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Wang J, Zhou C, Lu L, Wang S, Zhang Q, Liu Z. Differentiated metabolomic profiling reveals plasma amino acid signatures for primary glomerular disease. Amino Acids 2024; 56:46. [PMID: 39019998 PMCID: PMC11255010 DOI: 10.1007/s00726-024-03407-4] [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: 05/28/2024] [Accepted: 07/13/2024] [Indexed: 07/19/2024]
Abstract
Primary glomerular disease (PGD) is an idiopathic cause of renal glomerular lesions that is characterized by proteinuria or hematuria and is the leading cause of chronic kidney disease (CKD). The identification of circulating biomarkers for the diagnosis of PGD requires a thorough understanding of the metabolic defects involved. In this study, ultra-high performance liquid chromatography-tandem mass spectrometry was performed to characterize the amino acid (AA) profiles of patients with pathologically diagnosed PGD, including minimal change disease (MCD), focal segmental glomerular sclerosis (FSGS), membranous nephropathy, and immunoglobulin A nephropathy. The plasma concentrations of asparagine and ornithine were low, and that of aspartic acid was high, in patients with all the pathologic types of PGD, compared to healthy controls. Two distinct diagnostic models were generated using the differential plasma AA profiles using logistic regression and receiver operating characteristic analyses, with areas under the curves of 1.000 and accuracies up to 100.0% in patients with MCD and FSGS. In conclusion, the progression of PGD is associated with alterations in AA profiles, The present findings provide a theoretical basis for the use of AAs as a non-invasive, real-time, rapid, and simple biomarker for the diagnosis of various pathologic types of PGD.
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Affiliation(s)
- Jiao Wang
- Department of geriatric endocrinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450052, P. R. China
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450052, P. R. China
| | - Chunyu Zhou
- Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450052, P. R. China
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450052, P. R. China
| | - Liqian Lu
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450052, P. R. China
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450052, P. R. China
| | - Shoujun Wang
- Department of endocrinology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China
| | - Qing Zhang
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450052, P. R. China.
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450052, P. R. China.
| | - Zhangsuo Liu
- Blood Purification Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China.
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China.
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450052, P. R. China.
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450052, P. R. China.
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Wang M, Yang J, Fang X, Lin W, Yang Y. Membranous nephropathy: pathogenesis and treatments. MedComm (Beijing) 2024; 5:e614. [PMID: 38948114 PMCID: PMC11214595 DOI: 10.1002/mco2.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 07/02/2024] Open
Abstract
Membranous nephropathy (MN), an autoimmune disease, can manifest at any age and is among the most common causes of nephrotic syndrome in adults. In 80% of cases, the specific etiology of MN remains unknown, while the remaining cases are linked to drug use or underlying conditions like systemic lupus erythematosus, hepatitis B virus, or malignancy. Although about one-third of patients may achieve spontaneous complete or partial remission with conservative management, another third face an elevated risk of disease progression, potentially leading to end-stage renal disease within 10 years. The identification of phospholipase A2 receptor as the primary target antigen in MN has brought about a significant shift in disease management and monitoring. This review explores recent advancements in the pathophysiology of MN, encompassing pathogenesis, clinical presentations, diagnostic criteria, treatment options, and prognosis, with a focus on emerging developments in pathogenesis and therapeutic strategies aimed at halting disease progression. By synthesizing the latest research findings and clinical insights, this review seeks to contribute to the ongoing efforts to enhance our understanding and management of this challenging autoimmune disorder.
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Affiliation(s)
- Mengqiong Wang
- Department of NephrologyCenter for Regeneration and Aging MedicineThe Fourth Affiliated Hospital of School of Medicineand International School of Medicine, International Institutes of MedicineZhejiang UniversityYiwuChina
| | - Jingjuan Yang
- Department of NephrologyCenter for Regeneration and Aging MedicineThe Fourth Affiliated Hospital of School of Medicineand International School of Medicine, International Institutes of MedicineZhejiang UniversityYiwuChina
| | - Xin Fang
- Department of NephrologyCenter for Regeneration and Aging MedicineThe Fourth Affiliated Hospital of School of Medicineand International School of Medicine, International Institutes of MedicineZhejiang UniversityYiwuChina
| | - Weiqiang Lin
- Department of NephrologyCenter for Regeneration and Aging MedicineThe Fourth Affiliated Hospital of School of Medicineand International School of Medicine, International Institutes of MedicineZhejiang UniversityYiwuChina
| | - Yi Yang
- Department of NephrologyCenter for Regeneration and Aging MedicineThe Fourth Affiliated Hospital of School of Medicineand International School of Medicine, International Institutes of MedicineZhejiang UniversityYiwuChina
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Wang J, Zhou C, Zhang Q, Liu Z. Metabolomic profiling of amino acids study reveals a distinct diagnostic model for diabetic kidney disease. Amino Acids 2023; 55:1563-1572. [PMID: 37736814 PMCID: PMC10689543 DOI: 10.1007/s00726-023-03330-0] [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: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
Diabetic kidney disease (DKD), a highly prevalent complication of diabetes mellitus, is a major cause of mortality in patients. However, identifying circulatory markers to diagnose DKD requires a thorough understanding of the metabolic mechanisms of DKD. In this study, we performed ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) to reveal altered metabolic profiles of amino acids (AAs) in patients with DKD. We found decreased plasma levels of histidine and valine, increased urine levels of proline, decreased urine levels of histidine and valine, and increased saliva levels of arginine in patients with DKD compared with the levels in patients with type 2 diabetes mellitus (T2DM) and in healthy controls. Our analyses of the key metabolites and metabolic enzymes involved in histidine and valine metabolism indicated that the AAs level alterations may be due to enhanced carnosine hydrolysis, decreased degradation of homocarnosine and anserine, enhanced histidine methylation, and systemic enhancement of valine metabolism in patients with DKD. Notably, we generated a distinct diagnostic model with an AUC of 0.957 and an accuracy up to 92.2% on the basis of the AA profiles in plasma, urine and saliva differing in patients with DKD using logistic regression and receiver operating characteristic analyses. In conclusion, our results suggest that altered AA metabolic profiles are associated with the progression of DKD. Our DKD diagnostic model on the basis of AA levels in plasma, urine, and saliva may provide a theoretical basis for innovative strategies to diagnose DKD that may replace cumbersome kidney biopsies.
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Affiliation(s)
- Jiao Wang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450000, China
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450000, China
| | - Chunyu Zhou
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450000, China
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450000, China
- Blood Purification Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Qing Zhang
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450000, China.
| | - Zhangsuo Liu
- Research Institute of Nephrology, Zhengzhou University, Zhengzhou, 450000, China.
- Henan Province Research Center For Kidney Disease, Zhengzhou, 450000, China.
- Blood Purification Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
- Traditional Chinese Medicine Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Gigante A, Lai S, Pellicano C, De Marco O, Rosato E, Giannakakis K, D'Amati G, Muscaritoli M, Ferri C, Cianci R. Nephroangiosclerosis not related to hypertension: A matter to resolve in the era of precision medicine. J Hum Hypertens 2023; 37:931-935. [PMID: 36577802 DOI: 10.1038/s41371-022-00796-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
Nephroangiosclerosis (NAS) associated with hypertension continues to be one of the most causes of end stage renal diseases in Europe, but it is still poorly studied. The prevalence of NAS shows a large variability due to the difference among different countries regarding clinical presentations and the indication to perform renal biopsy. The study aimed to investigate the prevalence in biopsy-proven NAS patients and the association with hypertension and/or glomerulonephritis (GN). We included all patients referred for native kidney biopsy between 2003-2021 at Policlinic Umberto I of Rome. From 837 patients who underwent renal biopsy NAS was diagnosed in 80 (10.5%) patients. Serum creatinine was significantly higher in NAS [2.07 mg/dl (IQR 1.13-5.2) vs 1.1 mg/dl (IQR 0.8-2.1), p < 0.001] compared to patients without NAS. Hypertension was present in 45% of patients with NAS. Proteinuria was significantly higher in patients with mild-moderate NAS compared to patients with severe NAS [2.6 g/die (IQR 1-5) vs 1.5 g/die (IQR 0.86-2.3), p < 0.05]. We did not find any significant differences, including histological features, between NAS patients with hypertension and NAS patients without hypertension (p > 0.05). IgA nephropathy, focal segmental glomerulosclerosis and membranous nephropathy were the most frequent GN associated. In conclusion no specific histological features are reported in NAS with and without hypertension. More information on the phenotype, clinical presentation and markers are needed to improve histological and clinical diagnostics.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Oriana De Marco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Konstantinos Giannakakis
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Sapienza, Italy
| | - Giulia D'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Sapienza, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy
| | - Claudio Ferri
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, Internal Medicine and Nephrology Unit, ESH Excellence Center for Hypertension and Cardiovascular Prevention, San Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Sapienza, Italy.
