Sub-Nephrotic Proteinuria as the Indication for a Kidney Biopsy: Review
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Sub-nephrotic proteinuria as a clinical syndrome and an indication to renal biopsy has not much attention. In this systematic review, series from 24 studies have been researched. IgA nephropathy, MesPGN and MGN were respectively defined as the most likely diagnoses for patients undergoing renal biopsies due to sub-nephrotic proteinuria. Profound disparities were also detected with regard to the patients’ region of origin as well as their age subgroup. Due to the limitation of the number of series reporting data on sub-nephrotic proteinuria and associated pathological diagnoses, further data coming with the prospective reports are necessary to make more precise estimations.Objective:To find out the clinical pathological character of children IgA nephropathy(IgAN).Methods:To do the retrospective analysis of the clinical pathological data of children idiopathic IgA nephropathy diagnosed by renal biopsy from 1984 to 2005 June.Results:The common clinical IgAN ranks from pure hematuria (36.8%) to hematuria accompanied proteinuria(31.6%);the severity of clinical and pathological changes ranks from nephritic syndrome to hematuria accompanied proteinuria in which easily combined with renal failure and hypertension;the immune complexs deposit of nephritic syndrome mainly are IgA+IgG+IgM,but the deposit of pure hematuria and hematuria accompanied proteinuria are IgA+IgG.Conclusion:The clinical and pathological grades of children IgAN relating with therapy and prognosis help better comprehend children IgAN and formulate accurate treatmemt plan and evaluate prognosis objectively only through renal biopsy.
Nephritic syndrome
Macroscopic hematuria
Immunoglobulin A
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Objectives To explore the clinical manifestations,pathological features,and prognosis of primary IgA nephropathy(IgAN)in children. Methods The clinical manifestations and pathological features were analyzed in 81 children with IgAN. Effect of treatment was assessed in individual cases through 0.5 ～ 84 month follow-up. Results Simple hematuria and hematuria combined with proteinuria were the most common clinical manifestation (33.3%),followed by nephrotic syndrome(21.0%)and chronic nephritic syndrome(4.9%). Pathological analysis showed that Grade III nephropathy was the most common(53.1%),followed by Grade II (30.9%)and Grade IV(12.3%). The deposition of solo IgA in the glomeruli was the most common(75.3%),followed by IgA + IgM + IgG(+C3)deposition(17.3%) and IgA+IgM(+C3)deposition (7.4%). The severity of glomerular lesion was significantly correlated with clinical manifestations(χ2 = 6.769,P = 0.034). During the follow-up(mean duration of 27 months),66 out of 73 children (90.4%)had normal renal function and decreased excretion of protein in urine( 1 g/24 h=. Conclusions The clinical manifestations of primary IgAN in children are correlated with pathological changes. The patients with nephrotic syndrome or nephritic syndrome are more likely to have severe pathological changes. Renal functions will be improved when the the symptoms are relieved by early treatment.
Nephritic syndrome
Immunoglobulin A
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Renal pathology
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Objective:To investigate the clinical and pathological features of idiopathic membranous nephropathy (IMN) in Chinese adults. Methods:Two hundred and sixty four patients with membranous nephropathy from 1986 to 1997 were selected in this study. The clinical and pathological finding were compared among patients in different age groups with student t test. Results: (1) Patients between 21 and 40 years old were inclined to membranous nephropathy. (2) One hundred and six out of 264 patients had heavy proteinuria at presentation. Hypertension was found in 35 out of 264 patients. Renal insuffiency occured in 7.7% of the patients at the time of renal biopsy.Microscopic hematuria was found in 40.2% of them. Seventy four patients(28.0%) presented nephrotic syndrome. (3) Six of 37 patients had deterioration of renal function during the mean period of 49 months follow up. (4) Patients of stage Ⅰ,Ⅱ,Ⅲand Ⅳ of IMN accounted for 42.3%, 48.7%, 6.0% and 3.0%, respectively. Depositions of glomerular IgG,C 3 and C 1q were found in 93.2%, 98.8% and 58.3% of the patients. Conclusion: IMN often occurs at the age of 21 to 40 years in Chinese patients. The incidence of hypertension,microscopic hematuria and renal insufficiency is similar to that of other countries, while nephrotic syndrome is uncommon. [
Membranous Nephropathy
Chronic renal insufficiency
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Objective: To investigate the clinical and pathological features of idiopathic membranous nephropathy (IMN) in Chinese adults. Methods: From 1986 to 1997, 264 patients with biopsy proven membranous nephropathy were selected in this study. Clinical and pathological features were compared between patients at different ages by t test. Results: (1) Patients from 21- 40 years old were inclined to membranous nephropathy. (2) One hundred and six of the patients had heavy proteinuria at presentation. Hypertension was found in 35 patients. Renal insuffeiency occurred in 7.7% of the patients in renal biopsy. Microscopic hematuria was found in 40.2% of the patients. Seventy-four patients presented nephrotic syndrome. (3) Eight of the 57 patients had deterioration of renal function during an average 49-month follow-up. (4) Patients of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ accounted for 42.3%, 48.7%, 6.0% and 3.0% respectively. Glomeruli IgG, C3 and C1qdeposition was found in 93.2%, 98.8% and 58.3% of the patients. Conclusion: Younger patients are inclined to membranous nephropathy. The incidence of hypertension, microscopic hematuria and renal insuffcieney is similar to that of other countries, while nephrotic syndrome is uncommon.
