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Zhang P, Wang W, Chen S, Xu C, Peng J, Lin Y, Yao Q, Feng Y, Li G, Wang S. Spectrum of kidney pathological patterns and association with clinical characteristics in patients with increased serum creatinine in a single Chinese centre. Pathology 2025; 57:470-477. [PMID: 39979174 DOI: 10.1016/j.pathol.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 10/01/2024] [Accepted: 11/05/2024] [Indexed: 02/22/2025]
Abstract
Our objective was to clarify the pathological characteristics of native kidney biopsies and their association with clinical findings in patients with increased serum creatinine. Patients with elevated serum creatinine at native renal biopsy were included. Demographics, clinical details, and pathological findings of kidney biopsies were collected. Characteristics among subgroups based on serum creatinine, estimated glomerular filtration rate, and proteinuria levels were compared. Correlation analysis was performed to explore the relationship between clinical variables and pathological findings. The predictive value of clinical indexes for chronic pathological findings was examined using logistic regression. A total of 1478 patients were enrolled. The mean age was 47.4 years, and 58.1% were male. The most prevalent kidney disease group was immune complex mediated glomerulonephritis, followed in order by podocytopathy, metabolism-associated glomerulonephropathy and tubulointerstitial nephritis. The clinicopathological characteristics differed significantly among subgroups. Chronic pathological changes were mostly observed in patients with serum creatinine 3.0-4.5 mg/dL (265-398 μmol/L) or proteinuria 0.3-3.5 g/day. Serum creatinine was associated with tubulointerstitial changes, while albumin showed a stronger correlation with glomerular changes. The combination of serum creatinine and albumin can predict interstitial fibrosis and tubular atrophy (IFTA) at an area under the curve (AUC) of 0.647 (95% confidence interval 0.585-0.706). Clinicopathological characteristics of native kidney biopsy differed significantly by renal function and proteinuria in patients with elevated serum creatinine. The combination of serum creatinine and albumin can predict IFTA at a fair performance. Understanding of these associations helps to guide clinicians in the decision-making process regarding the timing and necessity of kidney biopsies.
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Affiliation(s)
- Ping Zhang
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Wei Wang
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Sipei Chen
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Chuan Xu
- Medical Information Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jin Peng
- Department of Histology, Embryology and Neurobiology, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yingying Lin
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Qi Yao
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Yunlin Feng
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China.
| | - Guisen Li
- Department of Nephrology and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, Chengdu, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China
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Chen F, Huang Y, Han M, Wang J. Delayed ureteric obstruction secondary to blood clot following renal biopsy: Case report and literature review. Medicine (Baltimore) 2025; 104:e42340. [PMID: 40324254 PMCID: PMC12055093 DOI: 10.1097/md.0000000000042340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 04/09/2025] [Accepted: 04/17/2025] [Indexed: 05/07/2025] Open
Abstract
RATIONALE Hemorrhage is a frequent complication following renal biopsy, whereas ureteral obstruction secondary to blood clot is an uncommon but significant adverse event. Presently, such obstructions typically manifest within the first-week postbiopsy; however, there are no documented cases of delayed-onset ureteral obstruction secondary to blood clots. PATIENT CONCERNS A 58-year-old male patient was admitted to Shaoxing Second Hospital with a 2-month history of recurrent bilateral lower extremity edema. He was diagnosed with nephrotic syndrome and subsequently underwent a renal biopsy. After a renal biopsy on day 19, the patient developed abdominal pain and hematuria. Follow-up examinations revealed a serum creatinine level of 181 μmol/L, and an abdominal computed tomography scan demonstrated a blood clot in the mid-portion of the right ureter. DIAGNOSES The patient was diagnosed with ureteric obstruction and acute renal failure. INTERVENTIONS The patient initially underwent bladder irrigation therapy; however, as there was no observable improvement in the condition after 48 hours, the decision was made to perform a transurethral ureteric stent placement. OUTCOMES The patient experienced immediate relief of abdominal pain following the procedure. On postoperative day 3, renal function had normalized. Seven days after surgery, the patient's hematuria had completely resolved, and he was discharged from the hospital. Two weeks later, the ureteral stent was removed during an outpatient visit. During the 6-month follow-up period, the patient remained in excellent health with no complications. LESSONS This case represents the first documented instance of delayed secondary ureteral obstruction due to blood clots following renal biopsy in China. When symptoms such as hematuria and flank pain occur after the procedure, ureteric obstruction should be highly suspected. Early diagnosis and prompt treatment are critical for optimizing patient outcomes.
