Analysis of the Clinical Pathway and Pathologic Features of 224 Cases of Renal Biopsy_West China Medical Journal

Authors：

 ZhuZaizhi , ZouXiting , ChenYongzhong , HuFuchang , BaiJianing , ChaoQun , YuanJin , PuChao , XuZhizhong

Department of Nephrology, Meishan People’s Hospital, Meishan, Sichuan 620010, P. R. China;

Corresponding?author：

Keywords：

Renal biopsy; Renal disease; Pathological type; Clinical pathway

DOI：

10.7507/1002-0179.201600231

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Objective To analyze the clinical manifestations and pathological patterns of renal diseases requiring percutaneous renopuncture, evaluate the clinical significance of renal biopsy and the value of clinical pathway for renal biopsy. Methods We retrospectively summarized and analyzed the clinical and pathological data, and the clinical pathway implementation of 224 patients who underwent renal biopsy between October 2009 and September 2014. Results In the 224 patients, there were 62 cases of IgA nephropathy (27.68%), 50 cases of minimal change nephropathy (22.32%), 28 cases of lupus nephritis (12.5%), 26 cases of membrane nephropathy (11.6%), 26 cases of mesangial proliferative glomerulonephritis (11.6%), 6 cases of purpura nephritis (2.68%), 4 cases of focal segmental glomerular sclerosis (1.79%), 4 cases of hepatitis B virus-associated membrane nephropathy (1.79%), 4 cases of nodular diabetic glomerulosclerosis (1.79%), 4 cases of acute tubulointerstitial nephropathy (1.79%), 2 cases of hypertensive renal damage (0.89%), 2 cases of membrano-proliferative glomerulonephritis (0.89%), 1 case of lipoprotein kidney disease (0.45%), and 1 case of fibrillary glomerulopathy (0.45%). A total of 220 specimens in the 224 cases were qualified, accounting for 98.21%. Diagnosis of 70 patients in the qualified 220 cases were re-corrected according to their renal pathology reports, accounting for 31.81%. In the 224 cases, there were 16 cases of gross hematuria (7.14%) and 24 of peri-renal hematoma (10.71%) after renal biopsy. Patients who met the requirement of clinical pathway were divided into clinical pathway group and control group randomly. Average hospitalization time of the clinical pathway group was (7.6±1.2) days, and the average cost was (5 860±237) yuan, both lower than the control group [(11.8±2.3) days, (7 658±360) yuan)]. The difference was statistically significant. Conclusions IgA nephropathy is the most common pathological type of primary glomerular diseases, and minimal change nephropathy the second. Lupus nephritis, membranous nephropathy, mesangial proliferative glomerulonephritis are still the most common types of glomerular diseases. Lupus nephritis becomes the first secondary glomerular disease. Ultrasound guided percutaneous renal biopsy is safe and has high success rate and high clinical application value. The implementation of clinical pathway can shorten the average length of hospital stay and reduce the average hospital cost.

Citation： ZhuZaizhi, ZouXiting, ChenYongzhong, HuFuchang, BaiJianing, ChaoQun, YuanJin, PuChao, XuZhizhong. Analysis of the Clinical Pathway and Pathologic Features of 224 Cases of Renal Biopsy. West China Medical Journal, 2016, 31(5): 845-849. doi: 10.7507/1002-0179.201600231 Copy

