The significance of renal biopsy by renal puncture biopsy

Understanding the changes of renal histomorphology provides an important basis for clinicians to judge disease, treat disease and estimate prognosis. It can be said that the development of renal pathological examination is a leap in the development of nephrology. At present, the result of renal pathology has become the gold index of renal disease diagnosis. To sum up, the clinical significance of renal puncture examination is mainly as follows:

(1) Definite diagnosis: The clinical diagnosis can be corrected by renal biopsy in more than one-third of patients.

(2) Guiding treatment: renal biopsy can modify the clinical treatment of nearly one third of patients.

(3) Prognosis estimation: Renal biopsy can more accurately assess the prognosis of patients with renal disease.

In addition, repeated renal pathology is sometimes required to understand the outcome of treatment or to understand the pathologic progression (e.g., crescentic nephritis, lupus nephritis, and IgA nephropathy).

In order to clarify the diagnosis, guide the treatment or judge the prognosis, and there is no contraindication of puncture, kidney puncture can be used for all kinds of primary, secondary and hereditary renal parenchymal diseases (especially diffuse lesions).

(1) Primary kidney disease: ① Acute nephritis syndrome, acute renal function deterioration, suspected acute nephritis, should be puncturated as soon as possible; According to the acute nephritis treatment for 2 ~ 3 months without improvement should be done kidney puncture. ② Primary nephrotic syndrome, treatment first, and renal puncture when hormone regulation treatment failed for 8 weeks; Or puncture first, according to pathological type there is a difference in treatment. ③ Asymptomatic hematuria, deformed erythrocyte hematuria clinical diagnosis is not clear, asymptomatic proteinuria, proteinuria continues >1g/d unclear diagnosis should be done renal biopsy examination.

(2) Secondary or hereditary kidney disease: renal puncture should be done when it is clinically suspected that it cannot be diagnosed, but the renal pathological data is of great significance to guide the treatment or judge the prognosis.

(3) Acute renal failure (ARF) : timely puncture should be performed when clinical and laboratory tests cannot determine the cause (including acute deterioration of renal function in patients with chronic kidney disease).

(4) Kidney transplantation: ① when the cause of obvious renal function decline is unclear, ② severe rejection decides whether to remove the kidney transplantation; ③ Suspected recurrence of the kidney disease in the transplanted kidney.

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