Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

American Journal of Nephrology - Tập 43 Số 1 - Trang 1-19 - 2016
Marco Fiorentino1, Davide Bolignano2, Vladimı́r Tesař3, Anna Pisano2, Wim Van Biesen4, Graziella D’Arrigo2, Giovanni Tripepi2, Loreto Gesualdo1
1Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, and
2CNR-Institute of Clinical Physiology, Reggio Calabria, Italy
3Department of Nephrology, 1st School of Medicine, Charles University, Prague, Czech Republic
4European Renal Best Practice, University Hospital Ghent, Ghent, Belgium

Tóm tắt

<b><i>Background:</i></b> Although the number of patients reaching end-stage kidney disease without a biopsy-proven diagnosis is increasing, the utility of renal biopsy is still an object of debate. We analyzed epidemiological data and the main indications for renal biopsy with a systematic, evidence-based review at current literature. <b><i>Summary:</i></b> There is a high discrepancy observed in biopsy rates and in the epidemiology of glomerular diseases worldwide, related to the different time frame of the analyzed reports, lack of data collection, the different reference source population and the heterogeneity of indications. The evidence-based analysis of indications showed that renal biopsy should be crucial in adults with nephrotic syndrome or urinary abnormalities as coexistent hematuria and proteinuria and in corticosteroid resistant-children with severe proteinuria. The knowledge of renal histology can change the clinical management in patients with acute kidney injury significantly, after the exclusion of pre-renal or obstructive causes of kidney damage. Scarce evidence indicates that renal biopsy can be useful in patients with advanced chronic kidney disease and its use should always be considered after weighing the benefits and potential risks. Renal biopsy should be crucial in patients with renal involvement due to systemic disease. In patients with diabetes with atypical features, renal biopsy may be fundamental to diagnose an unexpected parenchymal disease mislabeled as diabetic nephropathy. Finally, in elderly patients, the indications and the risks are not different from those in the general population. <b><i>Key Message:</i></b> Renal biopsy still remains a concrete approach for managing a substantial percentage of renal diseases.

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American Journal of Nephrology

Tập 43 Số 1

1-19

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