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Affiliation(s)
- Fenjuan Chen
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Yiqi Huang
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Meixiang Han
- Department of Nephrology, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
| | - Jinying Wang
- Department of Intensive Care Unit, Shaoxing Second Hospital, Shaoxing, Zhejiang, China
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Avramidou E, Psatha K, St John K, Tsoulfas G, Aivaliotis M. Future of non-invasive graft evaluation: A systematic review of proteomics in kidney transplantation. World J Transplant 2025; 15:96025. [PMID: 40104186 PMCID: PMC11612886 DOI: 10.5500/wjt.v15.i1.96025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 09/19/2024] [Accepted: 10/21/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Despite the developments in the field of kidney transplantation, the already existing diagnostic techniques for patient monitoring are considered insufficient. Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies (serum, urine) represent a promising innovation in the monitoring of kidney transplant recipients. AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment. METHODS A systematic review was conducted in accordance with PRISMA guidelines, based on research results from the PubMed and Scopus databases. The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related complications. Eligibility criteria included protein biomarkers and urine and blood samples, while exclusion criteria were language other than English and the use of low resolution and sensitivity methods. The selected research articles, were categorized based on the biological sample, condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted. Functional and network analysis of the selected proteins was performed. RESULTS In 17 included studies, 58 proteins were studied, with the cytokine CXCL10 being the most investigated. Biological pathways related to immune response and fibrosis have shown to be enriched. Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported. Overall, all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods, as far as renal graft assessment is concerned. CONCLUSION Our review suggests that protein biomarkers, evaluated in specific biological fluids, can make a significant contribution to the timely, valid and non-invasive assessment of kidney graft.
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Affiliation(s)
- Eleni Avramidou
- Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece
| | - Konstantina Psatha
- Laboratory of Medical Biology- Genetics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
- Functional Proteomics and Systems Biology (FunPATh), Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki GR-57001, Greece
| | - Kallisti St John
- Functional Proteomics and Systems Biology (FunPATh), Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki GR-57001, Greece
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Center for Research and Innovation in Solid Organ Transplantation, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54642, Greece
| | - Michalis Aivaliotis
- Functional Proteomics and Systems Biology (FunPATh), Center for Interdisciplinary Research and Innovation (CIRI-AUTH), Thessaloniki GR-57001, Greece
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
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Bhattacharya S, Nagaraju SP, Prabhu RA, Rangaswamy D, Rao IR, Bhojaraja MV, Shenoy SV. Sonological predictors of complications of percutaneous renal biopsy-a prospective observational study. Ir J Med Sci 2024; 193:2537-2544. [PMID: 38995486 PMCID: PMC11450080 DOI: 10.1007/s11845-024-03753-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters-kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications. METHODS This was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted. RESULTS Out of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis. CONCLUSION The incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.
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Affiliation(s)
- Shruti Bhattacharya
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shankar Prasad Nagaraju
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Dharshan Rangaswamy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Indu Ramachandra Rao
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Mohan V Bhojaraja
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Srinivas Vinayak Shenoy
- Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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Winter SP, Kobes PK, Naiga J, Walumbembe J, Nassanga R, Dunn DP, Crawford AM. A Portable and Inexpensive Model for Ultrasound-Guided Procedure Training in Low- and Middle-Income Countries. J Am Coll Radiol 2024; 21:1289-1291. [PMID: 37722465 DOI: 10.1016/j.jacr.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Stephen P Winter
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Patrick K Kobes
- Section Chief, Acute Care Imaging, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Joyce Naiga
- Makerere University, Department of Radiology, Kampala, Uganda
| | | | - Rita Nassanga
- Department Chair, Makerere University, Department of Radiology, Kampala, Uganda
| | - Dell P Dunn
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah.
| | - Amanda M Crawford
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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Codea AR, Popa R, Sevastre B, Biriș A, Neagu D, Popovici C, Mircean M, Ober C. Effect of Ultrasound-Guided Renal Biopsies on Urinary N-Acetyl-Beta-D-Glucosaminidase Index Activity in Dogs with Diffuse Parenchymal Nephropathies. Life (Basel) 2024; 14:867. [PMID: 39063620 PMCID: PMC11278122 DOI: 10.3390/life14070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Ultrasound-guided kidney biopsy is an essential diagnostics method that can increase the accuracy of the differential diagnosis between acute and chronic nephropathies. In addition, it will help clinicians perform an etiologic diagnosis, issue a prognosis, and orient therapy for the majority of parenchymal nephropathies. Due to the relative invasiveness and potential adverse effects, the use of kidney biopsies is limited among practitioners. RESULTS Twenty-eight dogs, of mixed breed and variable ages, of which 11 (39, 29%) were males and 17 (60, 71%) were females, were examined and underwent an ultrasound-guided kidney biopsy to establish a definitive diagnosis. The patients were presented with a variety of diffuse nephropathies, such as kidney lymphoma: 1 (3.57%), glomerulonephritis: 13 (46.43%), tubulointerstitial nephritis: 11 (39.29%), and nephrocalcinosis. A total of 3 (10.71%) of 18 (64.29%) were in acute kidney injury, and 10 (35.71%) were CKD patients. The type and the severity of the kidney lesions were correlated with changes in the urinary n-acetyl-beta-d-glucosaminidase index (iNAG. To quantify the side effects of percutaneous kidney biopsy, the magnitude of post-biopsy hematuria and changes in urinary iNAG activity were evaluated. The results indicate a significant post-biopsy increase in the urinary iNAG activity in all the patients that underwent this procedure (100.08 ± 34.45 U/g), with a pre-biopsy iNAG vs. 147.65 ± 33.26 U/g post-biopsy iNAG (p < 0.001), suggesting an intensification in the kidney tubular damage that comes consecutives to kidney puncture and sampling. Transitory macro- or microhematuria were constant findings in all the dogs that underwent ultrasound-guided kidney biopsy, but the magnitude and extent could not be associated with the platelet count (PLT 109/L), aPTT (s), and PT (s) levels in our patients, and they were also resolved after 12-24 h without therapeutic interventions. CONCLUSIONS Ultrasound-guided renal biopsy was shown to be a minimally invasive diagnostic procedure that causes transient and limited effects on kidney structures. Although these effects were minor and resolved without intervention, we feel that the benefit of obtaining higher-quality biopsied tissue outweighs the higher risks associated with this procedure.
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Affiliation(s)
- Andrei Răzvan Codea
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Romeo Popa
- Department of Pharmacology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Bogdan Sevastre
- Department of Surgery, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania;
| | - Alexandra Biriș
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Daniela Neagu
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Cristian Popovici
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Mircea Mircean
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Ciprian Ober
- Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania;
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Wijewickrama E, Behera S, Garcia P, Avila-Casado C, Caplin B, Paolo VS, Courville K, Friedman D, Madero M, Jha V, Kambham N, Levin A, Anand S. Kidney biopsies among persons living in hotspots of CKDu: a position statement from the International Society of Nephrology's Consortium of Collaborators on CKDu. Kidney Int 2024; 105:464-469. [PMID: 38160755 DOI: 10.1016/j.kint.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/02/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Eranga Wijewickrama
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Suman Behera
- Division of Nephrology, McMaster University, Hamilton, Ontario, Canada; Division of Nephrology, William Osler Health System, Brampton, Ontario, Canada
| | - Pablo Garcia
- Department of Medicine (Nephrology), University of New Mexico, Albuquerque, New Mexico, USA
| | - Carmen Avila-Casado
- Department of Laboratory Medicine & Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ben Caplin
- Department of Renal Medicine, University College London, London, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Vicente Sanchez Paolo
- Nephrology and Kidney Transplant Division, Social Security Guatemalan Institute, Concepción, Guatemala
| | - Karen Courville
- Section of Nephrology, Department of Medicine, Hospital Dr. Gustavo Nelson Collado, Chitré, Herrera, Panama; Instituto de Ciencias Médicas and Sistema Nacional de Investigación, Las Tablas, Los Santos, Panamá
| | - David Friedman
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Magdalena Madero
- Division of Nephrology, Instituto Nacional de Cardiologia Ignacio Chávez, Mexico City, Mexico
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India; School of Public Health, Imperial College, London, UK; Prasanna School of Public Health, Manipal Academy of Medical Education, Manipal, India
| | - Neeraja Kambham
- Department of Pathology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shuchi Anand
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
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Diongolé HM, Tondi ZMM, Garba A, Ganiou K, Chaibou L, Bonkano D, Aboubacar I, Seribah AA, Abdoulaye Idrissa AM, Atanda A, Rostaing L. Implementation of Kidney Biopsy in One of the Poorest Countries in the World: Experience from Zinder Hospital (Niger). J Clin Med 2024; 13:664. [PMID: 38337366 PMCID: PMC10856258 DOI: 10.3390/jcm13030664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Kidney biopsy (KB) has become essential in the nephrologist's approach to kidney diseases, both for diagnosis, treatment, and prognosis. Our objective is to describe the preliminary results of KBs in Niger, one of the poorest countries in the world. This is a descriptive cross-sectional study that took place over 36 months in the nephrology/dialysis department of the Zinder National Hospital. Biopsy results were obtained in less than 5 working days. Patients were responsible for covering the cost of the kidney biopsy. The data collected were analyzed using Epi Info V7 software. We performed 120 kidney biopsies during the study period. The average age of the patients was 35 years ± 15.4 [5-68]. The male/female sex ratio was 2:1. Patients' medical history included herbal medicine use in 33% of cases and high blood pressure in 27.5% of cases. Proteinuria was present at a rate of ≥3 g/24 h in 46.6% of them. The primary indication for kidney biopsy was glomerular syndrome in 62.5% of cases, including 50% with nephrotic syndrome. All kidney biopsies were performed with real-time ultrasound guidance, using an automatic gun fitted with a 16G needle. Regarding complications, macroscopic hematuria was present in 12.5% of cases. Inadequate kidney biopsy was infrequent (5.8% of cases). The most common findings were (i) glomerular diseases (58.4%), such as membranoproliferative glomerulonephritis (13.3%), focal-segmental glomerulosclerosis (10.6%), lupus nephritis (8.8%), minimal change disease (8%), and membranous nephropathy (2.7%), and (ii) tubulointerstitial changes (31.8%). Diabetic nephropathy was rare (2.6%), as was IgA nephropathy (0.9%). We have demonstrated that implementing a sustainable kidney biopsy program in a very poor country is feasible, thanks to the dedication of a specialized renal pathologist. Having a clear diagnosis can assist in properly treating these renal patients according to international guidelines, thereby delaying the progression to end-stage kidney disease.
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Affiliation(s)
- Hassane Moussa Diongolé
- Department of Nephrology and Dialysis, Université André Salifou de Zinder, Zinder B.P.656, Niger; (H.M.D.); (A.G.); (K.G.)
- Hôpital National de Zinder, Zinder B.P.656, Niger; (L.C.); (A.A.S.)
| | - Zeinabou Maiga Moussa Tondi
- Department of Nephrology and Dialysis, Université Abdou Moumouni, Niamey 10662, Niger;
- Hospital National Amirou Boubacar Diallo Lamordé Niamey, Niamey 10146, Niger;
| | - Abdoulazize Garba
- Department of Nephrology and Dialysis, Université André Salifou de Zinder, Zinder B.P.656, Niger; (H.M.D.); (A.G.); (K.G.)
- Hôpital National de Zinder, Zinder B.P.656, Niger; (L.C.); (A.A.S.)
| | - Kabirou Ganiou
- Department of Nephrology and Dialysis, Université André Salifou de Zinder, Zinder B.P.656, Niger; (H.M.D.); (A.G.); (K.G.)