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Xu LL, Zhang D, Weng HY, Wang LZ, Chen RY, Chen G, Shi SF, Liu LJ, Zhong XH, Hong SD, Duan LX, Lv JC, Zhou XJ, Zhang H. Machine learning in predicting T-score in the Oxford classification system of IgA nephropathy. Front Immunol 2023; 14:1224631. [PMID: 37600788 PMCID: PMC10437057 DOI: 10.3389/fimmu.2023.1224631] [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: 05/18/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Background Immunoglobulin A nephropathy (IgAN) is one of the leading causes of end-stage kidney disease (ESKD). Many studies have shown the significance of pathological manifestations in predicting the outcome of patients with IgAN, especially T-score of Oxford classification. Evaluating prognosis may be hampered in patients without renal biopsy. Methods A baseline dataset of 690 patients with IgAN and an independent follow-up dataset of 1,168 patients were used as training and testing sets to develop the pathology T-score prediction (T pre) model based on the stacking algorithm, respectively. The 5-year ESKD prediction models using clinical variables (base model), clinical variables and real pathological T-score (base model plus T bio), and clinical variables and T pre (base model plus T pre) were developed separately in 1,168 patients with regular follow-up to evaluate whether T pre could assist in predicting ESKD. In addition, an external validation set consisting of 355 patients was used to evaluate the performance of the 5-year ESKD prediction model using T pre. Results The features selected by AUCRF for the T pre model included age, systolic arterial pressure, diastolic arterial pressure, proteinuria, eGFR, serum IgA, and uric acid. The AUC of the T pre was 0.82 (95% CI: 0.80-0.85) in an independent testing set. For the 5-year ESKD prediction model, the AUC of the base model was 0.86 (95% CI: 0.75-0.97). When the T bio was added to the base model, there was an increase in AUC [from 0.86 (95% CI: 0.75-0.97) to 0.92 (95% CI: 0.85-0.98); P = 0.03]. There was no difference in AUC between the base model plus T pre and the base model plus T bio [0.90 (95% CI: 0.82-0.99) vs. 0.92 (95% CI: 0.85-0.98), P = 0.52]. The AUC of the 5-year ESKD prediction model using T pre was 0.93 (95% CI: 0.87-0.99) in the external validation set. Conclusion A pathology T-score prediction (T pre) model using routine clinical characteristics was constructed, which could predict the pathological severity and assist clinicians to predict the prognosis of IgAN patients lacking kidney pathology scores.
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Affiliation(s)
- Lin-Lin Xu
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Di Zhang
- Hunan Provincial Key Lab on Bioinformatics, School of Computer Science and Engineering, Central South University, Changsha, China
- WeGene, Shenzhen Zaozhidao Technology, Shenzhen, China
- Shenzhen WeGene Clinical Laboratory, Shenzhen, China
| | - Hao-Yi Weng
- Hunan Provincial Key Lab on Bioinformatics, School of Computer Science and Engineering, Central South University, Changsha, China
- WeGene, Shenzhen Zaozhidao Technology, Shenzhen, China
- Shenzhen WeGene Clinical Laboratory, Shenzhen, China
| | - Li-Zhong Wang
- Hunan Provincial Key Lab on Bioinformatics, School of Computer Science and Engineering, Central South University, Changsha, China
- WeGene, Shenzhen Zaozhidao Technology, Shenzhen, China
- Shenzhen WeGene Clinical Laboratory, Shenzhen, China
| | - Ruo-Yan Chen
- Hunan Provincial Key Lab on Bioinformatics, School of Computer Science and Engineering, Central South University, Changsha, China
- WeGene, Shenzhen Zaozhidao Technology, Shenzhen, China
- Shenzhen WeGene Clinical Laboratory, Shenzhen, China
| | - Gang Chen
- Hunan Provincial Key Lab on Bioinformatics, School of Computer Science and Engineering, Central South University, Changsha, China
- WeGene, Shenzhen Zaozhidao Technology, Shenzhen, China
- Shenzhen WeGene Clinical Laboratory, Shenzhen, China
| | - Su-Fang Shi
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Li-Jun Liu
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Xu-Hui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Shen-Da Hong
- Institute of Medical Technology, Health Science Center of Peking University, Beijing, China
| | - Li-Xin Duan
- The Sichuan Provincial Key Laboratory for Human Disease Gene Study, Research Unit for Blindness Prevention of Chinese Academy of Medical Sciences (2019RU026), Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ji-Cheng Lv
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Xu-Jie Zhou
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Kidney Genetics Center, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China
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Oyama M, Tamura H, Hidaka Y, Furuie K, Kuraoka S. Renal arteriovenous fistula discovered ~2 years after renal biopsy: A case report. Clin Case Rep 2023; 11:e7538. [PMID: 37334343 PMCID: PMC10276242 DOI: 10.1002/ccr3.7538] [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: 02/21/2023] [Revised: 05/09/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Key Clinical Message Although percutaneous renal biopsy is considered safe, this invasive procedure has complications such as renal arteriovenous fistula (RAVF). Even if complications such as RAVFs are not observed early after renal biopsy, considering the possibility of delayed renal hemorrhage, follow-up with ultrasound after renal biopsy even in asymptomatic cases could be important. Abstract Although percutaneous renal biopsy is considered safe, this invasive procedure can lead to complications such as renal arteriovenous fistula (RAVF). RAVF occurs when some arteries and veins communicate in the absence of capillaries in the renal hilum or renal parenchyma. It was previously thought to be relatively rare; however, with advances in imaging diagnostics, it is sometimes found asymptomatically. In addition, renal biopsy is the most common cause of acquired RAVF. In this case, RAVF was discovered 2 years after renal biopsy. Late-onset RAVF is scarce. This case highlights that even if complications such as RAVFs are not observed early after renal biopsy, considering the possibility of delayed RAVF, follow-up with ultrasound could be important.
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Affiliation(s)
- Maki Oyama
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Hiroshi Tamura
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Yuko Hidaka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Keishiro Furuie
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | - Shohei Kuraoka
- Department of Pediatrics, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
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Narkhede A, Yadav AK, Gupta A. N-Butyl Cyanoacrylate Embolization in Management of Iatrogenic Renal Hemorrhages—Single-Center Study Evaluating Safety and Efficacy. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1732795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Objectives: The aim of the study was to evaluate the efficacy of endovascular N-butyl cyanoacrylate (NBCA)/glue embolization alone in the management of iatrogenic renal injuries and its effect on renal function.
Methods: Thirty-one patients who presented with significant iatrogenic renal injuries over a time period ranging from June 2013 to June 2018 were evaluated. The clinical features, lab parameters, and imaging findings were recorded. The embolizing agent used was exclusively NBCA. The success rate was calculated along with the effect of glue embolization on kidney in the form of postembolization ischemia and change in the serum creatinine levels in immediate pre- and postembolization period. The time between the iatrogenic injury and angioembolization as well as the time from angioembolization to discharge was also calculated. Recurrence was evaluated at 1 and 6 months follow-up.
Results: NBCA embolization showed 100% technical and clinical success in our study and no recurrence was noted at follow-up. Glue was also able to achieve complete embolization in patients with coagulopathy (n = 14, 45.1%). Percentage area deficit of normal renal blush in the postembolization check angiogram varied from 4 to 15.7% with a mean deficit of 7.65%. No significant difference in the serum creatinine was noted in immediate postembolization period.
Conclusions: We conclude that glue is an effective embolizing agent for management of iatrogenic renal injuries even in coagulopathy patients with minimal area of parenchymal loss, no significant effect on renal functions, and no recurrence on 6 months follow-up.
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Affiliation(s)
- Amey Narkhede
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ajit Kumar Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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Nugroho TSA, Safriadi F, Noegroho BS. The role of intraoperative kidney mucosal biopsy on screening of squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820936885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Renal pelvic squamous cell carcinoma is a very rare tumor, with a prevalence <1% of all urinary tract tumors, about 0.5–8% of all kidney tumors, and the average age is 50–70 years. Although the incidence of renal squamous cell carcinoma is less common than renal cell carcinoma and renal transitional cell carcinoma, due to its more aggressive nature renal squamous cell carcinoma is often found intraoperatively and is already in an advanced stage or metastasis. The relevant medical history of squamous cell carcinoma is pyelonephritis, chronic nephrolithiasis, and a history of kidney stone surgery. Data which was obtained from previous research at Hasan Sadikin Hospital, from January 2014–December 2017, found the incidence of renal squamous cell carcinoma from nephrectomy procedures was 6%. Methods: This study was a cross-sectional study with a correlative analytic study, samples were taken consecutively from biopsy of kidney mucosa intraoperatively in hospitalized patients with kidney stones with size larger than 20 mm at the Department of Urology, Hasan Sadikin Hospital Bandung, which performed open kidney surgery or percutaneous nephrolithotomy from January–May 2019. Results: The number of samples in this study were from 30 patients, consisting of 16 males and 14 females. Five patients underwent open kidney surgery and 25 patients underwent percutaneous nephrolithotomy surgery, with an average of age of 49.5±11.8 years and 63.3% of patients were aged from 40–60 years. In this study, one patient (3.3%) showed squamous cell carcinoma of the kidney, a 57-year-old male patient with a left staghorn kidney stone who underwent left percutaneous nephrolithotomy surgery. Conclusion: There is a benefit for intraoperative kidney mucosal biopsy as a screening for squamous cell carcinoma of the kidney in nephrolithiasis patients with stones larger than 20 mm. Level of evidence: 3
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Utsch B, Hoppe H, Dittrich K, Amann K, Gugger M, Tschumi S, Galiano M, Plank C, Rascher W, Schmid A, Uder M, Dötsch J. Transvascular kidney biopsy in adolescent patients-safe alternative to open procedures. Clin Kidney J 2020; 14:451-453. [PMID: 33564456 PMCID: PMC7857809 DOI: 10.1093/ckj/sfaa092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Boris Utsch
- Department of Pediatrics, University Hospital Giessen-Marburg, Giessen, Germany.,Department of Pediatrics, Pediatric Nephrology, Inselspital, University of Berne, Berne, Switzerland.,Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hanno Hoppe
- Department of Radiology, Inselspital, University of Berne, Berne, Germany
| | - Katalin Dittrich
- Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Pediatrics, Pediatric Nephrology, University Hospital, Leipzig, Germany
| | - Kerstin Amann
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mathias Gugger
- Department of Pathology, Inselspital, University of Berne, Berne, Germany
| | - Sibylle Tschumi
- Department of Pediatrics, Pediatric Nephrology, Inselspital, University of Berne, Berne, Switzerland
| | - Matthias Galiano
- Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Plank
- Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Wolfgang Rascher
- Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Axel Schmid
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jörg Dötsch
- Department of Pediatrics, Pediatric Nephrology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Pediatrics, University of Cologne, Cologne, Germany
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11
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Schorr M, Roshanov PS, Weir MA, House AA. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Can J Kidney Health Dis 2020; 7:2054358120923527. [PMID: 32547772 PMCID: PMC7251654 DOI: 10.1177/2054358120923527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives: The risk and timing of bleeding events following ultrasound-guided
percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: We performed a retrospective study of 617 consecutive adult patients who
underwent kidney biopsy between 2012 and 2017 at a tertiary academic
hospital in London, Canada. We assessed frequency and timing of minor (not
requiring intervention) and major (requiring blood transfusion, surgery, or
embolization) bleeds and developed a personalized risk calculator for
these. Results: Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]:
10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI:
8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI:
1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%)
and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three
of 79 events were identified immediately on post-procedure ultrasound (92.4%
of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor
event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients
(0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not
recognized immediately; both required blood transfusions only. There were no
deaths or nephrectomies. A risk calculator using age, body mass index,
platelet count, hemoglobin concentration, size of the target kidney, and
whether the kidney is native, or an allograft predicted minor (C-statistic,
0.70) and major bleeding (C-statistic, 0.83). Conclusions: This retrospective study of 617 patients who had percutaneous
ultrasound-guided renal biopsies supports the safety of short post-biopsy
monitoring for most patients. A risk calculator can further personalize
estimates of complication risk (http://perioperativerisk.com/kbrc).
