Introduction: Percutaneous renal biopsy (PRB) is the gold standard for the diagnosis of most renal diseases. It is a safe and effective modality for the collection of renal tissue. However, many safety measures are no...Introduction: Percutaneous renal biopsy (PRB) is the gold standard for the diagnosis of most renal diseases. It is a safe and effective modality for the collection of renal tissue. However, many safety measures are not based on sufficient evidence and therefore vary considerably from a center to another. The aim of this work is to determine the rate of bleeding complications, to identify the risk factors for these complications, and to clarify the post renal biopsy prognosis. Materials and Methods: We performed a single-center retrospective observational study in the nephrology department at the University Hospital of Fez, including all patients who underwent percutaneous renal biopsy on native kidney between January 2018 and December 2019. Results: Overall, 157 biopsies were performed. Deglobulization was present in 20.4% (40) of patients, the mean age of patients was 41.57 ± 16.11 years [16.78]. The sex ratio M/F: 1.22. Diabetes mellitus was present in four cases (11.1%), arterial hypertension was present in four cases (11.1%). On clinical examination, systolic hypertension was found in 45.7%, diastolic hypertension in 45%, antihypertensive therapy was initiated in all patients with hypertension before. Hyperuremia was present in 29 patients (80.6%), renal failure was present in 77.8%. Anemia was present in 55.6%, thrombocytopenia in six cases (16.7%). Radiologically, the size of the kidneys was reduced in 5 patients (17.2%), differentiation was limited in 5 patients (17.2%). Major complications occurred in 3.8% (6/157). These six patients had a lumbar pain and required blood transfusions. A radiological embolization procedure was indicated in only one patient. Minor complications were seen in 21.6% (34/157). The diagnoses that were retained in patients with deglobulization were: Lupus in 34.71%, pauci-immune vasculitis in 13.79%, membranous glomerulonephritis in 10.34%, focal and segmental hyalinosis in 10.34%, membrano-proliferative glomerulonephritis in 10.34%. In univariate and multivariate analysis, the major risk factors for deglobulization found in our patients were: hyperuremia 80.6% (p: 0.017), acute renal failure 77.8% (p: 0.04), acute hemodialysis 24.7% (p: 0.02), hyperphosphatemia 63.6% (0.04). Conclusion: Renal biopsies are an overall safe procedure with rare major complications. Post-renal biopsy deglobulization is common. Routine post-biopsy ultrasound may not be necessary. Renal biopsies can be performed safely if risk factors are controlled, such as renal failure, hyperuremia, hyperphosphatemia, hemodialysis patients and a diagnosis of lupus nephropathy.展开更多
Most of the literature focused on the proliferative forms of the lupic Glomerulonephritis. Clinicians are increasingly confronted with cases of lupic nephropathy purely mesangial (class II). The aim of our study is to...Most of the literature focused on the proliferative forms of the lupic Glomerulonephritis. Clinicians are increasingly confronted with cases of lupic nephropathy purely mesangial (class II). The aim of our study is to describe the mode of presentation of the class II Lupus nephropathy, evaluate its evolutionary profile, and investigate possible risk factors for therapeutic misresponse, relapse or histological transformation. This is a retrospective descriptive and analytical study conducted in nephrology depratement at the Hassan II university hospital Fez from January 2009 until September 2018. We included 20 patients. The average age was 33.8 ± 7.25 years [22 - 50 years]. Nephropathy was inaugurated in half of the cases. The mean time of onset of nephropathy in relation to the lupic disease was 36.7 ± 45.4 months [1 - 144 months]. The main reason for consultation was non-nephrotic proteinuria (65%). Renal failure revealed diagnosis in three patients. All patients had a positive immunologic assessment. 90% of our patients received oral corticosteroid therapy with immunosuppressive therapy in 3 cases. Remission has been noted in all of our patients. After an average follow-up period of 39 ± 23 months [6 - 92 months], 45% relapsed. A second biopsy was performed in 80% of patients showing histologic transformation in four patients, requiring immunosuppressive therapy. The analytical study showed that the occurrence of relapse was significantly related to the presence of a known Lupus and its seniority. Proteinuria at 12 months was also significantly higher in the relapsed group. One patient died as a result of neurological complications. Another has Evolved into chronic end stage renal failure and has been put on hemodialysis.展开更多