Membranous Nephropathy
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Objectives To explore the dynamic changes of clinical features and pathological lesions in children with IgA nephropathy. Methods Clinical and pathological data of five children with IgA nephropathy were collected before and after each renal biopsy. Results Among 5 cases,4 children were biopsied twice, 1 child had 3 times. Basic clinical manifestations of 5 cases were persistent microscopic hematuria or intermittent gross hematuria with varied levels of proteinuria and decreased renal function. The basic renal pathology was mesangial proliferation. Repeated renal biopsies showed pathological progression. Conclusions Clinical features and renal pathological changes of IgA nephropathy were highly variable between cases. When severe relapse occurs,a repeat renal biopsy should be performed to provide information for further treatment. The indication for repeat renal biopsy was discussed.
Renal pathology
Gross hematuria
Mesangial proliferative glomerulonephritis
Microscopic hematuria
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Objective To study the pathology of primary IgA nephropathy and its clinical characteristics and explore the relationship between efficacy and prognosis.Methods Fifty-five patients with primary IgA nephropathy had their renal biopsy and analysis was done of pathological type,clinical manifestations,efficacy and prognosis.Results Patients with mild pathological types of asymptomatic hematuria and/or proteinuria had good efficacy, patients with severe pathological types of severe nephrotic syndrome with hypertension and renal insufficiency had poor efficacy. It indicated that renal pathology was significantly related toclinical manifestations,efficacy and prognosis.Conclusions Early renal biopsy and treatment can delay the deterioration of renal failure.
Key words:
Primary IgA nephropathy; Renal biopsy; Renal pathology
Renal pathology
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Objective To study IgA nephropathy(IgAN) the clinical features and the relationship between pathological grade,clinical treatment and prognosis.Methods A retrospective summary of percutaneous in 65 patients diagnosed as IgAN patients,according to Lee classification,system analysis and clinical indicators of tumor grade between.Results The pathological types in 65 patients were I,Ⅱ,Ⅲ,Ⅳ,V-type each 6.2%,12.3%,38.5%,40%,3.1%;Most pathology who showed mild asymptomatic hematuria and(or) proteinuria,good effect,and the pathological type of clinical manifestations of severe nephrotic syndrome,renal failure with hypertension,poor efficacy and poor prognosis.Conclusions The clinical pathological kidney diversification,early in time for renal biopsy and pathological classification of IgA nephropathy in guiding treatment and prognosis has important clinical significance.
Renal pathology
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Sub-nephrotic proteinuria as a clinical syndrome and an indication to renal biopsy has not much attention. In this systematic review, series from 24 studies have been researched. IgA nephropathy, MesPGN and MGN were respectively defined as the most likely diagnoses for patients undergoing renal biopsies due to sub-nephrotic proteinuria. Profound disparities were also detected with regard to the patients’ region of origin as well as their age subgroup. Due to the limitation of the number of series reporting data on sub-nephrotic proteinuria and associated pathological diagnoses, further data coming with the prospective reports are necessary to make more precise estimations.
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Objective To observe the pathological changes in children with frequently relapsing and refractory nephrotic syndrome.Methods 49 children with refractory nephrotic syndrome were repeated renal biopsy,and their pathology were compared.Results The 1st time of renal biopsy to repeated biopsy from 10 to 48 months,the mean interval was 20.6 months.At the time of the second biopsies,pathological changes in 12 cases and the pathologic change rate was 24.49%,pathological transformation of up to MCD(9 cases,75.0%),followed by MsPGN(3 cases,18.75%).FSGS,IgAN,MPGN and MN was not found in pathological transition.Conclusion These results suggest that the therapy management should be adjusted if the children with frequently relapsing and refractory nephrotic syndrome did not have a satisfactory clinical response.It is advocated that perform a repeat biopsy repeat biopsy as soon as possible if the effect is still poor,to keep abreast of pathological changes,adjustment and development of new treatment options.
Refractory (planetary science)
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