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Affiliation(s)
- Melissa Schorr
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
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12
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Abstract
After more than 6 decades of clinical practice, the transplant community continues to research noninvasive biomarkers of solid organ injury to help improve patient care. In this review, we discuss the clinical usefulness of selective biomarkers and how they are processed at the laboratory. In addition, we organize these biomarkers based on specific aims and introduce innovative markers currently under investigation.
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Affiliation(s)
- John Choi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Albana Bano
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
| | - Jamil Azzi
- Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA.
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13
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Zhang S, Lin Y, Ge X, Liu G, Zhang J, Xu S, Wu G, Chen S, Xu J, Suo S. Multiparameter diffusion-weighted imaging for characterizing pathological patterns in lupus nephritis patients: A preliminary study. J Magn Reson Imaging 2019; 50:1075-1084. [PMID: 30659687 DOI: 10.1002/jmri.26657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Microstructural changes of lupus nephritis (LN) kidney such as inflammatory cell infiltration or fibrosis could influence water molecular movement or diffusion, which indicates that diffusion-weighted imaging (DWI) may become a valuable tool in evaluation of this disease. PURPOSE To explore whether multiparameter diffusion-weighted imaging (mDWI) could contribute to characterize pathological patterns in LN patients. STUDY TYPE Retrospective. POPULATION Twenty-two patients with LN. FIELD STRENGTH/SEQUENCE Multi-b value DWI was performed with a 3.0 T scanner. ASSESSMENT Apparent diffusion coefficient (ADC)m , perfusion-related diffusion coefficient (Df ), molecular diffusion coefficient (Ds ), perfusion fraction (f), ADCs , α, ADCk , and mean kurtosis (MK) were calculated by monoexponential, biexponential, stretched-exponential, and kurtosis models fits, respectively. STATISTICAL TESTS Independent sample t-test, Pearson analysis and receiver operating characteristic (ROC). RESULTS In the whole group, the activity index (AI) correlated significantly with alpha values in the medulla (rho = -0.54, P = 0.03). The chronicity index (CI) correlated significantly with Ds values in the medulla (rho = -0.61, P = 0.02). No significant association was found between any other diffusion parameter and histologic grade with all P > 0.05. For differentiating proliferative LN (Class III or IV) from Class V, the area under the ROC curve (AUC) of alpha in the medulla was 0.833 (P = 0.023). DATA CONCLUSION: mDWI might be used for the characterization of pathological patterns in LN patients. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:1075-1084.
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Affiliation(s)
- Shan Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Yanwei Lin
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Xin Ge
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Guiqin Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Shuaishuai Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Guangyu Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Sheng Chen
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
| | - Shiteng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Pudong, Shanghai, China
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14
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Comparing laparoscopic and percutaneous renal biopsy for diagnosing native kidney disease: A matched pair analysis. Prog Urol 2018; 29:95-100. [PMID: 30579758 DOI: 10.1016/j.purol.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Percutaneous renal biopsy is a well-established diagnostic procedure in patients with underlying medical renal disease. Aim of this study is to compare the adequacy of the biopsy material, the diagnostic yield, and the complication rates of the trans-peritoneal laparoscopic approach and the image-guided percutaneous approach to renal biopsy in the diagnosis of native kidney disease. METHODS We performed a matched-pair analysis matching 1:3 40 patients who underwent trans-peritoneal laparoscopic renal biopsy to 120 patients who underwent percutaneous renal biopsy in the same years. Patients were retrospectively analyzed. Differences in adequacy of biopsy material (i.e. number of glomeruli, continuous), diagnostic yield (categorical) and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 test. RESULTS Laparoscopic biopsy was associated with a higher number of harbored glomeruli (median 50, IQR 20-77) compared to the percutaneous approach (median 10, IQR 7-15), P<0.001. Adequate biopsies containing at least ten glomeruli were obtained in a significantly higher percentage of patients in the laparoscopic group versus the percutaneous group (92.5% vs. 57.1%, P<0.001). The laparoscopic approach was also associated with a significantly higher diagnostic yield than the percutaneous approach (82.5% vs. 63.5%, P=0.027). Patients who underwent laparoscopic biopsy had no perioperative or postoperative complications, resulting in a significantly lower complication rate than percutaneous biopsy (0% vs. 4%, P<0.001), particularly in the need for transfusion for post-procedure bleeding (0% vs. 1.8%, P<0.001). CONCLUSIONS In this retrospective matched-pair analysis comparing patients undergoing renal biopsy for medical kidney disease, trans-peritoneal laparoscopic renal biopsy was safer and more effective for the diagnosis of medical renal diseases compared to percutaneous renal biopsy. Prospective trials with a good follow-up are needed to define the best candidate for each approach. LEVEL OF EVIDENCE 4.
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15
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Ferrara D, Esposito F, Blasio R, Mamone R, Severino R, Di Serafino M, Pecoraro C, Zeccolini M. Role of color Doppler ultrasound in the early diagnosis of a major complication after percutaneous renal biopsy: two case reports. J Ultrasound 2018; 21:343-349. [PMID: 30311148 DOI: 10.1007/s40477-018-0326-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Percutaneous renal biopsy (PRB) is an important procedure in the diagnostic and prognostic evaluation of renal disorders. Despite the relative simplicity, it can be a possible cause of iatrogenic renovascular injury. We describe two cases of iatrogenic pseudoaneurysm, a major post-biopsy complication, in two pediatric patients with persistent micro- and macro-hematuria, promptly diagnosed using color Doppler ultrasound, confirmed with renal arteriography and treated with embolization.
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Affiliation(s)
- Dolores Ferrara
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy.
| | - Francesco Esposito
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
| | - Roberta Blasio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rosanna Mamone
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
| | - Rosa Severino
- Emergency Radiology Department, San Carlo Hospital, Potenza, Italy
| | | | - Carmine Pecoraro
- Nephrology and Urology Unit AORN Santobono-Pausilipon, Naples, Italy
| | - Massimo Zeccolini
- Radiology Department, Santobono-Pausilipon Children Hospital, Mario Fiore ST 6, Naples, Italy
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16
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Cunningham A, Benediktsson H, Muruve DA, Hildebrand AM, Ravani P. Trends in Biopsy-Based Diagnosis of Kidney Disease: A Population Study. Can J Kidney Health Dis 2018; 5:2054358118799690. [PMID: 30263130 PMCID: PMC6149029 DOI: 10.1177/2054358118799690] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
Background Kidney biopsy is considered the gold standard for diagnosis of renal disease. It is increasingly performed in cases of diagnostic uncertainty, including in patients with coexistent diabetes and hypertension, for which a presumptive clinical diagnosis can be made. Little is known about the incidence and distribution of biopsy-proven kidney diseases. Changes in the distribution of biopsy diagnoses over time may have significant implications for resource allocation and future research. Objective We studied the relative frequency of kidney diseases in Southern Alberta over the past 30 years, to determine whether the population-standardized annual biopsy rate and incidence of selected diagnostic categories have changed. We hypothesized an increasing incidence of renal biopsies and a growing proportion of nonglomerular diseases (eg, tubulointerstitial disorders) likely due to evolving indications for biopsy. Given the rise in obesity, diabetes, and aging population with chronic kidney disease (CKD), we anticipated a rise in nephroangiosclerosis and diabetic nephropathy over time. Design Retrospective population-based cohort study using the Biobank for the Molecular Classification of Kidney Disease (BMCKD). Setting Southern Alberta, Canada. Patients All patients who underwent renal biopsy between 1985 and 2015 in our database. Measurements We used descriptive and quantitative analysis to characterize demographics and biopsy-based diagnoses. Methods We conducted a retrospective population-based cohort study to analyze all consecutive patients who underwent at least one kidney biopsy over a 30-year period in Southern Alberta (1985-2015). We considered the first adequate biopsy. We described the annual standardized incidence of biopsy-proven kidney diseases over time and summarized associated patient characteristics. We assumed a Poisson distribution for biopsy counts and used provincial demographic information to standardize rates. Results During the study period, 6434 people (58% male; mean age: 47.9 years) underwent a kidney biopsy. The population-standardized annual biopsy rate increased from 10.8 biopsies per 100 000 person-years in the first 5 years of the study (1985-1989) to 18.2 biopsies per 100 000 person-years in the last 5 years (2010-2014). The mean age at the time of biopsy increased from 42.5 years (1985-1989) to 51.4 years (2010-2014). Glomerular diseases remained the most prevalent histopathological group, with a growing representation of diabetic kidney disease from 3.69% to 16.18%, and a relative decrease in the proportion of other glomerular diseases from 72.32% to 62.92% of glomerular diagnoses. Tubulointerstitial diseases increased from 5.87% to 7.36% of total diagnoses. Limitations Classification schemes have changed over time, so recently recognized conditions may have been misclassified in earlier data. There was a changing group of pathologists and nephrologists over this period. Variations in interpretation and application of biopsy indications by physician may influence recorded prevalence of certain diagnoses. We do not yet have complete information on indications or patient outcomes linked to the database. Conclusions In Southern Alberta, kidney biopsy is being utilized more frequently and in older people. Diabetic nephropathy is increasingly diagnosed, which may reflect either or both changes in the prevalence of causative factors and local biopsy practices.
