Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 2934  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (17 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Indications for ...
 ::  Contraindication...
 ::  Article Tables

 Article Access Statistics
    Viewed18452    
    Printed229    
    Emailed20    
    PDF Downloaded267    
    Comments [Add]    

Recommend this journal


 


 
ISSUES IN PRACTICAL NEPHROLOGY
Year : 1994  |  Volume : 40  |  Issue : 3  |  Page : 135-6

The role of renal biopsy in nephrotic syndrome.


Department of Nephrology, Jaslok Hospital & Research Centre, Bombay.

Correspondence Address:
B V Gandhi
Department of Nephrology, Jaslok Hospital & Research Centre, Bombay.

Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 0008699379

Rights and PermissionsRights and Permissions



Keywords: Biopsy, Human, Nephrotic Syndrome, etiology,pathology,Sensitivity and Specificity,


How to cite this article:
Gandhi B V. The role of renal biopsy in nephrotic syndrome. J Postgrad Med 1994;40:135

How to cite this URL:
Gandhi B V. The role of renal biopsy in nephrotic syndrome. J Postgrad Med [serial online] 1994 [cited 2019 Nov 21];40:135. Available from: http://www.jpgmonline.com/text.asp?1994/40/3/135/541


My topic for the talk in issues in practical nephrology session is the Role of Renal Biopsy in Nephrotic Syndrome (NS). The introduction of renal biopsy in clinical practice by Inverson and Brun in 1951 has represented one of the most important advances in the field of Nephrology. Even today in spite of the flood of new and less invasive tests, renal biopsy is still considered by most nephrologists as an irreplaceable tool in diagnosis and prognosis and in deciding therapy in many renal diseases.

Let us start with the basics

The salient features of NS are: proteinuria > 3.5 gms/1.73 sq. m., hypoalbuminemia, hyperlipidemia and edema. Routine investigations done in such cases are: Detail history and physical examination followed by routine urinalysis, complete blood counts, BUN, Creatinine, 24 hour urinary proteins, Total proteins with A/G ratio and serum cholesterol level. In selected patients postprandial blood sugars, ANA, Anti DNA, serum protein electrophoresis, C3 and C4 are done. At times urine protein electrophoresis is also done to determine selectivity of proteinuria or Bence Jones protein.

The common causes of the Nephrotic Syndrome are shown in the [Table - 1].

Nephrotic Syndrome in pediatric and adult patients are of two distinct types (certain types of disease are very common in the pediatric group viz. Minimal change while in adult it is not so common). [Table:II] shows the patterns of NS in adult and pediatric group and their prevalence rates:

Most nephrologists refrain from doing a renal biopsy in the pediatric group of patients (less than 6 years) as most of them respond to therapy with prednisolone while in adults almost everyone performs a biopsy before starting therapy as most patients do not respond to standard therapy with steroid for eight to twelve weeks.

Before I go to the indications for a biopsy, I would like to enumerate the questions / treatment options in NS patients.

(1) Should NS be treated?

(2) Treatment options available at present include

(a) Prednisolone

(b) immunosuppressive therapy

(c) cyclosporin

(d) Plasma exchange and

(e) combinations.

(3) Which treatment to start and when to stop

(4) What are the side effects of therapy?

As with therapy, we need to answer some questions before we resort to a renal biopsy. Is a biopsy necessary in a given case or not? If so why? Will the biopsy provide us with more information than that obtained from routine tests? Is identification of the type of renal disease going to influence the prognosis and therapy? Renal biopsy will provide information as to the type and severity of renal disease and aid in the diagnosis, prognosis and guidelines for therapy.

Renal biopsy was first described by Ball in 1934 and later by Perez-Aza and Inverson and Brun in the early fifties. Modification of the original technique was described in 1954 by Mark and Muehrcke- (Prone position, Use of the exploring needle to gauge depth of the kidney and the use of Franklin modification of Vim- Silverman needle). Today most nephrologists use Tru- cut disposable biopsy needle or biopsy 'gun' and they perform the biopsy under ultrasound control to ensure a better yield.


  ::   Indications for renal biopsies: Top


1. Features suggesting a diagnosis other than minimal change nephropathy.

2. NS presenting in first year of life.

3. NS presenting after six years.

4. Failure to respond to adequate dose of steroid therapy in 28 days.

5. Frequently relapsing NS.

6. Steroid dependent NS.

7. Development of Steroid resistance

8. Change in clinical course.

9. Before starting immunosuppressive therapy.

10. Patient with renal insufficiency and NS.

The following complications may be encountered after renal biopsies. These include: a) Gross hematuria (5-7%) (b) Hemoperitoneum i) severe (0.21.4%) ii) Mild (85%) c) Arteriovenous fistula (15%) d) Aneurysm (rare) e) Renal dysfunction (rare) f) Puncture of other organs (rare).


  ::   Contraindications for renal biopsies (absolute and relative): Top


a) Solitary kidneys

b) Renal mass

c) Advanced chronic renal failure

d) Active urinary infection

e) Uncontrolled hypertension

f) Coagulation disorders

g) Renal artery aneurysm

h) Perinephric abscess

i) Horsheshoe kidneys.

The treatment of NS will be dealt with by Dr. MK Mani. In my opinion, the therapy of NS has many limitations and multiple side effects. I would therefore recommend that if we cannot make a patient better with our therapy, then we should not make them any worse with the side effects of our therapy. I will therefore conclude with the following advice - Do a renal biopsy in patients when indicated and thereafter decide whether to treat them or not.


    Tables

[Table - 1], [Table - 2]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow