(26.7%). Pathology types of 98 Secondary glomerular disease cases divided: lupus nephritis 34 patients (35.0%), nephritis 32 patients(35.0%), 11 cases of diabetic nephropathy(11.2%), 8 cases of hepatitis-B-virus associated with Glomerulonephritis(8.2%)and 4 cases of Amyloidosis(4.1%), malignant hypertension with renal damage in 9 cases (9.1%)。Pathology types of 7 renal tubules and tubulointerstitial disease:5 cases of acute tubular necrosis (71.4%), 2 cases of sub-acute tubulointerstitial injury(28.6%).DiscussionRenal disease is common in China ,because of its strong occult, many patients being dignosed until end-stage renal failure(ESRF) stage, bring enormous economic and social pressures to the famlly and society, so early detection of renal disease, delaying or curing renal diseasedevelop to ESRF has become particularly important. Renal biopsy and pathological test are the best diagnostic methods for renal disease, but because the method of renal biopsy is invasive, can cause hematuria, low back pain,perirenal hematoma, or even potentially nephrectomy , all of which make renal biopsy can not be used broader.From the perspective of primary glomerular disease, 134 cases of chronic Glomerulonephritis mainly was IgA nephropathy (44.8%),pathologic types of 129 cases whose clinical manifestations were nephrotic syndrome were mainly mesangial proliferative Glomerulonephritis (32.6%), membranous nephropathy (20.1%), IgA nephropathy (14.7%)..IgA nephropathy(82.0%) was the main pathological type of the 50 cases of latent glomerulonephritis. While this research showed IgA nephropathy most manifested chronic Glomerulonephritis(58.3%)and latent Glomerulonephritis(35%) in clinical types , mesangial proliferative glomerulonephritis manifesting nephrotic syndrome(62.7%) and chronic Glomerulonephritis(14.7%),nephritic syndrome(53.3%) andchronic Glomerulonephritis(26.7%) were the most frequent clinical manifestation of membranous nephropathy.From the analysis above of the primary glomerular diseases ,we can conclude that There are certain relationships between clinical manifestation and pathological type, such as mesangial proliferative Glomerulonephritis patients most manifested nephrotic syndrome in this research, and the pathological type of nephrotic syndrome mainly was mesangial proliferative Glomerulonephritis. Here was another example: pathological type of chronic Glomerulonephritis was mainly IgA nephropathy, and IgA nephropathy most manifested chronic Glomerulonephritis, so clinical manifestations and pathological types have a one-to-one relationship.This research is a 100% success rate in nenal biopsy, all tissues having the Glomerular, and number more than ten, higher than the literature reports 92.6%～99.2% success rate, considerring the high success rate was related with renal biopsy operator's experienced physicians, well cooperation between operator and patients. Renal biopsy complication rate of this group of cases was 28.6% (120/420), and there were common complication of hematuria, back pain, abdominal distension and perirenal hematoma to complications, 5 patients of perirenal hematoma being recoverd by extending the time of lying in the bed, giving the styptic, dringking plenty of water, no death and nephrectomy cases.In this research nephrotic syndrome, chronic Glomerulonephritis, lupus nephritis, amyloidosis, and other diseases had the similar complication rate , Complication rate of renal failure cases being slightly higher than the rate of non-renal failure casescomplications, both not significantly different. Hematuria, back pain, abdominal distension and perirenal hematoma and other complication occurred more in purpuric nephritis cases ,while hypertensive renal damage cases and chronic interstitial nephritis had the highst complication rate, analysising the relatively few cases cause complication rate high. This study show, age, sex, blood pressure, primary disease, puncture needle selection and other factors did not have apparent effect on renal biopsy complication rate for different people.conclusions:1.Primary glomerular disease is still the most common form of renal disease, and IgA nephropathy is the most common pathological type of primary glomerular diseases, that lupus nephritis isthe most common pathological type of secondary glomerular diseases 2.Clinical manifestation and pathological types of glomerular disease have a one-to-one relationship.3.This group of studies having shown that low back pain, hematuria, perirenal hematoma, and abdominal distension, urinary retention are common complications of renal biopsy, no nephrectomy and death, renal biopsy is relatively safe.