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Affiliation(s)
| | | | | | | | - Pietro Ravani
- Department of Medicine, University of Calgary, AB, Canada
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17
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Whittier WL, Gashti C, Saltzberg S, Korbet S. Comparison of native and transplant kidney biopsies: diagnostic yield and complications. Clin Kidney J 2018; 11:616-622. [PMID: 30289130 PMCID: PMC6165758 DOI: 10.1093/ckj/sfy051] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/18/2018] [Indexed: 01/20/2023] Open
Abstract
Background The safety and adequacy are established for the native percutaneous renal biopsy (PRB) but no prospective studies exist that directly compare these with transplant PRB. Methods From 1995 to 2015, 1705 adults underwent percutaneous native [native renal biopsy (NRB)] or transplant renal biopsy (TRB) by the Nephrology service. Real-time ultrasound and automated biopsy needles (NRB, 14 or 16 gauge; TRB, 16 gauge) were used. Patients were observed for 24 h (NRB) or 8 h (TRB) post-procedure. Adequacy was defined as tissue required for diagnosis plus glomerular yield. Complications were defined as those resulting in the need for an intervention, such as surgery, interventional radiologic procedure, readmission, blood transfusion and death. Data were collected prospectively in all biopsies. Results At the time of biopsy, NRB patients were younger (mean ± SD, 47 ± 17 versus 50 ± 14 years, P < 0.0001) and more often female (62 versus 48%, P < 0.0001) compared with TRB. A fellow supervised by an attending performed the procedure in 91% of NRB compared with 63% of TRB (P < 0.0001). TRB patients were more hypertensive [systolic blood pressure (SBP) 140 ± 22 versus 133 ± 18 mmHg, P < 0.0001] and had a higher serum creatinine (3.1 ± 1.8 versus 2.3 ± 2.2 mg/dL, P < 0.0001), activated partial thromboplastin time (28 ± 4.3 versus 27 ± 5 s, P < 0.0001) as well as lower hemoglobin (Hgb) (11.2 ± 1.8 versus 11.7 ± 2.1 g/dL, P < 0.0001) compared with NRB. Adequate tissue for diagnosis was obtained in > 99% of NRB and TRB (P = 0.71). Compared with TRB, NRB had a greater drop in Hgb after the biopsy (0.97 ± 1.1 versus 0.73 ± 1.3 g/dL, P < 0.0001), a higher complication rate (6.5 versus 3.9%, P = 0.02) and higher transfusion rate (5.2 versus 3.3%, P = 0.045). There was one death in each group attributed to the biopsy. Conclusions Although death is equally rare, the complication rate is higher in NRB compared with TRB despite TRB having more of the traditional risk factors for bleeding. Differences in technique, operator (fellow or attending) or needle gauge may explain this variability.
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Affiliation(s)
- William L Whittier
- Division of Nephrology, Rush University Medical Center, Chicago, IL, USA
| | - Casey Gashti
- Division of Nephrology, Rush University Medical Center, Chicago, IL, USA
| | - Samuel Saltzberg
- Division of Nephrology, Rush University Medical Center, Chicago, IL, USA
| | - Stephen Korbet
- Division of Nephrology, Rush University Medical Center, Chicago, IL, USA
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18
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Go DJ, Lee JY, Kang MJ, Lee EY, Lee EB, Yi EC, Song YW. Urinary vitamin D-binding protein, a novel biomarker for lupus nephritis, predicts the development of proteinuric flare. Lupus 2018; 27:1600-1615. [PMID: 29958502 DOI: 10.1177/0961203318778774] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lupus nephritis (LN) is a major complication of systemic lupus erythematosus (SLE). Conventional biomarkers for assessing renal disease activity are imperfect in predicting clinical outcomes associated with LN. The aim of this study is to identify urinary protein biomarkers that reliably reflect the disease activity or predict clinical outcomes. A quantitative proteomic analysis was performed to identify protein biomarker candidates that can differentiate between SLE patients with and without LN. Selected biomarker candidates were further verified by enzyme-linked immunosorbent assay using urine samples from a larger cohort of SLE patients ( n = 121) to investigate their predictive values for LN activity measure. Furthermore, the association between urinary levels of a selected panel of potential biomarkers and prognosis of LN was assessed with a four-year follow-up study of renal outcomes. Urinary vitamin D-binding protein (VDBP), transthyretin (TTR), retinol binding protein 4 (RBP4), and prostaglandin D synthase (PTGDS) were significantly elevated in SLE patients with LN, especially in patients with active LN ( n = 21). Among them, VDBP well correlated with severity of proteinuria (rho = 0.661, p < 0.001) and renal SLE Disease Activity Index (renal SLEDAI) (rho = 0.520, p < 0.001). In the four-year follow-up, VDBP was a significant risk factor (hazard ratio 9.627, 95% confidence interval 1.698 to 54.571, p = 0.011) for the development of proteinuric flare in SLE patients without proteinuria ( n = 100) after adjustments for multiple confounders. Urinary VDBP correlated with proteinuria and renal SLEDAI, and predicted the development of proteinuria.
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Affiliation(s)
- D J Go
- 1 Division of Rheumatology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.,2 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - J Y Lee
- 2 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - M J Kang
- 2 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - E Y Lee
- 3 Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - E B Lee
- 3 Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - E C Yi
- 2 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - Y W Song
- 2 Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea.,3 Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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19
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Bashir S, Mukund A, Syed RF, Nayak SL, Rastogi A, Sarin SK. Combined Fluoroscopy and Ultrasound-Guided Transjugular Kidney Biopsy in Cirrhotic Patients. J Vasc Interv Radiol 2018; 29:696-703. [DOI: 10.1016/j.jvir.2017.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 10/17/2022] Open
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20
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Affiliation(s)
- R. Sam
- Cook County Hospital, Chicago, IL, USA
| | - T. S. Ing
- Veterans Affairs Hospital, Hines, IL, USA
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21
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Nagata H, Sato M, Ogura M, Yoshikawa T, Yamamoto K, Matsumura S, Kano Y, Saida K, Sako M, Kamei K, Yoshioka T, Ogata K, Ito S, Ishikura K. Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome. Nephrology (Carlton) 2017; 23:592-596. [PMID: 28976051 DOI: 10.1111/nep.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
Children with systemic lupus erythematosus (SLE) generally undergo a pretreatment kidney biopsy. However, some of these patients, especially those with antiphospholipid syndrome (APS), may experience serious coagulopathic complications. We report herein two cases of paediatric SLE with APS in which, despite normal blood test results, the disparate coagulopathic complications of haemorrhage and embolism developed following a kidney biopsy. Case 1 was, an 8-year-old male in whom, primary APS was initially diagnosed. Fourteen months later SLE was diagnosed. Based on a percutaneous kidney biopsy, International Society of Nephrology and the Renal Pathology Society (ISN/RPS) class III-A lupus nephritis was histologically diagnosed. On post-biopsy Day 9, a giant haematoma in the fascia of the left kidney developed and was accompanied by changes in the vital signs. Case 2, a 13-year-old male, initially received the diagnosis of SLE with APS and underwent two courses of pulse methylprednisolone therapy. His coagulation abnormalities improved, and a percutaneous needle kidney biopsy was performed, leading to the histological diagnosis of ISN/RPS class III-A lupus nephritis. Furthermore, thrombotic microangiopathy was also detected in the renal histopathology. On post biopsy Day 6, the patient experienced right leg pain. A contrast CT and lower extremity ultrasonography detected a massive deep vein thrombosis and partial left pulmonary artery thrombosis. A kidney biopsy in children with SLE and APS can cause lethal coagulopathic complications, and the risks to such patients should be weighed carefully before the procedure is performed.