- Hôpital National de Zinder, Zinder B.P.656, Niger; (L.C.); (A.A.S.)
| | - Laouali Chaibou
- Hôpital National de Zinder, Zinder B.P.656, Niger; (L.C.); (A.A.S.)
| | - Djibrilla Bonkano
- Hospital National Amirou Boubacar Diallo Lamordé Niamey, Niamey 10146, Niger;
| | | | | | | | | | - Lionel Rostaing
- CHU Grenoble, Néphrologie-Hémodialyse, Aphérèses-Transplantation Rénale, 38043 Grenoble, France
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9
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Lu R, Sun F, Zhang L, Zhang C, Du J, Hao J, Zhao L. Detection of microvascular damage of membranous nephropathy by MicroFlow imaging: a novel ultrasound technique. Quant Imaging Med Surg 2024; 14:958-971. [PMID: 38223077 PMCID: PMC10784053 DOI: 10.21037/qims-23-1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
Background MicroFlow imaging (MFI) is a novel noninvasive ultrasound (US) technique that depicts microcirculatory blood vessels in the kidney while filtering out tissue motion and enhancing blood flow signals. We aimed to investigate the value of MFI for the detection of renal microvascular perfusion in chronic kidney disease caused by stage I-II membranous nephropathy (MN). Methods Seventy-six participants including biopsy-proven MN (n=38) and healthy volunteers (n=38) were prospectively examined using MFI from March 2020 to December 2020. In addition, patients with MN were subdivided into a mild group, a moderate group, and a severe group based on the results of vascular pathology evaluation. All MFI images were analyzed by Image Pro Plus to obtain a cortical vascular index (VI). Basic patient information, relative US parameters and laboratory results were then acquired for each participant. Finally, after the univariate analysis among multiple groups, binary logistic regression (forward LR) and ordered logistic regression were used for multivariate analysis. Significance was set at P<0.05. Results VI was significantly lower in MN patients compared with that of healthy controls (0.65±0.09 vs. 0.35±0.18, P<0.001). After multivariate analysis, we found that the exploratory diagnostic performance of VI [area under the curve (AUC): 0.94; 95% confidence interval (CI): 0.89-0.99] outperformed that of serum creatinine (Scr) (AUC: 0.87; 95% CI: 0.79-0.95) in identifying MN. We also observed considerable differences among MN groups in parameters including VI (P=0.006), estimated glomerular filtration rate (eGFR) (P=0.037), shape (P=0.013), and impression (P=0.007). In addition, in the group with mild vascular damage, the exploratory diagnostic performance of VI (AUC: 0.79; 95% CI: 0.64-0.94) was better than other parameters, such as eGFR (AUC: 0.63; 95% CI: 0.43-0.84). Conclusions MFI detected abnormal renal microvascular perfusion in patients with MN (particularly in those with early vascular damage or preserved renal function) without the use of a contrast agent. Combining MFI with B-mode US can improve the predictive performance of traditional kidney US.
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Affiliation(s)
- Renjie Lu
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Fangfang Sun
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lili Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Chao Zhang
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jie Du
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Jianxun Hao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
| | - Lirong Zhao
- Department of Diagnostic Ultrasound Center, the First Hospital of Jilin University, Changchun, China
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10
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Mbanefo NR, Igbokwe OO, Iloh ON, Chikani UN, Bisi-Onyemaechi AI, Muoneke VU, Okafor HU, Uwaezuoke SN, Odetunde OI. Percutaneous kidney biopsy and the histopathologic patterns of kidney diseases in children: An observational descriptive study at a South-East Nigerian tertiary hospital. Niger J Clin Pract 2023; 26:795-801. [PMID: 37470655 DOI: 10.4103/njcp.njcp_855_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Kidney biopsy remains the best standard for kidney tissue analysis. Although percutaneous kidney biopsy is an invasive procedure, it is an indispensable part of interventional nephrology for accurate diagnosis, selection of appropriate therapy protocol, and prognostication of kidney diseases in children. With improvement in expertise among pediatric nephrologists, data on procedure outcomes are now being documented. Aim: We aimed to describe the outcomes in a 5-year practice of kidney biopsy at the pediatric nephrology unit in a southeast Nigerian tertiary hospital. PATIENTS AND METHODS An observational descriptive study conducted on the kidney biopsy performed in our facility from 2017 to 2022. The focus was on the patients' clinical profile, indications for biopsy, the adopted procedure, and the histopathologic findings. RESULTS A total of 69 patients had kidney biopsy, 40 (58.0%) were males, while 29 (42.0%) were females. Sixty-four (92.7%) patients had the procedure at the age of >10 years, while five (7.2%) at the age of <7 years. The patients' prebiopsy mean systolic and diastolic blood pressures were 111.20 ± 16.93 and 74.64 ± 12.69 mmHg, respectively. Their estimated glomerular filtration rate (eGFR) was 119.27 ± 52.78 ml/min/1.73 m2. The most frequent indication was steroid resistance (39/69, 56.5%). Focal segmental glomerulosclerosis was the commonest histopathologic finding (38/69, 55.0%). CONCLUSION Outcomes of percutaneous kidney biopsy at a Nigerian tertiary hospital are adjudged successful. The histopathologic patterns highlight FSGS as the major cause of steroid resistance in childhood nephrotic syndrome in this clime.
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Affiliation(s)
- N R Mbanefo
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O O Igbokwe
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O N Iloh
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - U N Chikani
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - A I Bisi-Onyemaechi
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - V U Muoneke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - H U Okafor
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - S N Uwaezuoke
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - O I Odetunde
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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11
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Ekrikpo U, Obiagwu P, Chika-Onu U, Yadla M, Karam S, Tannor EK, Bello AK, Okpechi IG. Epidemiology and Outcomes of Glomerular Diseases in Low- and Middle-Income Countries. Semin Nephrol 2023; 42:151316. [PMID: 36773418 DOI: 10.1016/j.semnephrol.2023.151316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Glomerular diseases account for a significant proportion of chronic kidney disease in low-income and middle-income countries (LMICs). The epidemiology of glomerulonephritis is characterized inadequately in LMICs, largely owing to unavailable nephropathology services or uncertainty of the safety of the kidney biopsy procedure. In contrast to high-income countries where IgA nephropathy is the dominant primary glomerular disease, focal segmental glomerulosclerosis is common in large populations across Latin America, Africa, Middle East, and South East Asia, while IgA nephropathy is common in Chinese populations. Despite having a high prevalence of known genetic and viral risk factors that trigger focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis also is common in adults and children in some African countries. Treatment of glomerular diseases in adults and children in LMICs largely is dependent on corticosteroids in combination with other immunosuppressive therapy, which often is cyclophosphamide because of its ready availability and low cost of treatment, despite significant adverse effects. Partial and/or complete remission status reported from studies of glomerular disease subtypes vary across LMIC regions, with high rates of kidney failure, mortality, and disease, and treatment complications often reported. Improving the availability of nephropathology services and ensuring availability of specific therapies are key measures to improving glomerular disease outcomes in LMICs.
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Affiliation(s)
- Udeme Ekrikpo
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Patience Obiagwu
- Department of Paediatrics, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ugochi Chika-Onu
- Department of Medicine, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
| | - Sabine Karam
- Division of Nephrology, University of Minnesota, Minnesota, MN; Division of Nephrology, Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ikechi G Okpechi
- Department of Medicine, University of Alberta, Edmonton, Canada; Division of Nephrology, University of Cape Town, Cape Town, South Africa.
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12
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Ho QY, Lim CC, Tan HZ, Sultana R, Kee T, Htay H. Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis. Transplantation 2022; 106:1497-1506. [PMID: 35019898 DOI: 10.1097/tp.0000000000004033] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. METHODS This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). RESULTS The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. CONCLUSIONS The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.
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Affiliation(s)
- Quan Yao Ho
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | | | - Hui Zhuan Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | | | - Terence Kee
- Department of Renal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Transplant Centre, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
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