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1. 蔡廣研, 陳香美. 慢性腎臟病并發癥治療現狀及思考[J]. 中國實用內科雜志, 2010, 30(2) : 102-103.
2. 中華人民共和國衛生部. 衛生部辦公廳關于印發腎臟內科專業 4個臨床路徑的通知[EB/OL]. (2009-12-11) [2010-01-01]. http://www.nhfpc.gov.cn/zhuzhan/wsbmgz/201304/1730f243b3254c99862c975ac384d695.shtml.
3. 劉紅, 方藝, 許迅輝, 等. 2444例腎活檢臨床病理分析[J]. 中國臨床醫學, 2010, 17(4) : 535-539.
4. 陳惠萍, 曾彩虹, 胡偉新, 等. 10594例腎活檢病理資料分析[J]. 腎臟病與透析腎移植雜志, 2000, 9(6) : 501-509.
5. 史曉虎, 李文歌, 楊冠男, 等. 腎病綜合征的疾病構成: 單中心臨床研究[J]. 中日友好醫院學報, 2012, 26(4) : 195-198.
6. 楊楨華, 劉倩, 伍巧源, 等. 老年原發性腎小球疾病患者的腎臟病理與臨床特征[J]. 廣西醫科大學學報, 2012, 29(4) : 571-572.
7. Saito T, Sato K. Lipoprotein glumerulopathy:glomerular lipoprotein thrombi in a patient with hyperlipoproteinemia[J]. Am J Kidney Dis, 1989, 13(2) : 148-153.
8. 龔如軍, 劉志紅, 陳朝紅, 等. 載脂蛋白E及其基因變異在脂蛋白腎病發病中的作用[J]. 腎臟病與透析腎移植雜志, 2001, 10(4) : 329-334.
9. Pham T, Kodvawala A, Hui DY. The receptor binding domain of apolipoprotein E is responsible for its antioxidant activity[J]. Biochemistry, 2005, 44(20) : 7577-7582.
10. 賀西南, 向少偉. 脂蛋白腎病的研究現狀[J]. 中國中西醫結合腎病雜志, 2007, 8(7) : 433-434.
11. Arakawa M, Fueki H, Hirano H, et al. Idiopathic mesangiodegenerative glomerulopathy:a proposal of new disease entity[J]. Nichi-Jin-Shi (Japanese), 1979, 121(5) : 914-915.
12. Ikeda K, Yokoyama H, Tomosugi N, et al. Primary glomerular fibrosis: a new nephropathy caused by diffuse intra-glomerular increase in atypical type Ⅲ collagen fibers[J]. Clin Nephrol, 1990, 33(4) : 155-159.
13. 陳楠, 徐耀文, 潘曉霞, 等. 膠原Ⅲ腎小球病家系報道[J]. 中華腎臟病雜志, 2005, 21(11) : 645-648.
14. 周福德, 鄒萬忠, 黃朝興, 等. 膠原Ⅲ腎小球病(附二例報告)[J]. 中華腎臟病雜志, 1998, 14(2) : 4-7.
15. 李玲, 鄒萬忠, 王素霞, 等. Ⅲ型膠原腎小球病的形態學觀察[J]. 中華病理學雜志, 2005, 34(7) : 385-388.
16. 陳芳, 呂吟秋, 陳波, 等. Ⅲ型膠原腎小球病二例[J]. 中華腎臟病雜志, 2012, 28(8) : 663.
17. Hisakawa N, Yasdoka N, Nishiya K, et al. Collagenofibrotic glomerulonephropathy associated with immune complex deposits[J]. Am J Nephrol, 1998, 18(2) : 134-141.
18. Naruse K, lto H, Moriki T, et al. Mesangial cell activation in the collagenofibrotic glomerulonephropathy. Case report and review of the literature[J]. Virchows Arch, 1998, 433(2) : 183-188.
19. Ordonez NC, Rosai J. Urinary tract[M]//Rosai J, Ackerman L. Surgical pathology. 9 th ed. London: Mosby, 2004: 1218-1219.
20. Iskandar SS, Herrera GA. Glomerulopathies with organized deposits[J]. Semin Diagn Pathol, 2002, 19(3) : 116-132.
21. Vogt BA, Wyatt RJ, Burke BA, et al. Inherited factor H deficiency and collagen type Ⅲ glomerulopathy[J]. Pediatr Nephrol, 1995, 9(1) : 11-15.

West China Medical Journal

Analysis of the Clinical Pathway and Pathologic Features of 224 Cases of Renal Biopsy

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