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Affiliation(s)
- Hiroko Nagata
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takahisa Yoshikawa
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kazuna Yamamoto
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Sohshi Matsumura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuji Kano
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Ken Saida
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ogata
- Department, of Pathology, Federation of National Public Service Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kenji Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
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22
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Shamshirgar F, Bagheri SM. Percutaneous ultrasound-guided renal biopsy; A comparison of axial vs. sagittal probe location. ACTA ACUST UNITED AC 2017; 55:96-102. [PMID: 28186959 DOI: 10.1515/rjim-2017-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Renal biopsy is an important method for diagnosis of renal parenchymal abnormalities. Here, we compare the effectiveness and complications of percutaneous ultrasound-guided renal biopsy using axial vs. sagittal probe locations. METHODS In a cross-sectional survey, in 2012, patients with a nephrologist order were biopsied by a radiology resident. Renal biopsy was done on 15 patients using axial (A group) and the same number of biopsies done with sagittal probe location (S group). The two groups were compared in term of the yields and complications of each method. RESULTS In the A group, the ratio of glomeruli gathered to the number of obtained samples was significantly higher than in the S group. Nine patients in the A group (60%) required only two samplings, whereas 66.7% in the S group required more than two attempts. Microscopic hematuria was more common in the A; conversely, gross hematuria was less common in the A group. Meagre hematomas were more frequent in the S group. When compared with hemoglobin level before biopsy, its level 24 hours after biopsy was similar within groups. CONCLUSION Our study shows that percutaneous ultrasound-guided renal biopsy using axial probe provides better yield with fewer efforts and fewer serious complications.
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23
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Mallat SG, Abou Arkoub R, El Achkar B, Saade C, El-Merhi F. Renal pseudoaneurysm formation post allograft biopsy: a case report. BJR Case Rep 2017; 3:20150502. [PMID: 30363297 PMCID: PMC6159256 DOI: 10.1259/bjrcr.20150502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/04/2016] [Accepted: 11/15/2016] [Indexed: 11/21/2022] Open
Abstract
Renal pseudoaneurysm (PSA) is a rare complication post kidney transplant biopsy that accounts for less than 1% of allograft dysfunction. Imaging guidelines in the diagnosis of renal PSA have not yet been developed owing to the low occurrence and limited data availability. However, contrast-enhanced CT and magnetic resonance angiography (MRA) are the preferred modalities in detecting PSA owing to the high contrast and spatial resolution. However, magnetic resonance angiography is preferred since non-contrast imaging techniques can see blood flow patterns in renal PSA without the use of contrast media that may alter renal function. We present a rare complication in a 48-year-old male receiving a living related kidney transplant and found to have renal PSA post allograft biopsy. We review the clinical features, imaging and treatment outcome with the developed PSA in the transplanted kidney post allograft biopsy.
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Affiliation(s)
- Samir G Mallat
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Abou Arkoub
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassam El Achkar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Saade
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi El-Merhi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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24
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Rathod KR, Popat BA, Pandey A, Jamale TE, Hase NK, Deshmukh HL. Safety and effectiveness of transjugular renal biopsy: A single center study. Indian J Nephrol 2017; 27:118-123. [PMID: 28356663 PMCID: PMC5358151 DOI: 10.4103/0971-4065.196932] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although percutaneous renal biopsy remains the preferred method, there are several scenarios where transjugular approach is more suitable. We hereby describe our technique of transjugular renal biopsy (TJRB) and evaluate its safety and efficacy. We retrospectively collected data regarding indication for the transjugular route of biopsy, its complications, clinical and laboratory data, and adequacy of samples from patients' records. TJRB was performed when the patients were at a high risk for bleeding from percutaneous renal biopsy. Tissue samples were assessed by a pathologist for adequacy. All patients were followed up with ultrasonographic scan 3 h after the procedure and on day 3. Nine patients (age 41.5 ± 15.4 years; 8 men) underwent 9 TJRB procedures. The procedure was technically successful in all patients. Six patients (66.67%) had a platelet count of <50,000/mcL, 2 (33.3%) had an elevated International Normalized Ratio of more than 1.4, and 1 had both. 3.2 ± 0.4 cores were obtained, with median (range) number of glomeruli being ten (7-11). Adequate renal tissue sample was obtained in all the patients. Though capsular perforation developed in 5 patients, none had major complication requiring management (endovascular treatment or blood transfusion). TJRB is a safe and effective in patients with contraindications to percutaneous biopsy.
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Affiliation(s)
- K R Rathod
- Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - B A Popat
- Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - A Pandey
- Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - T E Jamale
- Department of Nephrology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N K Hase
- Department of Nephrology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - H L Deshmukh
- Department of Radiology, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Clark E, Barsuk JH, Karpinski J, McQuillan R. Achieving Procedural Competence during Nephrology Fellowship Training: Current Requirements and Educational Research. Clin J Am Soc Nephrol 2016; 11:2244-2249. [PMID: 27269612 PMCID: PMC5142073 DOI: 10.2215/cjn.08940815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Concerns have previously been raised as to whether training programs are ensuring that nephrology fellows achieve competence in the procedural skills required for independent practice. We sought to review the current requirements for procedural training as well as educational research pertaining to achieving competence in the core nephrology procedures of nontunneled (temporary) hemodialysis catheter insertion and percutaneous kidney biopsy. At this time, there is no universal approach to procedural training and assessment during nephrology fellowship. Nonetheless, simulation-based mastery learning programs have been shown to be effective in improving fellows' skills in nontunneled (temporary) hemodialysis catheter insertion and should be provided by all nephrology training programs. For percutaneous kidney biopsy, the development and evaluation of inexpensive simulators are a promising starting point for future study. Current practice with respect to procedural training during nephrology fellowship remains imperfect; however, the ongoing shift toward competency-based evaluation provides opportunities to refocus on improvement.
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Affiliation(s)
- Edward Clark
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and
| | - Jolanta Karpinski
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, Ontario, Canada
| | - Rory McQuillan
- Division of Nephrology, University Health Network and The University of Toronto, Toronto, Ontario, Canada
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Lubas A, Wojtecka A, Smoszna J, Koziński P, Frankowska E, Niemczyk S. Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys. Int Urol Nephrol 2016; 48:1667-73. [PMID: 27580732 PMCID: PMC5031753 DOI: 10.1007/s11255-016-1411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
Abstract
Purpose Renal biopsy-related arteriovenous fistula (RB-AVF), although usually asymptomatic, may sometimes result in serious clinical implications. The aim of the study was to prospectively evaluate the incidence of RB-AVF in native kidneys, together with the assessment of hemodynamic characteristics and the impact of the histopathological results of biopsy. Methods The study included 138 patients (age 46.2 ± 15.2; 70 F, 68 M), who underwent percutaneous renal biopsy (PRB) of the native kidney. In all patients, 2D and color Doppler ultrasound was performed 24 h after PRB in order to exclude RB-AVF. Results Bleeding complications in the form of hematomas were found in 136 patients (98.55 %), and 23 cases of RB-AVF were observed (16.67 %). RB-AVF group had an increased maximal hematoma diameter and reduced number of glomeruli in PRB. The segmental arteries supplying the fistulas are characterized by higher maximum flow velocity (FV) and a lower resistance index (RI) compared to the normal segmental arteries (difference 45.9 ± 20.0 cm/s and 0.252 ± 0.104, respectively). In the ROC analysis, RI ≤ 0.524 allowed to detect RB-AVF with a sensitivity of 91 % and specificity of 100 % (AUC 0.998, p < 0.001). In approximately 39 % of RB-AVF cases, 2D ultrasound detected a hyperechogenic ischemic area between the fistula and the renal capsule. Conclusions Arteriovenous fistula is a quite frequent complication of native renal biopsy and can cause ischemia in the renal parenchyma detected by ultrasound. The arteries supplying the fistula are characterized by an increased flow velocity and reduced resistance index.
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Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
| | - Anna Wojtecka
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Koziński
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Abstract
Percutaneous urologic biopsy is a safe and effective technique and can comprise a significant proportion of the daily workload of the interventional radiologist. This article discusses the indications and rationale for the performance of renal, ureter, and bladder biopsy as well as the approach to performing such biopsies, pitfalls, and potential complications.
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Affiliation(s)
- Aoife Kilcoyne
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA.
| | - Debra A Gervais
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Maruno M, Kiyosue H, Tanoue S, Hongo N, Matsumoto S, Mori H, Sagara Y, Kashiwagi J. Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture. Radiographics 2016; 36:580-95. [PMID: 26871987 DOI: 10.1148/rg.2016150124] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.
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Affiliation(s)
- Miyuki Maruno
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiro Kiyosue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shuichi Tanoue
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Norio Hongo
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Shunro Matsumoto
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Hiromu Mori
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Yoshiko Sagara
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
| | - Junji Kashiwagi
- From the Department of Radiology, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Yufu-shi, Oita 879-5593, Japan (M.M., H.K., S.T., N.H., S.M., H.M.); Department of Radiology, Tsurumi Hospital, Beppu, Japan (Y.S.); and Department of Radiology, Oita Prefectural Hospital, Oita, Japan (J.K.)
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El Hammoumi J, Boukatta B, Houari N, Elbouazzaoui A, Sbai H, Kanjaa N. [Hemorrhagic shock following a renal biopsy: report of a case]. Pan Afr Med J 2016; 22:115. [PMID: 26848362 PMCID: PMC4733490 DOI: 10.11604/pamj.2015.22.115.6292] [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: 02/07/2015] [Accepted: 06/03/2015] [Indexed: 12/02/2022] Open
Abstract
La ponction biopsie rénale (PBR) est un examen indispensable en néphrologie mais à risque de complications graves surtout hémorragique. Nous rapportons l'observation d'un patient âgé de 27 ans ayant bénéficié d'une PBR pour un diagnostic étiologique d'une insuffisance rénale aigue, l’évolution après la biopsie a été marquée par l'installation d'un choc hémorragique d'où la prise en charge en réanimation avec une néphrectomie d'hémostase.
