An Overview Of Renal Biopsy Needle Pathology
Nov 09, 2022
A kidney biopsy is usually called a renal biopsy. Due to the wide variety of renal diseases, complex etiology and pathogenesis, the clinical manifestations of many renal diseases are not completely consistent with the histological changes of the kidney. In order to clarify the etiology and pathology of the disease and further confirm the specific diseases of the patient, it is necessary to do kidney biopsy at this time! In recent years, with the development of science and technology, the update of imaging equipment and the improvement of operating skills, the technique of percutaneous kidney biopsy has been widely developed, which can directly observe the changes of renal morphology of kidney disease and can carry out a series of observations. Due to the improvement of puncture technique, the application of immunohistochemistry and electron microscopy, the quality of diagnosis has been greatly improved. It has become an important means for the diagnosis, treatment and prognosis of kidney disease. It also contributed to the etiology and development trend of various glomerular diseases. A kidney biopsy is necessary if:
1. Nephrotic syndrome: When the etiology of nephrotic syndrome is unknown, consider whether it is secondary to systemic disease;
2. Renal biopsy is required to determine the pathological type of renal damage in patients with rapid renal decline in glomerulonephritis.
3. In acute nephritis syndrome, renal biopsy can detect the form and extent of inflammatory and immune deposits, which is very important for the early diagnosis and treatment of acute nephritis. Clinical manifestations are atypical for primary acute nephritis or acute nephritis that does not heal after several months or with decreased renal function.
4. In adults with primary nephrotic syndrome, it is best to do kidney biopsy before hormone use to determine the tissue type, so as to avoid the side effects caused by blind use of hormones, especially in patients with ineffective treatment, kidney biopsy should be performed.
5. Patients with hematuria who have excluded non-glomerular hematuria through various examinations and fail to establish a diagnosis can be considered for kidney biopsy. For patients with persistent hematuria with no clinical manifestations or hematuria accompanied by proteinuria, renal biopsy should be performed for those with a 24-hour urinary protein quantity of more than 1 gram.
6. For patients with pure proteinuria for a long time without any symptoms, renal biopsy can be used to clarify the pathological type, so as to facilitate drug use and prognosis judgment.
7. Patients with lupus nephritis, renal hypertension, acute renal failure, and chronic renal failure of unknown cause may undergo kidney biopsy to aid diagnosis.
When these conditions occur, it is advisable for patients to go to the hospital for a kidney biopsy for a definitive diagnosis.
It is mainly used in the diagnosis of lupus nephritis in rheumatic immune system diseases, and is an important means to understand the pathological types of lupus nephritis. In recent years, due to the improvement of kidney biopsy technique, kidney biopsy guided by B ultrasound has been gradually developed more widely. Renal biopsy is the main basis for diagnosis, treatment adjustment and prognosis. One of the main roles of renal biopsy in lupus nephritis is to determine the degree of lesion activity and chronic change in order to understand prognosis and guide treatment.
Active lupus nephritis (lupus nephritis) has been recognized as a guideline for intensive treatment. It is an important index for active corticosteroid and cytotoxic drug therapy. For example, ① glomerular segmental necrosis; ② Obvious proliferation of glomerular cells; ③ the change of the substrate film wire ring; (4) Electron microscopy revealed more electron compact deposits, nuclear fragments and hematoxylin bodies in subcutaneous and mesangial regions. ⑤ cellular crescent body; ⑥ small renal vascular lesions; ⑦ Extensive interstitial edema and monocyte infiltration.
But if lupus nephritis is mainly chronic disease, the curative effect is poor. Evidence of chronic disease is: ① glomerulosclerosis; ② fibrous crescent body; ③ Renal tubule atrophy; ④ Renal interstitial fibrosis; (5) Adhesion of renal sacs; ⑥ Renal tubule sclerosis. The 5-year survival rate of kidney was significantly lower in patients with predominance of the above chronic indicators.
