 Abstract | | |
Glomerular diseases are considered to be a significant cause of chronic kidney disease. Kidney biopsy continues to be an essential diagnostic tool. We review the renal biopsies which were done on children below the age of 14 years in the past 10 years (from January 2008 to September 2018) in a single tertiary pediatric hospital in Saudi Arabia to determine the patterns of renal disease among Saudi children as well-correlating clinical presentation with histopathological diagnosis. A total of 203 pediatric kidney biopsies were performed. The mean age was 7.3 ± 3.9 years (3 months to 14 years). There were 105 males and 98 females. The most frequent indication for renal biopsy was nephrotic syndrome in 58.9% of patients, followed by acute glomerulo- nephritis in 20.8%. Other indications included significant proteinuria, persistent microscopic hematuria, acute kidney injury of uncertain etiology, in the remaining 20% of biopsies. Clinical diagnosis was consistent with histopathological diagnosis in 92% of the cases. Minimal change disease was the most common cause of primary glomerular diseases in 37.4%, followed by focal segmental glomerulosclerosis in 20.2%. Lupus nephritis represents the most common cause of the secondary renal disease (8.4%). Complications of kidney biopsy were observed in only 16.3% of patients, of whom 9.9% had perirenal hematomas and 6.4% of the patients developed either microscopic hematuria or macroscopic hematuria.
How to cite this article:
Al-Sadoon EI, Rahim KA, AlAnazi A, Faqeehi H, AlBatati S. Spectrum of pediatricbiopsy-proven renal diseases: A single center experience. Saudi J Kidney Dis Transpl 2020;31:176-81 |
How to cite this URL:
Al-Sadoon EI, Rahim KA, AlAnazi A, Faqeehi H, AlBatati S. Spectrum of pediatricbiopsy-proven renal diseases: A single center experience. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2022 May 20];31:176-81. Available from: https://www.sjkdt.org/text.asp?2020/31/1/176/279938 |
| Introduction | |  |
Glomerular disease is a major cause of chronic kidney disease.[1],[2] Its pattern varies widely between countries and reflects the possible effects of socioeconomic, genetic, and environmental factors as well as the practice of nephrologists.
Renal biopsy is an important safe tool for achieving the right diagnosis, treating patients based on histopathological diagnosis and predicting the clinical course and outcome.[3],[4],[5]
The aim of this study is to investigate the indications and complications of renal biopsy in the native and transplant kidneys, to analyze the histopathological pattern in a tertiary care center in Saudi Arabia, and to examine the relationship between the clinical presentation and histopathological diagnosis.
| Materials and Methods | | |
This is a retrospective study in children up to the age of 14 years, who underwent a percutaneous renal biopsy in native kidneys at King Fahad Medical City, Riyadh, in the period between January 2008 and September 2018.
After obtaining Institutional Review Board approval for this study, all data including age, gender, indication for renal biopsy, and histo- pathological diagnosis and complications were collected from the medical records.
After informed consent, blood workup, ultrasound-guided renal biopsies were performed by an interventional radiologist under general anesthesia. Renal ultrasound was performed for all the patients prior and immediately post biopsy, children were observed for vital signs and any change in urine color and amount. Follow-up hemoglobin was also performed after 6-24 h for all the patients. The patients were discharged on the next day with strict instructions to avoid heavy exercise for one week. Most of the renal biopsies were examined by one renal pathologist. The specimens were studied under light, immunofluorescent and electron microscopy.
| Statistical Analysis | | |
Descriptive statistics were used to characterize the distribution of the variables and the characteristics of the sample. Characteristics of the study patients were reported as counts (percentage) for categorical variables and mean (standard deviation) for continuous variables. All statistical analyses were performed using IBM Statistical Package for the Social Sciences Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA).
| Results | | |
A total of 203 pediatric kidney biopsies were performed during the study period. The mean age was 7.3 ± 3.9 years (3 months to 14 years). There were 105 males and 98 females. Twenty- three patients (11.3 %) had more than one renal biopsy.
The most frequent indication for renal biopsy was nephrotic syndrome (NS) in 58.9% of patients followed by acute glomerulonephritis in 20.8%. Other indications including significant proteinuria, persistent microscopic hema- turia, and acute kidney injury of uncertain etiology were present in 20% [Table 1]. Clinical diagnosis was consistent with histo- pathological diagnosis in 92% of the cases.
Of the 119 patients with NS, 51 (43.2%) had steroid-resistant NS (47 diagnosed with primary steroid-resistant and the rest as secondary steroid-resistant), 41 34.7% of the patients were steroid-dependent, five patients frequently relapsing NS, 15 (12.7%) presented in atypical presentation [Figure 1].
Minimal change disease (MCD) is the most common cause of primary glomerular diseases in (37.4%), followed by focal segmental glomerulosclerosis (FSGS) in (20.2%). Lupus nephritis was the most common cause of secondary renal disease (8.4%) [Table 2].
Complications of kidney biopsy were observed in only 16.7% of patients; 9.9% had peri-renal hematomas and 6.4 % of the patients developed either microscopic hematuria or macroscopic hematuria [Figure 2].
Two of the patients had a major complication, and their characteristics are shown in [Table 3]. | Table 3: Characteristics of patients who developed major complications after percutaneous native kidney biopsy.
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| Discussion | | |
Glomerular diseases were distributed differently by geographic regions.[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18] Histopathological diagnosis is important in determining a more accurate diagnosis and long-term prognosis, especially with the availability of a wide range of therapies.[10]
Previous published studies revealed differences in the frequency of specific types of glomerular diseases that may be attributable to ethnicity, genetic, or environmental factors.
In the majority of the published reports, NS was the most common indication for biopsy.[8],[9],[10],[11],[12],[13],[14] In reports from Italy and England, proteinuria was the most common indication for biopsy.[15] A study from Hong Kong revealed that systematic diseases were the predominant cause for biopsy.[11]
Similar to what was found in most reports, NS was the leading indication for renal biopsy in our cases. The most common primary glomerular disease in nephrotic children was MCD, which accounts for 90% of the NS in children worldwide as reported by Fogo[19] FSGS account for 20%, which in line with reports from different parts of the world.[20],[21]
Percutaneous renal biopsy was described in 1934.[22],[23] Since then many technical changes have made renal biopsy safe procedure, but still carries complications some risks.[24],[25],[26],[27] Several studies have shown that patients with poor renal function have an increased risk of post renal biopsy complications.[28],[29],[30],[31],[32]
Weight of the patient is considered as contributing factor in developing perirenal hematoma Needle gauge is another contributing factor for hematoma.[27],[33]
In this study, high rate of perirenal hematoma fining reflects our routine practice of routine US immediately after renal biopsies. Most of these hematomas are small with no clinical significance. However, it was common in echogenic kidneys, underweight, and younger children.
This study may provide some insight to the frequency of biopsy-proven renal disease among pediatric age group, and renal biopsy complications, hoping that will stimulate initiation of a database in national scale. However, it is limited by retrospective design, and small number of renal biopsies, in particular for renal graft biopsies as our center is not a referral center for renal transplant.
Conflict of interest: None declared.
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Correspondence Address:
Ebtisam Ibraheem Al-Sadoon
Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh
Saudi Arabia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-2442.279938
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3] |