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Affiliation(s)
| | - Brahim Boukatta
- Service de Réanimation Polyvalente A4, CHU Hassan II, Fès, Maroc
| | - Nawfal Houari
- Service de Réanimation Polyvalente A4, CHU Hassan II, Fès, Maroc
| | | | - Hicham Sbai
- Service de Réanimation Polyvalente A4, CHU Hassan II, Fès, Maroc
| | - Nabil Kanjaa
- Service de Réanimation Polyvalente A4, CHU Hassan II, Fès, Maroc
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Guo Z, Liu X, Li M, Shao C, Tao J, Sun W, Li M. Differential urinary glycoproteome analysis of type 2 diabetic nephropathy using 2D-LC-MS/MS and iTRAQ quantification. J Transl Med 2015; 13:371. [PMID: 26608305 PMCID: PMC4660682 DOI: 10.1186/s12967-015-0712-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/23/2015] [Indexed: 01/20/2023] Open
Abstract
Background Diabetic nephropathy (DN) is the leading cause of chronic kidney failure and end-stage kidney disease. More accurate and non-invasive test for the diagnosis and monitoring the progression of DN is urgently needed for the better care of such patients. Methods In this study we utilized urinary glycoproteome to discover the differential proteins during the course of type 2 DN. The urinary glycoproteins from normal controls, normalbuminuira, microalbuminura, and macroalbuminuria patients were enriched by concanavalin A (ConA) and analyzed by 2DLC/MS/MS and isobaric tags for relative and absolute quantitation quantification. Results A total of 478 proteins were identified and 408 were annotated as N-linked glycoproteins. A total of 72, 107 and 123 differential proteins were identified in normalbuminuria, microalbuminuria and macroalbuminuria, respectively. By bioinformatics analysis, in normalbuminruia state, cell proliferation and cell movement were activated, which might reflect the compensatory phase during the disease development. In micro- and macro-albuminuria, cell death and apoptosis was activated, which might reflect the de-compensatory phase. Pathway analysis showed acute phase proteins, the member of high density lipoprotein and low density lipoprotein proteins were changed, indicating the role of the inflammatory response and lipid metabolism abnormality in the pathogenesis of DN. Six selected differential proteins were validated by Western Blot. Alpha-1-antitrypsin (SERPINA1) and Ceruloplasmin are the two markers with excellent area under curve values (0.929 and 1.000 respectively) to distinguish the microalbuminuria and normalbuminuria. For the first time, we found pro-epidermal growth factor and prolactin-inducible protein were decreased in macroalbuminuria stage, which might reflect the inhibition of cell viability and the activation of cell death in kidney. Conclusions Above data indicated that urinary glycoproteome could be useful to distinguish the differences in protein profiles in different stages in DN, which will help better individualized care of patients in DN. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0712-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhengguang Guo
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing, 100005, China.
| | - Xuejiao Liu
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyan, Wangfujing Street, Beijing, China.
| | - Menglin Li
- National Key Laboratory of Medical Molecular Biology, Department of Physiology and Pathophysiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing, 100005, China.
| | - Chen Shao
- The Center for Biomedical Information, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing, 100005, China.
| | - Jianling Tao
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyan, Wangfujing Street, Beijing, China.
| | - Wei Sun
- Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, 5 Dong Dan San Tiao, Beijing, 100005, China.
| | - Mingxi Li
- Department of Nephrology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyan, Wangfujing Street, Beijing, China.
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Madhusudhan KS, Gamanagatti S, Gupta AK. Endovascular embolization of pseudoaneurysm of left colic artery developing after renal biopsy. Indian J Nephrol 2015. [PMID: 26199477 PMCID: PMC4495480 DOI: 10.4103/0971-4065.146029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vascular complications after percutaneous renal biopsy are uncommon and may require interventional management. In most of these cases, the pathology is a renal arterial pseudoaneurysm (PsA) or an arterio-venous fistula. Injury to other vessels like aorta, lumbar arteries or mesenteric arteries is rare with only one case of left colic artery PsA reported in literature. We report a case of a 60-year-old female, who developed left colic artery PsA after renal biopsy, which was successfully embolized through endovascular route using microcoils.
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Affiliation(s)
- K S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Gamanagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Prasad N, Kumar S, Manjunath R, Bhadauria D, Kaul A, Sharma RK, Gupta A, Lal H, Jain M, Agrawal V. Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications. Clin Kidney J 2015; 8:151-6. [PMID: 25815170 PMCID: PMC4370312 DOI: 10.1093/ckj/sfv012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 01/12/2023] Open
Abstract
Background Percutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compare the biopsy yield and complications rate of the real-time ultrasonagram (USG)-guided PRB and needle tracking with and without needle guide in two different study periods. Methods We compared the yield and complications of 2138 kidney biopsies performed in two different periods, 1510 biopsies during the first period from April 2004–December 2010 and 628 biopsies during second period from January 2011–March 2013. All biopsies in both periods were performed by nephrologists. Radiologists provided the real-time image without needle guide during the first period while nephrologists performed both imaging and biopsy with needle guide during the second period. Results Of all the 2138 patients, 226 (10.5%) patients developed 118 minor and 108 major complications. Only 13 (2.1%) major complications occurred in the second period and 95 (6.7%) in the first period (P < 0.001). The relative risk of developing a major complication without guide was 3.04 times greater than that of the biopsies performed with use of the guide. The mean number of glomeruli per biopsy obtained during the second period (17.98 ± 6.75) was significantly greater than that of the first period (14.14 ± 6.01) (P = 0.004). The number of passes to acquire adequate tissue (P = 0.001) and percentage of cortex on biopsy (P = 0.001) were also significantly better in the second period. The optimal observation period post biopsy is 24 h. Conclusions Real-time USG imaging supported by needle guide device is associated with better biopsy yield and fewer complications.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Shashi Kumar
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Revanasiddappa Manjunath
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Anupama Kaul
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Raj K Sharma
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Amit Gupta
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Hira Lal
- Department of Radiology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Manoj Jain
- Department of Pathology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Vinita Agrawal
- Department of Pathology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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Zhang T, Chen H, Liang S, Chen D, Zheng C, Zeng C, Zhang H, Liu Z. A non-invasive laboratory panel as a diagnostic and prognostic biomarker for thrombotic microangiopathy: development and application in a Chinese cohort study. PLoS One 2014; 9:e111992. [PMID: 25372665 PMCID: PMC4221199 DOI: 10.1371/journal.pone.0111992] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/03/2014] [Indexed: 12/12/2022] Open
Abstract
Background Thrombotic microangiopathy (TMA) in the kidney is a histopathologic lesion that occurs in a number of clinical settings and is often associated with poor renal prognosis. The standard test for the diagnosis of TMA is the renal biopsy; noninvasive parameters such as potential biomarkers have not been developed. Methods We analyzed routine parameters in a cohort of 220 patients with suspected TMA and developed a diagnostic laboratory panel by logistic regression. The levels of candidate markers were validated using an independent cohort (n = 46), a cohort of systemic lupus erythematosus (SLE) (n = 157) and an expanded cohort (n = 113), as well as 9 patients with repeat biopsies. Results Of the 220 patients in the derivation cohort, 51 patients with biopsy-proven TMA presented with a worse renal prognosis than those with no TMA (P = 0.002). Platelet and L-lactate dehydrogenase (LDH) levels showed an acceptable diagnostic value of TMA (AUC = 0.739 and 0.756, respectively). A panel of 4 variables - creatinine, platelets, ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats 13) activity and LDH - can effectively discriminate patients with TMA (AUC = 0.800). In the validation cohort, the platelet and LDH levels and the 4-variable panel signature robustly distinguished patients with TMA. The discrimination effects of these three markers were confirmed in patients with SLE. Moreover, LDH levels and the 4-variable panel signature also showed discrimination values in an expanded set. Among patients undergoing repeat biopsy, increased LDH levels and panel signatures were associated with TMA status when paired evaluations were performed. Importantly, only the 4-variable panel was an independent prognostic marker for renal outcome (hazard ratio = 3.549; P<0.001). Conclusions The noninvasive laboratory diagnostic panel is better for the early detection and prognosis of TMA compared with a single parameter, and may provide a promising biomarker for clinical application.
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Affiliation(s)
- Tao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Huimei Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing University School of Medicine, Nanjing, 210093, P. R. China
- * E-mail: (HC); (ZL)
| | - Shaoshan Liang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Dacheng Chen
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Chunxia Zheng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Caihong Zeng
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Haitao Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
| | - Zhihong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P. R. China
- * E-mail: (HC); (ZL)
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Chung S, Koh ES, Kim SJ, Yoon HE, Park CW, Chang YS, Shin SJ. Safety and tissue yield for percutaneous native kidney biopsy according to practitioner and ultrasound technique. BMC Nephrol 2014; 15:96. [PMID: 24957046 PMCID: PMC4071327 DOI: 10.1186/1471-2369-15-96] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 06/19/2014] [Indexed: 12/18/2022] Open
Abstract
Background Although percutaneous renal biopsy remains an essential tool in the diagnosis and treatment of renal diseases, in recent times the traditional procedure of nephrologists has been performed by non-nephrologists rather than nephrologists at many institutions. The present study assessed the safety and adequacy of tissue yield during percutaneous renal biopsy according to practitioners and techniques based on ultrasound. Methods This study included 658 native renal biopsies performed from 2005 to 2010 at a single centre. The biopsies were performed by nephrologists or expert ultrasound radiologists using the ultrasound-marked blind or real-time ultrasound-guided techniques. Results A total of 271 ultrasound-marked blind biopsies were performed by nephrologists, 170 real-time ultrasound-guided biopsies were performed by nephrologists, and 217 real-time ultrasound-guided biopsies were performed by radiologists during the study period. No differences in post-biopsy complications such as haematoma, need for transfusion and intervention, gross haematuria, pain, or infection were observed among groups. Glomerular numbers of renal specimens from biopsies performed by nephrologists without reference to any technique were higher than those obtained from real-time ultrasound-guided biopsies performed by expert ultrasound radiologists. Conclusions Percutaneous renal biopsy performed by nephrologists was not inferior to that performed by expert ultrasound radiologists as related to specimen yield and post-biopsy complications.
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Affiliation(s)
| | | | | | | | | | | | - Seok Joon Shin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 137-701, Republic of Korea.
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Schmid A, Jacobi J, Kuefner MA, Lell M, Wuest W, Mayer-Kadner I, Benz K, Schmid M, Amann K, Uder M. Transvenous Renal Transplant Biopsy via a Transfemoral Approach. Am J Transplant 2013; 13:1262-71. [PMID: 23489636 DOI: 10.1111/ajt.12199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 11/27/2012] [Accepted: 01/17/2013] [Indexed: 01/25/2023]
Abstract
Percutaneous renal biopsy (PRB) of kidney transplants might be prevented by an elevated risk of bleeding or limited access to the allograft. In the following, we describe our initial experience with 71 transvenous renal transplant biopsies in 53 consecutive patients with unexplained reduced graft function who were considered unsuitable candidates for PRB (4.2% of all renal transplant biopsies at our institution). Biopsies were performed via the ipsilateral femoral vein with a renal biopsy set designed for transjugular renal biopsy (TJRB) of native kidneys. Positioning of the biopsy system within the transplant vein was achievable in 58 of 71 (81.7%) procedures. The specimen contained a median of 10 glomeruli (range 0-38). Tissue was considered as adequate for diagnosis in 56 of 57 (98.2%) biopsies. With respect to BANFF 50.9% of the specimen were adequate (>10 glomeruli), 47.4% marginally adequate (1-9 glomeruli) and 1.8% inadequate (no glomeruli). After implementation of real-time assessment all specimen contained glomeruli. One of the fifty-eight (1.8%) procedure-related major complications occurred (hydronephrosis requiring nephrostomy due to gross hematuria). Transfemoral renal transplant biopsy (TFRTB) is feasible and appears to be safe compared to PRB. It offers a useful new alternative for histological evaluation of graft dysfunction in selected patients with contraindications to PRB.
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Affiliation(s)
- A Schmid
- Department of Radiology, University of Erlangen-Nuremberg, Germany.
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Visciano B, Di Pietro RA, Rossano R, Mancini A, Zamboli P, Cianciaruso B, Pisani A. Nephrotic syndrome and autosomal dominant polycystic kidney disease. Clin Kidney J 2012; 5:508-11. [PMID: 26069794 PMCID: PMC4400568 DOI: 10.1093/ckj/sfs147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 09/19/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development and growth of cysts in the kidneys and other organs. In ADPKD patients, nephrotic range proteinuria is unusual and needs to be investigated further to exclude coexisting glomerular disease. Among the anecdotal case reports of ADPKD associated with nephrotic syndrome, focal segmental glomerulosclerosis occurs most frequently. METHODS We report the case of a 26-year-old male with ADPKD and concomitant nephrotic syndrome, in which an ultrasound (US)-guided renal biopsy showed a mesangioproliferative glomerulonephritis. We treated the patient with prednisone 1 mg/kg/day, because of the failure of treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker association. RESULTS After 6 months of steroid treatment, we observed a stability of his GFR and a reduction of proteinuria. CONCLUSION This case report and other cases of the literature underline the importance of a renal biopsy in patients with ADPKD and nephrotic syndrome in order to make an accurate diagnosis and an appropriate treatment/prevention of renal function deterioration.
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Affiliation(s)
- Bianca Visciano
- Department of Nephrology, University of Naples Federico II,Naples,Italy
| | | | - Roberta Rossano
- Department of Nephrology, University of Naples Federico II,Naples,Italy
| | - Antonio Mancini
- Department of Nephrology, University of Naples Federico II,Naples,Italy
| | - Pasquale Zamboli
- Department of Nephrology, Second University of Naples,Naples,Italy
| | - Bruno Cianciaruso
- Department of Nephrology, University of Naples Federico II,Naples,Italy
| | - Antonio Pisani
- Department of Nephrology, University of Naples Federico II,Naples,Italy
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Korbet SM. Nephrology and the Percutaneous Renal Biopsy: A Procedure in Jeopardy of Being Lost Along the Way. Clin J Am Soc Nephrol 2012; 7:1545-7. [DOI: 10.2215/cjn.08290812] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012; 19:179-87. [PMID: 22578678 DOI: 10.1053/j.ackd.2012.04.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/04/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022]
Abstract
Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.
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Sargsyan SA, Serkova NJ, Renner B, Hasebroock KM, Larsen B, Stoldt C, McFann K, Pickering MC, Thurman JM. Detection of glomerular complement C3 fragments by magnetic resonance imaging in murine lupus nephritis. Kidney Int 2011; 81:152-9. [PMID: 21956190 DOI: 10.1038/ki.2011.332] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
One of the challenges of treating patients with glomerulonephritis is to accurately assess disease activity. As renal biopsies are routinely stained for deposits of C3 activation fragments and glomerular C3 deposits are found in most forms of glomerulonephritis, we sought to determine whether a relatively noninvasive measure of C3 fragment deposition in the kidney can serve as a good biomarker of disease onset and severity. We recently developed a magnetic resonance imaging (MRI)-based method of detecting glomerular C3 and used this to track the progression of renal disease in the MRL/lpr mouse model of lupus nephritis using superparamagnetic iron oxide nanoparticles conjugated to complement receptor type 2 as a targeting agent. Quantitative immunofluorescence showed that glomerular C3b/iC3b/C3d deposition progressively increased with disease activity, a finding replicated by the T2-weighted MRI. The T2 relaxation times decreased with disease activity in the cortex and medulla of the MRL/lpr but not in MRL/Mpj control mice. Thus, MRI contrast agents targeted to glomerular C3 fragments can be used to noninvasively monitor disease activity in glomerulonephritis. As therapeutic complement inhibitors are used in patients with renal disease, this method, should it become feasible in humans, may identify those likely to benefit from complement inhibition.
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Affiliation(s)
- Siranush A Sargsyan
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
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Abstract
This article describes the current state-of-the-art technique of percutaneous transplant renal biopsy. A brief overview of the history of transplant renal biopsy is given. The indications and contraindications are discussed, including pre- and postprocedure patient management. The technique of the procedure and the devices that are available in the market are described.
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Affiliation(s)
- Iftikhar Ahmad
- Assistant Professor of Radiology, Indiana University School of Medicine, University Hospital, Indianapolis, Indiana
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Sarabu N, Maddukuri G, Munikrishnappa D, Martin KJ, Qazi RA, Alvarez A, Schmitz PG. Safety and Efficacy of Transjugular Renal Biopsy Performed by Interventional Nephrologists. Semin Dial 2010; 24:343-8. [DOI: 10.1111/j.1525-139x.2010.00762.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mishra A, Tarsin R, Elhabbash B, Zagan N, Markus R, Drebeka S, Abdelmola K, Shawish T, Shebani A, Abdelmola T, Elusta A, Ehtuish EF. Percutaneous ultrasound-guided renal biopsy: A Libyan experience. Indian J Nephrol 2010; 20:76-9. [PMID: 20835320 PMCID: PMC2931137 DOI: 10.4103/0971-4065.65299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study was done to assess the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB), to ascertain the risk factors for complications and determine the optimal period of observation. The radiologist (A.M.) at the National Organ Transplant Centre, Central Hospital, Tripoli, Libya, performed 86 PRBs between February 1, 2006, and January 31, 2008, using an automated biopsy gun with 16-gauge needle. Coagulation profile was done in all the patients. All patients were kept on strict bed rest for six hours post-procedure. Eighty six renal biopsies were performed on 78 patients referred from rheumatology department and eight post-kidney transplant recipients; 23 were males with age range 15 – 56 years and 63 females with age range 16 – 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in four biopsies. Class I lupus nephritis (LN) was seen in 1 patient, class II lupus nephritis in 7 patients, class III LN in 13 patients and class IV LN in 29 patients. All the eight renal allografts were diagnosed as acute tubular necrosis or acute interstitial rejection. The risk of post-biopsy bleeding was higher in women, older patients and higher PTT. The overall complication rate was 5.8%. Three complications were observed within six hours of biopsy. No late complication was seen. PRB under real-time ultrasound-guidance is a safe and efficacious procedure to establish the histological diagnosis and should be done as out-patient procedure. Observation time of six hours post-biopsy is optimal.
