Clinical And Pathological Study Of Percutaneous Renal Biopsy In Children

Objective:There are many kinds of renal diseases in children,most of which are glomerular diseases.Because of their different clinical or pathological types,the treatment and long-term prognosis of children are different.The purpose of this study is to summarize the data of children undergoing percutaneous renal biopsy in our hospital,analyze their clinical and pathological features,fully understand the importance of percutaneous renal biopsy in children’s renal diseases,and provide reference materials for clinicians.Methods:The clinical and pathological data(including general data,clinical diagnosis,laboratory indexes and pathological types)of children under 18 years old who were undergoing renal biopsy and hospitalized in the Department of Pediatrics and Nephrology of the First Affiliated Hospital of Nanchang University from November 1,2011 to November 30,2019 were collected and analyzed retrospectively,and the data were processed by SPSS26.0 statistical software.The measurement data were expressed by mean ± standard deviation,the differences between groups were compared by t-test,while the counting data were expressed by frequency or percentage,and the differences between groups were compared by chi-square test or Fisher exact probability method.Using α = 0.05 as the test level,P < 0.05 represented that the difference was statistically significant.After statistics,the characteristics and the correlation between clinical and pathology were analyzed respectively.Results:1.Overall situation:A total of 142 children were included in this study,with an average age of 13.63±3.41 years old,including 101 cases(71.13%)in primary glomerular disease group,34 cases(23.94%)in secondary glomerular disease group,6 cases(4.23%)in hereditary nephropathy group and 1 case(0.7%)in renal tubulointerstitial disease group.In terms of sex composition,there were 98 males and 44 females,with a male-to-female ratio of 2.23.In the primary glomerular disease group,there were more males(78 cases)than females(23 cases).In the secondary glomerular disease group,females(19 cases)were slightly more than males(15 cases).In terms of age,the number of cases in the ≥ 10-year-old group was 120(84.51%),accounting for the vast majority.And there were 17 cases(11.97%)in the 7 to 10-year-old group and 5 cases(3.52%)in the < 7-year-old group.2.Comparison of laboratory indexes:Compared with PGD group,the levels of complement C3,complement C4,total cholesterol and high-density lipoprotein in SGD group were lower,and the average levels of albumin and serum calcium were higher.The increase of serum IgG was smaller in SGD group than in PGD group.The difference was statistically significant(P < 0.05).3.Clinical type:(1)The most common clinical type of primary glomerular disease was nephrotic syndrome(77 cases,accounting for 76.24%),followed by hematuria and / or proteinuria(13 cases,accounting for 12.87%),acute glomerulonephritis(5 cases,accounting for 4.95%)and rapidly progressive glomerulonephritis(4 cases,accounting for 3.96%).Among the clinical types,chronic glomerulonephritis(2 cases,accounting for 1.98%)was the least common.(2)Among the secondary glomerular diseases,Henoch-Schonlein purpura nephritis(24 cases,accounting for 70.59%)was the most common,followed by lupus nephritis(8 cases,accounting for 23.53%).Hepatitis B virus-associated glomerulonephritis(2 cases,accounting for 5.88%)was the least common.4.Pathological type:In primary glomerular diseases,IgA nephropathy was the most common pathological diagnosis(40 cases,accounting for 40.00%),followed by minimal change disease(28 cases,accounting for 28.00%).The pathological diagnosis of lupus nephritis was mainly type IV(4 cases),followed by type IV + V(3 cases)and type Ⅱ(1 case).In Henoch-Schonlein purpura nephritis,the main pathological diagnosis was grade Ⅱa(13 cases),followed by grade Ⅱb(5 cases),grade Ⅲa(4 cases)and grade Ⅲb(2 cases).There were 2 cases of hepatitis B virus-associated glomerulonephritis.1 case was mesangial proliferative glomerulonephritis.1 case was membranous nephropathy.5.Clinicopathological relationship of primary glomerular disease:There was no obvious one-to-one correspondence between clinical type and pathological type of primary glomerular disease.The pathological types of children with nephrotic syndrome were widely distributed.Minimal change disease and IgA nephropathy were the most common.The main pathological type of children with hematuria and / or proteinuria was IgA nephropathy.6.Complications after renal biopsy:Postoperative complications occurred in 46 cases,accounting for 32.40% of the total.Among the complications,the incidence of hematuria was high(26 cases,accounting for 18.31%),followed by low back pain(16 cases,accounting for 11.27%).There were few cases of infection(4 cases,accounting for 2.82%).And there was no perirenal hematoma in the complications.Conclusions:1.Primary glomerular diseases are predominant in children.Males are more common than females,and adolescents account for the majority.2.In this group of data,nephrotic syndrome is the most common clinical type of primary glomerular disease,and IgA nephropathy is the most common pathological type.Among the secondary glomerular diseases,Henoch-Schonlein purpura nephritis is the most common,and most of the pathological types are grade Ⅱ and grade Ⅲ.The major pathological types of lupus nephritis are type IV and type IV above lesion.3.There is no obvious one-to-one correspondence between clinical and pathological types of primary glomerular disease,so it is necessary to make a diagnosis and guide the follow-up treatment by comprehensive analysis of clinical and pathological data of renal biopsy.4.The clinical diagnosis of hereditary nephropathy is difficult and easy to be ignored,which needs to be combined with the pathological results of renal biopsy and the family history of the child.5.Ultrasound-guided percutaneous renal biopsy in children is easy to operate,with high success rate and low incidence of postoperative complications.The main postoperative complications are hematuria and low back pain.And the general symptoms can be relieved by proper treatment,such as full rest and hemostasis.