Safety Analysis And Clinical Application Of CT-guided And Ultrasound-guided Percutaneous Renal Biopsy In 97 Children With Chronic Kidney Disease

Objective:To summarize the clinical data of children with chronic kidney disease who were conducted undergoing percutaneous renal biopsy in the Second Affiliated Hospital of Medical University from January 2008 to January 2019,and to analyze the safety of CT and ultrasound-guided percutaneous renal biopsy,and to investigate the clinical application of renal biopsy.Methods:The retrospective study selected 97 children with chronic kidney disease who were conducted undergoing percutaneous renal biopsy in the Second Affiliated Hospital of Medical University from January 2008 to January 2019 as objects.They were divided into CT-guided group and ultrasound-guided group according to guidance method.The safety of percutaneous renal biopsy puncture under different guidance methods was evaluated by retrospective analysis and comparison the success rate of the selected materials and the incidence rate of postoperative complications in the two groups.The clinical application value of renal biopsy was discussed by summarizing the clinical data and renal pathology data of the 97 children.Results:1.A total of 97 children with chronic kidney disease who were conducted undergoing percutaneous renal biopsy in our department from January 2008 to January,including 47 cases of males,50 cases of women,age range 3.1~16 years old,average age(9.75±4.6)years;56 cases in CT guidance Group,41 cases in ultrasound guidance Group.There was no statistically significant comparison between the gender composition and age composition of the two groups(P > 0.05).2.The success rate of material extraction in CT-guided group and ultrasound-guided group were both 100%.The comparison in the number of glomeruli under light microscope between the two groups was no statistically significance(P >0.05).3.The incidence of microscopic hematuria in the 97 children with percutaneous renal biopsy was 100%,the incidence of complications was 10.3%,including microhematuria hematuria(3.1%),lumber pain(5.1%),perirenal hematoma(2.1%).No renal arterio-venous fistula,renal abscess,severe hemorrhage,acute renal failure and other serious complications occurred in the 97 children.4.The incidence of complications in CT-guided group was 10.7%,including microhematuria hematuria(3.6%),lumber pain(5.4%),perirenal hematoma(1.8%),and the incidence of complications in ultrasound guidance group was 9.7%,including microhematuria hematuria(2.4%),lumber pain(4.9%),perirenal hematoma(2.4%).The comparison of the complication rate has no statistical significance(P > 0.05).5.The most common clinical diagnosis of primary glomerular disease in this study was nephrotic syndrome(63.3%),followed by isolated hematuria(22.4%);the most common pathological diagnosis was Ig A nephropathy(42.8%),followed by glomerular minimal change and glomerular minor lesion.The simple type primary nephrotic syndrome has various pathological types,including glomerular minimal change(56.2%),glomerular minor lesion(12.5%),Ig M nephropathy(12.5%),mesangial proliferative glomerulonephritis(6.3%)and focal segmental glomerulosclerosis(6.3%).Purpuranephritis(51.0%)was the most common in the secondary glomerular disease,followed by lupus nephritis.The most common clinical manifestaion of purpura nephritis was hematuria and proteinuria(45.8%),followed by nephrotic syndrome(25%),isolated proteinuria(20.8%),isolated hematuria(8.3%);the most common pathological types was grade ?-a(33.3%),followed by grade ?-b(29.2%),grade ?-a(20.8%),?-b(33.3%).The clinical manifestations and pathological types in the purpura nephritis are not consistent.The most common clinical manifestations of lupus nephritis were nephrotic syndrome,hematuria and proteinuria(both 31.8%),followed by isolated proteinuria(27.2%),isolated hematuria and renal insufficiency(both 4.8%);the most common pathological type was type-?(40.9%),followed by type-?(31.8%),type-?(14.3%),type-?(9.1%),type-?(4.5%).Yet the clinical manifestations and pathological types in the lupus nephritis have no correspondence.1 case of hereditary glomerular disease was thin basement membrane nephropathy which was diagnosed under light microscope.6.In this study,the diagnostic correction rate of the 97 children after renal biopsy was 25.6%.Conclusion:1.Percutaneous renal biopsy under CT or ultrasound guidance which have high success rate,ideal material extraconl satisfaction,less and slight complications,is safe and reliable for children.But ultrasound-guided percutaneous renal biopsy puncture is more economical,easier to operate,and has no radiation,which is more suitable for children.2.The severity of clinical manifestation is not completely parallel with the severity of pathological changes in children renal disease.Renal biopsy can clearly judge the pathological type and nature of renal disease,assess the degree of renal injury,guide effective treatment,avoid delayed treatment and over treatment.