Analysis Of Clinical And Pathological Data Of Patients With Repeated Renal Biopsy

Objective:In this study,the clinical and pathological data of 76 patients with repeated renal biopsy were retrospectively analyzed.The clinical manifestations,laboratory parameters,pathology and treatment regimen of the two renal biopsy patients were compared to explore the rational indications and significance of repeated renal biopsy.Methods:Seventy-six patients who underwent a renal biopsy from the Second Hospital of Jilin University from January 2002 to December 2018 were enrolled.The patients were enrolled in the first and second renal biopsy,it mainly includes general information,pathological data,clinical manifestations,laboratory tests and clinical treatment plans,and retrospective analysis of all data.Statistical analysis was performed using SPSS 21.0 statistical software.Results:1.General information: Among the 76 patients,34 were male,accounting for 44.7%,42 were female,accounting for 55.3%,and the ratio of male to female was 1:1.25.The average age of the first renal biopsy was 37.05±14.52 years old,and the average age of the second renal biopsy was 40.83±14.36 years old.The median mean interval between two renal biopsies was 3.5 years.The number of repeated renal biopsies increased slightly during the 16 years,with the highest number of repeated renal biopsies in 2015,accounting for 11.8%.2.Pathological type distribution: Among the 76 patients with repeated renal biopsy,the pathological type of the first renal biopsy was: lupus nephritis up to 26 cases(34.2%),followed by 16 cases(21.1%)of membranous nephropathy,13 cases(17.1%)of mesangial proliferative glomerulonephritis,6 cases(7.9%)of IgA nephropathy,4cases(5.3%)of minimal change disease,3 cases(3.9%)of allergic purpuric nephritis,2 cases(2.6%)of hepatitis B virus associated glomerulone nephritis,renal injury caused by hypertension?acute interstitial nephritis?focal glomerulonephritis? focal segmental glomerular sclerosis?intravascular proliferative lesions with crescent formation and diffuse proliferative glomerulonephritis are 1 case(1.3%)respectively.Compared with the first renal biopsy,there were49 cases of renal pathological changes in the second renal biopsy,accounting for 64.5% of the total.The pathological distribution was: 30 cases(39.5%)of lupus nephritis,14 cases(18.4%)of membranous nephropathy,8 cases(10.5%)of focal segmental glomerulo sclerosis,6 cases(7.9%)of focal glomerulonephritis,5 cases(6.6%)of mesangial proliferative glomerulonephritis,IgA nephropathy and allergic purpuric nephritis are 3 cases(Separate 3.9%)respectively,2 cases(2.6%)of hepatitis B virus associated glomerulone nephritis,renal injury caused by hypertension ? chronic interstitial nephritis ? membrane proliferative glomerulonephritis ? sclerosing nephritis and Minimal change disease are 1 case(1%)respectively.3.Comparison of clinical and pathological data of patients with lupus nephritis repeated renal biopsy: Among the 26 patients,there was no significant difference in clinical manifestations between the two patients before and after renal biopsy.Compared with the first renal biopsy,the clinical classification and laboratory parameters of the second renal biopsy are: the number of patients with nephrotic syndrome,occult nephritis and nephritic syndrome decreased,but the difference was not statistically significant.The number of patients with insufficiency increased(P<0.05);patients with WBC,HB,PLT,SCr,TG increased,eGFR decreased(P<0.05).Compared with the first renal biopsy,the SLEDIA score of the second renal biopsy patient was increased,but there was no statistical difference.Of the 26 patients with lupus nephritis recurrent renal biopsy,20 cases had pathological changes.Compared with the first renal biopsy,the number of patients with IV+V lupus nephritis increased after the second renal biopsy(P<0.05);the pathological changes are: glomerular sclerosis,balloon adhesion,tubular atrophy,renal interstitial cell infiltration,renal interstitial fibrosis increased in the second renal biopsy(P<0.05);the index of AI,CI increased in second renal biopsy(P < 0.05).Compared to the first renal biopsy,of the 26 patients with lupus nephritis recurrent renal biopsy,23 cases had a change in treatment regimen,the GC+FK506,GC+FK506+MMF treatment regimens increased(P<0.05),GC+LEF,GC+MMF treatment regimen reduced(P<0.05).4.Comparison of clinical and pathological data of patients with membranous nephropathy repeated renal biopsy: Compared with the first renal biopsy,eGFR,24-hour urine protein quantitation,and SCr increased(P<0.05)in the second renal biopsy.In 16 patients,there were 10 cases of idiopathic membranous nephropathy and 6 cases of atypical membranous nephropathy in the first renal biopsy.After the second renal biopsy,pathological changes occurred in 10 patients,and 3 cases of atypical membranous nephropathy were converted into lupus nephritis.There were 8 cases with crescent appeared in the second renal biopsy(P<0.05).There were 9 patients with treatment changes,GC+CTX and GC+FK506 increased compared with the first time,but there was no statistically significant difference.5.Comparison of clinical and pathological data of patients with mesangial proliferative glomerulonephritis repeated renal biopsy: Compared with the first renal biopsy,there was no statistically significant difference in the changes of laboratory test in the second renal biopsy.In 14 patients,the pathological type of 9 patients have changed after the second renal biopsy(P<0.05);compared with the first renal biopsy,the renal tubular atrophy,aortic glassy degeneration increased in the second renal biopsy(P <0.05);the treatment regimen of 9 cases have been changed in the second renal biopsy,and the number of GC treatment alone decreased(P<0.05).6.In 21 patients with recurrent renal biopsy,compared with the first renal biopsy,11 patients had a pathological change in the second renal biopsy,and the pathology was aggravated compared with the first time.One of the patients,the inmmunofluorescence showed "full hall bright" and light microscopy showed hypertrophic lesions in the capillaries with crescent formation at the first renal biopsy,consistent with the pathological diagnosis of lupus nephritis,but the ANA spectrum was completely negative,in the second renal biopsy,ANA multiple positive,and pathology Diagnosed was IV+V type lupus nephritis.Conclusion:1.The number of lupus nephritis was the highest in patients with repeated renal biopsy,followed by membranous nephropathy and mesangial proliferative glomerulonephritis.2.The clinical and renal pathology of most patients were aggravated in the second renal biopsy compared with the first time.3.Patients with atypical membranous nephropathy in the first renal biopsy should be alert to secondary glomerular disease.4.Patients with renal pathology consistent with lupus nephritis but serologically negative should be followed up.5.Repeated renal biopsy has important diagnostic value for dynamic observation of renal pathological changes,clear pathological types,adjustment of treatment options,and prognosis.