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Bekassy Z, Lindström M, Rosenblad T, Aradóttir S, Sartz L, Tullus K. Is kidney biopsy necessary in children with idiopathic nephrotic syndrome? Acta Paediatr 2023; 112:2611-2618. [PMID: 37642221 DOI: 10.1111/apa.16959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
AIM To investigate the need, in the Northern European setting, to perform kidney biopsy in children with steroid-sensitive nephrotic syndrome. METHODS In this retrospective study 124 individuals aged 1-18 years with idiopathic nephrotic syndrome, followed in the paediatric hospitals in southern Sweden from 1999 to 2018, were included. RESULTS There was a median follow-up time of 6.5 (0.2-16.8) years. The majority (92%) of children were steroid-sensitive and of them, 60.5% were frequently relapsing or steroid-dependent. Microscopic haematuria was found at onset in 81.1% and hypertension in 8.7%. At least one kidney biopsy was performed in 93 (75%). The most common indication was a steroid-dependent or relapsing course (58.4%). One of 79 steroid-sensitive children had another histological diagnosis than minimal change nephropathy 1.3%, 95% confidence interval (0.002, 0.068). Bleeding occurred after eight biopsies (6.6%). Twenty individuals (30.7%) were transferred to adult units, 18 still on immunosuppression. CONCLUSION We have in our cohort of unselected children with idiopathic nephrotic syndrome confirmed that a kidney biopsy rarely gives important medical information in steroid-sensitive children without any other complicating factor and that the liberal policy of kidney biopsy in the Nordic countries safely can be changed.
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Affiliation(s)
- Zivile Bekassy
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Martin Lindström
- Department of Clinical Sciences, Division of Pathology, Lund University, Lund, Sweden
| | - Therese Rosenblad
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Sunna Aradóttir
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lisa Sartz
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Section for Paediatric Nephrology, Skåne University Hospital, Lund, Sweden
| | - Kjell Tullus
- Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK
- Division of Paediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Zhan T, Lou A. Comparison of outcomes of an 18-gauge vs 16-gauge ultrasound-guided percutaneous renal biopsy: a systematic review and meta-analysis. Ren Fail 2023; 45:2257806. [PMID: 37724553 PMCID: PMC10512899 DOI: 10.1080/0886022x.2023.2257806] [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: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023] Open
Abstract
Background: The needle size used in ultrasound-guided percutaneous renal biopsy significantly influences the efficacy and safety of the procedure. The aim of this study is to perform a comparative analysis of 16-gauge and 18-gauge needles for ultrasound-guided percutaneous renal biopsy.Methods: This systematic review and meta-analysis included randomized controlled trials and observational studies that compared the outcomes of using 18-gauge and 16-gauge needles for ultrasound-guided percutaneous renal biopsy. The efficacy parameters included a mean number of glomeruli obtained and the number of passes, while the safety parameters focused on the rate of complications. We searched multiple databases, assessed the risk of bias, and conducted statistical analyses using appropriate models.Results: Fifteen studies were included. Compared to the 18-gauge needle, the use of 16-gauge needle for the biopsy was associated with the significantly higher mean number of glomeruli obtained (pooled SMD 0.61, 95%CI: 0.32 to 0.89; p < 0.001) and fewer required passes (pooled SMD -0.57, 95%CI: -0.97 to -0.18; p = 0.004). No significant difference was observed in the individual safety parameters, including pain, hematuria, need for blood transfusion, major, and minor complications. However, the use of 16-gauge needle was associated with higher odds of total complications (pooled OR 1.57, 95%CI: 1.16 to 2.13; p = 0.004).Conclusion: While the 16-gauge needle for ultrasound-guided percutaneous renal biopsy offers improved efficacy in terms of a higher mean number of glomeruli and fewer required passes, it is associated with higher total complications. A judicious needle size selection that would consider patient-specific factors and risk-benefit ratio, is crucial for optimizing patient outcomes.
