versão On-line ISSN 1683-9803
TROCHE, A et al. Clinical and Anatomopathological Characteristics of Patients Undergoing Renal Biopsy at a Pediatric Nephrology Unit. Pediatr. (Asunción) [online]. 2009, vol.36, n.1, pp.29-34. ISSN 1683-9803.
Introduction: Glomerulopathies can have varied clinical expression during childhood. They can manifest clinically as minor urinary anomalies, nephritic syndrome, acute or chronic glomerulonephritis (GN), or nephrotic syndrome (NS). Indications for renal biopsy (RB) are based on age, clinical manifestations, progression, and response to treatment, including corticosteroid resistance in nephrotic syndrome, among other factors. In properly selected cases it provides a useful guide for diagnosis, prognosis, and treatment of glomerular conditions. Objective: To describe the epidemiology, clinical presentation, and histological results in patients hospitalized in the children’s nephrology ward for whom a renal biopsy was done. Methods: An observational and descriptive retrospective cross-sectional study with review of the patient records of patients hospitalized in the children’s nephrology ward from March 2007 to May 2008 who underwent a renal biopsy with results analyzed by optical and electronic microscopy and direct immunofluorescence in the pathology department of the Health Sciences Research Institute (IICS). Results: The 10 patients who underwent biopsy included 3 females and 7 males, with an average age of 9.1 years (Range: 2 to 16 years). Of the renal biopsies, 2 were done open sky, in 2 patients ages 2 and 3 years, while 8 were done by ultrasound-guided percutaneous puncture. Initial clinical presentation included NS (50%), minor urinary anomalies (40%), NS associated with nephrosis (10%). Renal biopsy findings included lupus nephritis (40%), corticosteroid resistant NS (30%), nephrotic syndrome associated with renal insufficiency (10%), suspected hereditary nephritis (10%), and proteinuria and chronic renal insufficiency (10%). In patients with corticosteroid resistant nephrotic syndrome, diagnosis by optical microscopy found 1 case of chronic membranous GN with membranoproliferative areas, 1 case of focal segmental glomerulosclerosis associated with nephrocalcinosis, and 1 case of mesangial proliferative GN. The cases of lupus nephritis all corresponded to diffuse proliferative GN. Mild mesangial glomerulonephritis was reported in the case of suspected hereditary nephritis. Three samples (30%) were inadequate. Conclusion: Nephrotic syndrome was the most common clinical presentation seen in patients who were biopsied. The most common type of glomerulopathy found was diffuse proliferative GN. Diverse histologies were found in the corticosteroid resistant cases of NS. The preferred method for RB was ultrasound-guided percutaneous puncture, with open-sky biopsies reserved for the smallest patients.
Palavras-chave : renal biopsy; glomerulopathy; clinical presentation; pathology.