성인 신생검 1000례에 대한 분석

Abstract

We performed 1,000 consecutive native kidney biopsies using the 14 gauge Franklin-modified Vim-Silverman needle in adults at Keimyung University Hospital between Dec. 1978 and Aug. 1994 to assess the knowledge regarding renal histology on patient management. The indications for renal biopsy were :nephrotic syndrome (61.1%), hematuria and proteinuria(17.1%), glomerulopathy associated with systemic diseases(11.2%), renal insufficiency(3.3%), acute glomerulonephritis(3.2%), acute renal failure(2.6%), uremia(1.0%) and rapidly progressive glomerulonephritis(0.5%). One core of renal was tissue obtained in 20.7% of the cases, 2 cores in 53.3% and above 3 cores in 26.0%. The tissue specimen was adequate for histological evaluation in 90.6% of the cases. The major glomerular diseases were minimal change nephrotic syndrome(27.8%), Ig A nephropa thy(17.3%), focal segmental glomerulosclerosis(10.6%), menbranous nephropathy(10.4%), lupus nephritis(8.1%), membranous proliferative glomerulonephritis(7.6%), chronic glomerulonephritis(3.5%) and crescentic glomerulopathy(1.5%). Complications occurred in 51.8% of the total biopsies performed, consisting of microscopic hematuria lasting for more than 12 hours(38.3%), gross hematuria(9.1%), pain and tenderness(5.8%) and perirenal hematoma(2.7%). Major complications occurred in 12 patients(1.2%) in whom active therapy was required. In 7 cases, active hemorrhage developed and transfusion was required. Surgical repair of laceration with persistent bleeding was required in two patients. Three patients developed arteriovenous arteriovenous fistula following renal biopsies, who were treated successfully with superselective embolization. We suggested that a percutaneous renal biopsy is necessary for optimal evaluation of the glomerular disease when it comes to patient management.