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Affiliation(s)
- Tingting Zhan
- Department of Ultrasound, The Second People’s Hospital of Lishui, Lishui, Zhejiang, China
| | - Ali Lou
- Department of Ultrasound, The Second People’s Hospital of Lishui, Lishui, Zhejiang, China
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Pilania RK, Venkatesh GV, Nada R, Vignesh P, Jindal AK, Suri D, Tiewsoh K. Renal Biopsy in Children-Effect on Treatment Decisions: A Single-Center Experience. Indian J Pediatr 2021; 88:1036-1039. [PMID: 33847911 DOI: 10.1007/s12098-021-03721-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Renal biopsy is an important diagnostic tool, though invasive and carries risks involved with sedation. The authors wanted to compare suspect histopathological diagnosis with final diagnosis and find out impact of biopsy findings on treatment. They retrospectively analyzed 108 patients. Details of patients, diagnosis, treatment and complications due to kidney biopsy were documented. Statistical analysis was done using SPSS version 20.0 (IBM, NY). Indications of 108 children (69 boys, 39 girls) undergoing renal biopsy were steroid-resistant nephrotic syndrome (35.1%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (12%), nephrotic range proteinuria with atypical features (16.7%), lupus nephritis (13%), and acute kidney injury (AKI) stage 3 (17.6%). Suspect and histopathological diagnoses were similar in 53% cases with agreement factor of 0.462. Treatment changed in 28.7%. Renal biopsy made substantial impact in patients with nephrotic range proteinuria with atypical features (55.6%) and AKI stage 3 (52.6%). One (0.9%) had developed gross hematuria, which resolved spontaneously.
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Affiliation(s)
- Rakesh Kumar Pilania
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - G V Venkatesh
- Pediatric Nephrology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Kumar Jindal
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Karalanglin Tiewsoh
- Pediatric Nephrology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Roebuck DJ, McLaren CA. Pediatric interventional radiology - does it add value? Pediatr Radiol 2021; 51:570-573. [PMID: 33743040 DOI: 10.1007/s00247-020-04935-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 01/29/2023]
Abstract
Although attempts have been made to show that pediatric interventional radiology adds value in children's hospitals, none has been particularly persuasive. An analysis of individual procedures would seem to be the most scientific approach, but there are numerous problems, including the effects that different health care systems have on clinical practice and the difficulty of generalizing the results of a single-center study to other hospitals, even within the same type of health care system. It is unsurprising that there are no published randomized controlled trials comparing both the costs and outcomes of specific pediatric interventional radiology procedures with surgical alternatives, and in fact these may not be feasible. There is only anecdotal evidence of the value of pediatric interventional radiology in multidisciplinary teams in children's hospitals. Currently, the best justification may be the counterfactual: demonstrating what can go wrong if pediatric interventional radiology expertise is not available.
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Affiliation(s)
- Derek J Roebuck
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia. .,Division of Paediatrics, Medical School, University of Western Australia, Crawley, Australia.
| | - Clare A McLaren
- Department of Medical Imaging, Perth Children's Hospital, Locked Bag 2010, Nedlands, 6009, Australia.,School of Molecular and Life Sciences, Curtin University, Bentley, Australia
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Nazario M, Nicoara O, Becton L, Self S, Hill J, Mack E, Evans M, Twombley K. Safety and utility of surveillance biopsies in pediatric kidney transplant patients. Pediatr Transplant 2018; 22:e13178. [PMID: 29582530 DOI: 10.1111/petr.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 01/04/2023]
Abstract
There is currently no way to diagnose a rejection before a change in serum creatinine. This had led some to start doing SB, but little data exist on the utility and safety of SB in pediatric patients. There is also little known on practice patterns of pediatric nephrologists. A retrospective review of pediatric kidney transplant SB between January 2013 and January 2017 at a single center was performed. A survey went to the PedNeph email list. There were 47 SB; 15 at 6 months, 12 at 1 year, 13 at 2 years, and 7 at 3 years. There were 3 minor (1 gross hematuria and 2 hematomas) and no major complications. On 6-month SB, 1 had SC 1A ACR (6.7%) with no BR ACR. On the 12-month SB, there were 5 with SCBR ACR (41.7%) and 1 with SC AMR (8.3%). On the 2-year SB, there were 4 that had SCBR ACR (30.8%), and 1 with SC AMR (7.7%). On the 3-year SB, 1 had chronic transplant glomerulitis (14.3%). The survey showed that 34.3% of pediatric nephrologists perform SB. SB can be performed safely. By early identification of histological lesions, SB gives us an opportunity for individualized immunosuppressive regimens that may prevent chronic allograft dysfunction and improve long-term graft outcome.
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Affiliation(s)
- Maritere Nazario
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Oana Nicoara
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren Becton
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Sally Self
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Jeanne Hill
- Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Mack
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Melissa Evans
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Twombley
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
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