文摘Introduction: Percutaneous renal biopsy (PRB) is the gold standard for the diagnosis of most renal diseases. It is a safe and effective modality for the collection of renal tissue. However, many safety measures are not based on sufficient evidence and therefore vary considerably from a center to another. The aim of this work is to determine the rate of bleeding complications, to identify the risk factors for these complications, and to clarify the post renal biopsy prognosis. Materials and Methods: We performed a single-center retrospective observational study in the nephrology department at the University Hospital of Fez, including all patients who underwent percutaneous renal biopsy on native kidney between January 2018 and December 2019. Results: Overall, 157 biopsies were performed. Deglobulization was present in 20.4% (40) of patients, the mean age of patients was 41.57 ± 16.11 years [16.78]. The sex ratio M/F: 1.22. Diabetes mellitus was present in four cases (11.1%), arterial hypertension was present in four cases (11.1%). On clinical examination, systolic hypertension was found in 45.7%, diastolic hypertension in 45%, antihypertensive therapy was initiated in all patients with hypertension before. Hyperuremia was present in 29 patients (80.6%), renal failure was present in 77.8%. Anemia was present in 55.6%, thrombocytopenia in six cases (16.7%). Radiologically, the size of the kidneys was reduced in 5 patients (17.2%), differentiation was limited in 5 patients (17.2%). Major complications occurred in 3.8% (6/157). These six patients had a lumbar pain and required blood transfusions. A radiological embolization procedure was indicated in only one patient. Minor complications were seen in 21.6% (34/157). The diagnoses that were retained in patients with deglobulization were: Lupus in 34.71%, pauci-immune vasculitis in 13.79%, membranous glomerulonephritis in 10.34%, focal and segmental hyalinosis in 10.34%, membrano-proliferative glomerulonephritis in 10.34%. In univariate and multivariate analysis, the major risk factors for deglobulization found in our patients were: hyperuremia 80.6% (p: 0.017), acute renal failure 77.8% (p: 0.04), acute hemodialysis 24.7% (p: 0.02), hyperphosphatemia 63.6% (0.04). Conclusion: Renal biopsies are an overall safe procedure with rare major complications. Post-renal biopsy deglobulization is common. Routine post-biopsy ultrasound may not be necessary. Renal biopsies can be performed safely if risk factors are controlled, such as renal failure, hyperuremia, hyperphosphatemia, hemodialysis patients and a diagnosis of lupus nephropathy.
文摘Most of the literature focused on the proliferative forms of the lupic Glomerulonephritis. Clinicians are increasingly confronted with cases of lupic nephropathy purely mesangial (class II). The aim of our study is to describe the mode of presentation of the class II Lupus nephropathy, evaluate its evolutionary profile, and investigate possible risk factors for therapeutic misresponse, relapse or histological transformation. This is a retrospective descriptive and analytical study conducted in nephrology depratement at the Hassan II university hospital Fez from January 2009 until September 2018. We included 20 patients. The average age was 33.8 ± 7.25 years [22 - 50 years]. Nephropathy was inaugurated in half of the cases. The mean time of onset of nephropathy in relation to the lupic disease was 36.7 ± 45.4 months [1 - 144 months]. The main reason for consultation was non-nephrotic proteinuria (65%). Renal failure revealed diagnosis in three patients. All patients had a positive immunologic assessment. 90% of our patients received oral corticosteroid therapy with immunosuppressive therapy in 3 cases. Remission has been noted in all of our patients. After an average follow-up period of 39 ± 23 months [6 - 92 months], 45% relapsed. A second biopsy was performed in 80% of patients showing histologic transformation in four patients, requiring immunosuppressive therapy. The analytical study showed that the occurrence of relapse was significantly related to the presence of a known Lupus and its seniority. Proteinuria at 12 months was also significantly higher in the relapsed group. One patient died as a result of neurological complications. Another has Evolved into chronic end stage renal failure and has been put on hemodialysis.