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Affiliation(s)
- A Mishra
- Department of Radiology, National Organ Transplant Center, Central Hospital, Tripoli, Libya
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Tabatabai S, Sperati CJ, Atta MG, Janjua K, Roxbury C, Lucas GM, Fine DM. Predictors of complication after percutaneous ultrasound-guided kidney biopsy in HIV-infected individuals: possible role of hepatitis C and HIV co-infection. Clin J Am Soc Nephrol 2009; 4:1766-73. [PMID: 19808221 DOI: 10.2215/cjn.03880609] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES HIV-infected patients often undergo kidney biopsy. The risks of percutaneous ultrasound-guided kidney biopsy in this population are not well established. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a case-control, single-center study of 1116 (243 with HIV infection and 873 without) consecutive ultrasound-guided biopsies from 1024 patients. The primary outcome was any major or minor complication. Major complications included biopsy-associated bleeding that required transfusion, angiography, or surgery; hypotension that required intervention; and death. Minor complications included development of a hematoma or gross hematuria. The odds of complication was assessed with logistic regression. RESULTS Overall complication rates (8.6 versus 7.2%) did not significantly differ between HIV-infected and noninfected individuals. HIV-positive status did not predict complication. In the entire cohort, hepatitis C infection was associated with a 2.08 (95% confidence interval [CI] 1.47 to 2.93) increased odds of complication, and each 10,000-cells/mm(3) decrease in prebiopsy platelet count a 1.05 (95% CI 1.02 to 1.08) increased odds of complication. In addition, prebiopsy hematocrit <30% and estimated GFR <30 ml/min per 1.73 m(2) were associated with major complication. Whereas the association of prebiopsy platelet count was not modified by HIV infection, hepatitis C/HIV co-infection was associated with a 5.71 (95% CI 1.89 to 17.2) increased odds of complication as compared with 1.27 (95% CI 0.73 to 2.19) in hepatitis C-positive/HIV-negative individuals. CONCLUSIONS Ultrasound-guided percutaneous kidney biopsy is a relatively safe, well-tolerated procedure in the HIV-infected population. HIV-infected individuals who are co-infected with hepatitis C seem to be at greatest risk.
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Affiliation(s)
- Sayed Tabatabai
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Abstract
CONTEXT The first renal biopsy was carried out more than a century ago, but its widespread introduction into clinical use, beginning in the 1950s, helped develop nephrology into the powerful subspecialty of internal medicine that it is today. In the past 25 years, the use of the spring-loaded biopsy gun, in combination with newer visualization techniques, including ultrasound and computed axial tomography scanning, has led to greater tissue yield and to a much lower risk of complication. During this same time, our understanding of renal pathology has increased many fold. Correct fixation and processing of renal biopsy tissue is critical, and the laboratory must be skilled with renal biopsy light microscopy, immunohistochemistry, and transmission electron microscopy preparation. OBJECTIVES To provide an overview of the renal biopsy, including the techniques and its complications, and to summarize proper laboratory methods for processing renal biopsy tissue. DATA SOURCES This article is based on a review of the literature and on the experience of the author. CONCLUSIONS The experienced nephropathologist, knowledgeable in both renal medicine and pathology and thus able to correlate subtle tissue-derived information with appropriate clinical data, remains the most important key to the development of an accurate clinicopathologic diagnosis.
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Affiliation(s)
- Patrick D Walker
- Nephropathology Associates, 10810 Executive Center Drive, Little Rock, AR 72211, USA.
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Oshiro Y, Umena S, Noda M. Focal segmental glomerulosclerosis complicating solitary kidney. Clin Exp Nephrol 2008; 13:81-4. [PMID: 18688570 DOI: 10.1007/s10157-008-0076-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Accepted: 06/30/2008] [Indexed: 11/25/2022]
Abstract
A 78-year old woman with complicating solitary kidney had nephrotic syndrome. Renal biopsy specimens showed focal segmental glomerulosclerosis (FSGS). First, the patient was treated with angiotensin receptor blocker (ARB) and angiotensin converting enzyme inhibitor (ACEI). Proteinuria decreased from 10 to 6 g/day, but overall the nephrotic syndrome did not improve. Additional treatment with prednisolone and cyclosporine reduced proteinuria to less than 1.0 g/day. We report that combination therapy with ARB, ACEI, prednisolone, and cyclosporine was successful for FSGS complicating solitary kidney.
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Affiliation(s)
- Yoshiyuki Oshiro
- Department of Internal Medicine, Kawasaki Medical School Kawasaki Hospital, 2-1-80 Nakasange, Okayama, Japan.
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Safety and diagnostic yield of transjugular renal biopsy. J Vasc Interv Radiol 2008; 19:546-51. [PMID: 18375299 DOI: 10.1016/j.jvir.2007.12.447] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 12/05/2007] [Accepted: 12/17/2007] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the safety and tissue acquisition with transjugular renal biopsy (TJRB) by using the Quick-Core method in patients who were at high risk for complications with percutaneous renal biopsy. MATERIALS AND METHODS This was a retrospective study, and indication for the transjugular route, complications, clinical and laboratory data, and adequacy of samples were abstracted from patient records. TJRB was performed when the patient had thrombocytopenia or coagulopathy and was at high risk for bleeding from percutaneous renal biopsy. Follow-up images were available in 25 patients; nine underwent abdominal ultrasonography (US) and 17 underwent computed tomography (CT) (one patient underwent both US and CT). The hemoglobin level, prothrombin time, international normalized ratio (INR), partial thromboplastin time, platelet count, and serum creatinine level were obtained before and after biopsy, and these findings were correlated with clinical outcomes. RESULTS Thirty-nine patients underwent 39 TJRB procedures and comprise the current study population. The procedure was technically successful in 38 of the 39 patients (97%). Twenty-four of 39 patients (63%) had a platelet count of less than or equal to 75 x 10(9)/L, 11 (29%) had an elevated INR of more than 1.4, and seven received therapeutic anticoagulation. Patients with a platelet count of less than or equal to 75 x 10(9)/L or those with an elevated INR of more than 1.4 after transfusion were not at increased risk of hematoma formation (P = not statistically significant). The mean serum creatinine level at biopsy was 283 mumol/L +/- 150. A mean of 1.8 cores +/- 1.1 were obtained, with 5.0 glomeruli +/- 3.8, 2.1 glomeruli +/- 2.8, and 2.4 glomeruli +/- 3 at light, immunofluorescence, and electron microscopy, respectively. The renal tissue was sufficient for diagnosis in 92% of patients. Major complications occurred in one patient (2.6%). Minor complications-primarily renal hematoma-occurred in 52% of the patients. Contrast medium-induced nephropathy occurred in three patients (7.8%), two of whom also had renal hematomas. CONCLUSIONS TJRB is a relatively safe and effective diagnostic tool in high-risk patients with coagulopathy and thrombocytopenia who require renal tissue for accurate diagnosis.
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Abbott KC, Yeo FE. A new supine anterolateral approach to percutaneous ultrasound-guided renal biopsy. NATURE CLINICAL PRACTICE. NEPHROLOGY 2008; 4:244-245. [PMID: 18301407 DOI: 10.1038/ncpneph0769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 01/24/2008] [Indexed: 05/26/2023]
Affiliation(s)
- Kevin C Abbott
- Nephrology Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307-5001, USA.
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Arthur JM, Powell TB. Urinary Biomarkers in Diabetic Nephropathy and Other Glomerular Diseases. Clin Proteomics 2008. [DOI: 10.1002/9783527622153.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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See TC, Thompson BC, Howie AJ, Karamshi M, Papadopoulou AM, Davies N, Tibballs J. Transjugular renal biopsy: our experience and technical considerations. Cardiovasc Intervent Radiol 2008; 31:906-18. [PMID: 18266029 DOI: 10.1007/s00270-008-9308-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 11/22/2007] [Accepted: 11/28/2007] [Indexed: 12/01/2022]
Abstract
The purpose of this study was to describe the indications for and technique of transjugular renal biopsy (TJRB) and evaluate the efficacy and complications of this method. We performed a retrospective review of 59 patients who underwent TJRB using the Quick-core needle biopsy system (Cook, Letchworth, UK) over a 4-year period. The indications for obtaining renal biopsy included acute renal failure, chronic renal failure, nephrotic syndrome, and proteinuria with or without other associated disease. Indications for the transjugular approach included coagulopathy, biopsy of a solitary kidney or essentially single functioning kidney, simultaneous renal and hepatic biopsy, morbid obesity, and failed percutaneous biopsy. All but four cases were performed via the right internal jugular vein. The right, left, or both renal veins were cannulated in 41, 14, and 4 cases, respectively. Combined liver and renal biopsies were obtained in seven cases. Diagnostic biopsy specimens were obtained in 56 of 59 patients (95%). The number and size of tissue cores ranged from 1 to 9 mm and from 1 to 20 mm, respectively. The mean numbers of glomeruli per procedure on light microscopy and electron microscopy were 10.3 and 2.6, respectively. Specimens for immunohistology were acquired in 49 cases, of which 40 were adequate. Of the 56 successful TJRB procedures, 34 (61%) were associated with isolated capsular perforation (19), contained subcapsular leak (10), isolated collecting system puncture (1), and concurrent collecting system and capsular perforation (4). There was a significant increase in capsular perforation with six or more needle passes, although no significant correlation was seen between number of needle passes and complication. Six patients had minor complications defined as hematuria or loin pain. Seven patients developed major complications, of whom five received blood transfusion alone. Two required intervention: in one an arteriocalyceal fistula was embolized and the patient was temporarily dialyzed; the remaining patient required ureteric stenting. In conclusion, TJRB provides an adequate yield for diagnosis. Complication rates are relatively high, but patients are also at high risk from the conventional percutaneous approach. Patient selection and optimization are critical to avoid major complications.
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Affiliation(s)
- Teik Choon See
- Radiology Department, Addenbrookes Hospital, Hills Road, Box 219, Cambridge, CB2 2QQ, UK.
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