https://doi.org/10.4081/reumatismo.2023.1586
Discrepancies between clinical and pathological findings seen at renal biopsy in rheumatological diseases
Submitted: 23 April 2023
Accepted: 4 July 2023
Published: 18 September 2023
Accepted: 4 July 2023
Abstract Views: 1063
PDF: 369
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective. Renal biopsy contributes to the diagnosis, follow-up, and treatment of many rheumatic conditions. This study assessed the diagnostic role and safety of renal biopsies in a tertiary rheumatology clinic.
Methods. Renal biopsies performed between June 2020 and December 2022 were screened, and demographic, clinical, histopathological, and safety data were collected from patient records.
Results. In this study, 33 males and 38 females were included. Except for 1 patient who received acetylsalicylic acid, antiaggregant, and/or anticoagulant drugs were stopped before the biopsy. Complications included a decrease of hemoglobin in 8 patients (11.3%) and microscopic hematuria in 40 patients (56.3%). Control ultrasonography was performed in 16 patients (22.5%), and a self-limiting hematoma was found in 4 of them (5.6%) without additional complications. While less than 10 glomeruli were obtained in 9 patients (9.9%), diagnosis success was 94.4%. Histopathological data were consistent with one of the pre-biopsy diagnoses in 54 of 67 cases (80.6%) but showed discrepancies in 19.4% (n=13) of patients. A repeat biopsy was performed in 7 patients for re-staging or insufficient biopsy.
Conclusions. Renal biopsy significantly contributes to rheumatology practice, especially in patients with complex clinical and laboratory findings or in whom different treatments can be given according to the presence, severity, and type of renal involvement. Although the possibility of obtaining insufficient tissue and the need for re-staging and repeat biopsy in the follow-up might be expected, complication risk does not seem to be a big concern. Renal biopsy often evidenced discrepancies between pre-biopsy diagnosis and histopathological findings.
Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 2004; 15: 241-50.
DOI: https://doi.org/10.1097/01.ASN.0000108969.21691.5D
Saleh M, Eltoraby EE, Tharwat S, Nassar MK. Clinical and histopathological features and short-term outcomes of lupus nephritis: a prospective study of 100 Egyptian patients. Lupus 2020; 29: 993-1001.
DOI: https://doi.org/10.1177/0961203320928424
Van Daalen EE, Wester Trejo MAC, Goceroglu A, Ferrario F, Joh K, Noël LH, et al. Developments in the histopathological classification of ANCA-associated glomerulonephritis. Clin J Am Soc Nephrol 2020; 15: 1103-11.
DOI: https://doi.org/10.2215/CJN.14561119
Working Group of the International Ig ANN and the Renal Pathology Society, Cattran DC, Coppo R, Cook HT, Feehally J, Roberts ISD, et al. The Oxford classification of IgA nephropathy: rationale, clinicopathological correlations, and classification. Kidney Int 2009; 76: 534-45.
Koopman JJE, Rennke HG, Leatherwood C, Speyer CB, D'Silva K, McMahon GM, et al. Renal deposits of complement factors as predictors of end-stage renal disease and death in patients with lupus nephritis. Rheumatology 2020; 59: 3751-8.
DOI: https://doi.org/10.1093/rheumatology/keaa174
Durel CA, Sinico RA, Teixeira V, Jayne D, Belenfant X, Marchand-Adam S, et al. Renal involvement in eosinophilic granulomatosis with polyangiitis (EGPA): a multicentric retrospective study of 63 biopsy-proven cases. Rheumatology 2021; 60: 359-65.
DOI: https://doi.org/10.1093/rheumatology/keaa416
Kifer N, Bulimbasic S, Sestan M, Held M, Kifer D, Srsen S, et al. Semiquantitative classification (SQC) and Oxford classifications predict poor renal outcome better than the international study of kidney disease in children (ISKDC) and Haas in patients with IgAV nephritis: a multicenter study. J Nephrol 2023; 36: 441-9.
DOI: https://doi.org/10.1007/s40620-022-01509-4
Morales E, Trujillo H, Bada T, Alonso M, Gutierrez E, Rodriguez E, et al. What is the value of repeat kidney biopsies in patients with lupus nephritis? Lupus 2021; 30: 25-34.
DOI: https://doi.org/10.1177/0961203320965703
Agarwal SK, Sethi S, Dinda AK. Basics of kidney biopsy: a nephrologist's perspective. Indian J Nephrol 2013; 23: 243-52.
DOI: https://doi.org/10.4103/0971-4065.114462
Xie W, Xu J, Xie Y, Lin Z, Xu X, Zhang X, et al. Adequacy and complication rates of percutaneous renal biopsy with 18- vs. 16-gauge needles in native kidneys in Chinese individuals. BMC Nephrol 2020; 21: 337.
DOI: https://doi.org/10.1186/s12882-020-01987-3
Amann K, Haas CS. What you should know about the work-up of a renal biopsy. Nephrol Dial Transplant 2006; 21: 1157-61.
DOI: https://doi.org/10.1093/ndt/gfk037
Lubbers H, Mahlke R, Haake C, Lankisch PG. A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs. Z Gastroenterol 1993; 31: 484-5.
Ahmed AM, Anees M, Riaz A, Mueed S. Percutaneous renal biopsy by automated biopsy gun. J Coll Physicians Surg Pak 2003; 13: 263-6.
Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012; 19: 179-87.
DOI: https://doi.org/10.1053/j.ackd.2012.04.003
Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 2012; 60: 62-73.
DOI: https://doi.org/10.1053/j.ajkd.2012.02.330
Roth R, Parikh S, Makey D, Foster J, Rozenblit G, Satoskar A, et al. When size matters: diagnostic value of kidney biopsy according to the gauge of the biopsy needle. Am J Nephrol 2013; 37: 249-54.
DOI: https://doi.org/10.1159/000347219
Geldenhuys L, Nicholson P, Sinha N, Dini A, Doucette S, Alfaadhel T, et al. Percutaneous native renal biopsy adequacy: a successful interdepartmental quality improvement activity. Can J Kidney Health Dis 2015; 2: 8.
DOI: https://doi.org/10.1186/s40697-015-0043-z
Katsuyama E, Miyawaki Y, Sada KE, Asano Y, Hayashi K, Yamamura Y, et al. Association of explanatory histological findings and urinary protein and serum creatinine levels at renal biopsy in lupus nephritis: a cross-sectional study. BMC Nephrol 2020; 21: 208.
DOI: https://doi.org/10.1186/s12882-020-01868-9
Haridasan S, Rathi M, Sharma A, Nada R, Kumar S, Ramachandran R, et al. Outcome of biopsy-proven lupus nephritis with low glomerular filtration rate at presentation. Int J Rheum Dis 2020; 23: 1201-9.
DOI: https://doi.org/10.1111/1756-185X.13907
Moroni G, Ponticelli C. Secondary membranous nephropathy. A narrative review. Front Med 2020; 7: 611317.
DOI: https://doi.org/10.3389/fmed.2020.611317
How to Cite
Deniz, R., Güner, N., Ekmen, Ş.A., Mutlu, İ.N., Özgür, D., Karaalioğlu, B., … Bes, C. (2023). Discrepancies between clinical and pathological findings seen at renal biopsy in rheumatological diseases. Reumatismo, 75(3). https://doi.org/10.4081/reumatismo.2023.1586
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