Hong Kong Med J 2008;14:348-55 | Number 5, October 2008
Ten-year review of disease pattern from percutaneous renal biopsy: an experience from a paediatric tertiary renal centre in Hong Kong
LK Yuen, WM Lai, SC Lau, PC Tong, KC Tse, MC Chiu
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong
OBJECTIVE. To study the childhood renal disease pattern based on the renal biopsy histology in a local paediatric tertiary renal centre.
DESIGN. Retrospective study.
SETTING. Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.
PATIENTS. All patients who underwent real-time ultrasound-guided closed renal biopsy from 1 April 1997 to 31 March 2007 were included.
RESULTS. A total of 209 renal biopsies were performed, 162 on native kidneys and 47 on grafts. In the native group, major indications were renal manifestations secondary to systemic diseases (34%), followed by idiopathic nephrotic syndrome (28%) and haematuria (27%). In 94% the histopathology revealed glomerular diseases. Among the primary glomerular diseases, thin glomerular basement membrane disease, immunoglobulin A nephropathy, minimal change disease, and focal segmental glomerulosclerosis accounted for most. In all, 37% of patients with steroid-resistant nephrotic syndrome had focal segmental glomerulosclerosis and its relative incidence was increased when compared to previous studies. Minimal change disease and minimal change disease with mesangial immunoglobulin M deposits accounted for the majority of steroid dependent and frequent relapsers. Among patients with isolated microscopic haematuria, 73% had thin glomerular basement membrane disease, while patients with concomitant haematuria and proteinuria had a wide variety of pathology. In the kidney graft group, acute graft dysfunction was due to acute rejection in 38% of the patients, followed by calcineurin inhibitor toxicity in 14%. Chronic allograft nephropathy caused chronic allograft dysfunction in the majority of cases. Post-transplant proteinuria was caused by recurrence of the primary renal disease in all of our patients.
CONCLUSION. This study provides updated epidemiological information for childhood renal disease and a change in the pattern of disease was observed.
Key words: Biopsy; Glomerulonephritis, IGA; Glomerulosclerosis, focal segmental; Kidney transplantation; Nephrotic syndrome
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