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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2020  |  Volume : 31  |  Issue : 1  |  Page : 176-181
Spectrum of pediatricbiopsy-proven renal diseases: A single center experience


Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia

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Date of Submission05-Feb-2019
Date of Acceptance09-Mar-2019
Date of Web Publication3-Mar-2020
 

   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 2020 Apr 7];31:176-81. Available from: http://www.sjkdt.org/text.asp?2020/31/1/176/279938



   Introduction Top


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 Top


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 Top


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 Top


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.
Table 1: Indication for kidney biopsy.

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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].
Figure 1: Distribution of patients with NS.

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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].
Table 2: The renal biopsy results

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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].
Figure 2: Post renal biopsy complications.

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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 Top


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.



 
   References Top

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Al-Sabban E. Spectrum of glomerular disease among children in Saudi Arabia. Saudi J Kidney Dis Transpl 1997:8:285-8.  Back to cited text no. 2
    
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Visconti L, Cernaro V, Ricciardi CA, et al. Renal biopsy: Still a landmark for the nephro- logist. World J Nephrol 2016:5:321-7.  Back to cited text no. 3
    
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Horvatic I, Hrkac A, Zivko M, Kozjak D, Galesic K. Value of ultrasound-guided percutaneous renal biopsy in diagnosis of the renal diseases. Acta Med Croatica 2007:61:399-403.  Back to cited text no. 4
    
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Srija M, Lakshminarayana G, Anil M, Rajesh R, Kurian G, Unni VN. Pattern of renal diseases on kidney biopsies at a tertiary care hospital in Kerala.Amrita J Med 2011:7:32-9.  Back to cited text no. 6
    
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Ramesh CV, Ravi KM, Prasad G. Spectrum of biopsy proven renal disease Referral hospital experience in a developing nation: Analysis based on 624 renal biopsies. IJSR 2015:4:70-48.  Back to cited text no. 7
    
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Begum A, Al Mamun A, Jesmine T, et al. Pattern of glomerular diseases in Bangladeshi children: A clinico-pathological study. Nephrol Urol 2017:1:7-9.  Back to cited text no. 8
    
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Hadidi R, Hadidi M, AlDabbas M. Spectrum of biopsy-proven kidney disease in children at a Jordanian hospital. Saudi J Kidney Dis Transpl 2014:25:680-3.  Back to cited text no. 9
    
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Nawaz Z, Mushtaq F, Mousa D, et al. Pattern of glomerular disease in the Saudi population: A single-center, five-year retrospective study. Saudi J Kidney Dis Transpl 2013:24:1265-70.  Back to cited text no. 10
    
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Yuen LK, Lai WM, Lau SC, Tong PC, Tse KC, Chiu MC. Ten-year review of disease pattern from percutaneous renal biopsy: An experience from a paediatric tertiary renal centre in Hong Kong.Hong Kong Med J 2008: 14:348-55.  Back to cited text no. 11
    
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Demircin G, Delibaş A, Bek K, et al. A one- center experience with pediatric percutaneous renal biopsy and histopathology in Ankara, Turkey. Int Urol Nephrol 2009:41:933-9.  Back to cited text no. 12
    
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Abdelraheem MB, Ali TM, Mohamed RM, et al. Pattern of glomerular diseases in Sudanese children: A clinico-pathological study. Saudi J Kidney Dis Transpl 2010:21:778-83.  Back to cited text no. 13
    
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Batinic D, Scukanec-Spoljar M, Milosevic D, et al. Clinical and histopathological characteristics of biopsy-proven renal diseases in Croatia. Acta Med Croatica 2007:61:361-4.  Back to cited text no. 14
    
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Hussain F, Mallik M, Marks SD, Watson AR: British Association of Paediatric Nephrology. Renal biopsies in children: Current practice and audit of outcomes.Nephrol Dial Transplant 2010:25:485-9.  Back to cited text no. 15
    
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Paripovic D, Kostic M, Kruščic D, et al. Indications and results of renal biopsy in children: A 10-year review from a single center in Serbia. J Nephrol 2012:25:1054-9.9.  Back to cited text no. 16
    
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Printza N, Bosdou J, Pantzaki A, et al. Percutaneous ultrasound-guided renal biopsy in children: A single centre experience. Hippokratia 2011:15:258-61.  Back to cited text no. 17
    
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Lanewala A, Mubarak M, Akhter F, Aziz S, Bhatti S, Kazi JI. Pattern of pediatric renal disease observed in native renal biopsies in Pakistan. J Nephrol 2009:22:739-46.  Back to cited text no. 18
    
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Fogo AB. Minimal change disease and focal segmental glomerulosclerosis. Nephrol Dial Transplant 2001:16Suppl 6:74-6.  Back to cited text no. 19
    
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Gulati S, Sharma AP, Sharma RK, Gupta A. Changing trends of histopathology in childhood nephrotic syndrome.Am J Kidney Dis 1999:34:646-50.  Back to cited text no. 20
    
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Filler G, Young E, Geier P, Carpenter B, Drukker A, Feber J. Is there really an increase in non-minimal change nephrotic syndrome in children? Am J Kidney Dis 2003;42:1107-13.  Back to cited text no. 21
    
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Gwyn NB. Biopsies and the completion of certain surgical procedures. Can Med Assoc J 1923;13:820-3.  Back to cited text no. 22
    
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Ball RP. Needle (aspiration) biopsy. J Tenn Med Assoc 1934;27:203-6.  Back to cited text no. 23
    
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Kersnik Levart T, Kenig A, Buturovic Ponikvar J, Ferluga D, Avgustin Cavic M, Kenda RB. Real-time ultrasound-guided renal biopsy with a biopsy gun in children: Safety and efficacy. Acta Paediatr 2001;90:1394-7.  Back to cited text no. 24
    
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AlRasheed SA, AlMugeiren MM, Abdurrahman MB, Elidrissy AT. The outcome of percutaneous renal biopsy in children: An analysis of 120 consecutive cases. Pediatr Nephrol 1990;4:600-3.  Back to cited text no. 25
    
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Tøndel C, Vikse BE, Bostad L, Svarstad E. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol 2012;7:1591-7.  Back to cited text no. 26
    
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Rianthavorn P, Kerr SJ, Chiengthong K. Safety of paediatric percutaneous native kidney biopsy and factors predicting bleeding complications. Nephrology (Carlton) 2014;19:143-8.  Back to cited text no. 27
    
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Tøndel C, Vikse BE, Bostad L, Svarstad E. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol 2012;7:1591-7.  Back to cited text no. 30
    
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Torres Muñoz A, Valdez-Ortiz R, González- Parra C, Espinoza-Dávila E, Morales-Buenrostro LE, Correa-Rotter R. Percutaneous renal biopsy of native kidneys: Efficiency, safety and risk factors associated with major complications. Arch Med Sci 2011;7:823-31.  Back to cited text no. 31
    
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Preuss S, Kuechle C, Wagenpfeil S, et al. Retrospective analysis of ultrasound-detected bleeding complications after ultrasound-guided transcutaneous kidney biopsies. Ultrasound Med Biol 2017;43:153-62.  Back to cited text no. 32
    
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Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: A systematic review and meta- analysis. Am J Kidney Dis 2012;60:62-73.  Back to cited text no. 33
    

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Correspondence Address:
Ebtisam Ibraheem Al-Sadoon
Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh
Saudi Arabia
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DOI: 10.4103/1319-2442.279938

PMID: 32129211

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