Ultrasonografi eşliğinde böbrek biyopsisi yapılan çocukların retrospektif olarak değerlendirilmesi
Date
2005
Authors
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Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Amaç: Böbrek biyopsisi, böbrek hastalığının histolojik tanısını koymak için böbrekten küçük bir parçanın belirli bir teknikle alınması işlemidir. Çocuklarda böbrek hastalıklarının tanı, tedavi ve prognozunun belirlenmesinde yol gösterici olan önemli bir yöntemdir. Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi (UÜTF) Pediatrik Nefroloji Bilim Dalı'nda böbrek biyopsisi yapılan hastaların; 1) Biyopsi endikasyonlarını, 2) Klinik ve patolojik bulguları arasındaki ilişkisini, 3) Biyopsi sonrası gelişebilecek komplikasyon sıklığını belirlemek istedik. Gereç ve Yöntemler: UÜTF Pediatrik Nefroloji Bilim Dalı'nda Haziran 1997 ve Ocak 2003 yılları arasında böbrek biyopsisi yapılan hastalar retrospektif olarak değerlendi. Yüzseksenüç hastaya yapılan 193 böbrek biyopsisi incelendi. Çalışma için gerekli bilgiler hastaların klinik yatış dosyalarından ve poliklinik izlem dosyalarından elde edildi. Böbrek biyopsi endikasyonları izole hematüri (İH), asemptomatik proteinüri, nefrotik sendrom (NS), akut nefritik sendrom (ANS), nefrotik+nefritik sendrom (NS+ANS), akut böbrek yetmezliği (ABY) ve kronik böbrek yetmezliği (KBY) şeklinde 7 bölümde; patoloji sonuçları ise primer glomerülonefritler, sekonder glomerülonefritler, tubulointerstisyel nefrit (TİN), kronik böbrek hastalığı ve diğerleri şeklinde 5 grupta incelendi. Biyopsi sonrası gelişebilecek komplikasyonlar makroskopik hematüri, perirenal hematom, arteriyovenöz fistül (AVF), pseudoanevrizma, lokalize enfeksiyon ya da sepsis, çevre organlarda yaralanma, nefrektomi ve ölüm şeklinde sıralandı. Semptomatik hematom, 72 saatten uzun süren makroskopik hematüri, AVF, pseudoanevrizma, çevre organların zedelenmesi, nefrektomi, sepsis ve ölüm majör komplikasyon olarak tanımlandı. Bulgular ve Sonuç: Çalışmaya alınan hastalarımızın 88i (%45.6) kız, 105'i (%54.4) erkek olup ortalama biyopsi yaşları 4 ay ile 17.5 yaş arasında (8.62 ± 0.3 yaş) bulundu. Biyopsilerde elde edilen doku örneklerinde ortalama glomerül sayısı 21.2±0.95 olarak saptandı. Hastalarımızın 187'sinde (%96.9) elde edilen doku örneklerinde glomerül sayısı histopatolojik tanı için yeterli bulundu. Ancak 6 hastamızda (%3.1) glomerül sayısı tanı için yeterli değildi. Endikasyonlar içinde en sık NS (48.2), renal patolojiler içinde en sık primer glomerülonefritler (%58) saptandı. Primer glomerülonefritler içinde en sık minimal lezyon hastalığı (MLH) (%26.7) ve fokal segmental glomerüloskleroz (FSGS) (%21.4), sekonder glomerülonefritler içinde ise henoch-schönlein purpurası nefriti (HSP-N) (%43.2) ve sistemik lupus eritematozus nefriti (SLE nefriti) (%18.9) saptandı. Elde edilen histopatolojik tanıların değişik klinik tablolarla ilişkili olabileceği ortaya kondu. Hastalarımızın %15.5'inde biyopsi sonrası komplikasyon izlendi. Bu hastaların 24'ünde minör komplikasyon varken majör komplikasyon yalnız 6'sınde (%3.1) gürüldü. Majör komplikasyonlardan semptomatik hematom hastalarımızın %1.1 'inde, 72 saatten uzun süren makroskopik hematüri %1.5'inde ve pseudoanevrizma %0.5'inde izlendi. Komplikasyon oranımız diğer araştırmacılardan düşük saptandı. Komplikasyon oranları KBY'li hastalarda istatistiksel olarak anlamlı yüksek bulundu (p<0.01). Sonuç olarak, çocuklarda en sık nefrotik sendrom nedeni ile böbrek biyopsisi yapıldığı görülmüştür. Böbrek biyopsisi yapılan hastalarda primer glomerülonefritler içinde ilk sırada MLH ve ikinci sırada FSGS olduğu gözlenmiştir. Sekonder glomerülonefritler içinde ise en sık HSP-N ve ikinci Sırada SLE nefriti bulunmuştur. Elde edilen patolojik sonuçların değişik klinik tanılar ile ilişkili olabileceği saptanmıştır. Hastalarımızda biyopsi sonrası gelişen komplikasyon sayısının diğer araştırmalara göre daha düşük olduğu saptanmıştır. Komplikasyon sayısının KBY olan hastalarda istatistiksel olarak anlamlı yüksek olduğu bulunmuştur (p<0.01). çalışmamız sonucunda çocuklarda ultrasonografi eşliğinde böbrek biyopsisinin böbrek hastalıklarının tanısında, prognozunda yol gösterici ve güvenilir bir metod olduğu kanısına varılmıştır.
Objective: Renal biopsy is a prodecure of taking a small sample from renal tissue with a definite technique to make histological diagnosis of a renal disease. It is an important method in detremination of diagnosis, teratment and prognosis of renal diseases in children. In this study, we aimed to determine;1) Renal biopsy indications,2) The relation between clinical and histopathological findings and 3) The frequency of complications after renal biopsy done to the children in the department of pediatric nephrology in Uludag University Medical Faculty.Material and methods: The patients who underwent to renal biopsy in pediatric nephrology deparment of Uludag University Medical Faculty between June 1997 and January 2003 were assessed retrospectively. Hundred and ninety three renal biopsies done to 183 patients were examined. The information necessary for the study was obtained from out-patient and in-patient observation cards belonging to each patient. Renal biopsy indications were examined in seven parts as isolated hematuria (IH), asymptomatic proteinuria, nephrotic syndrome (NS), acute nephritic syndrome (ANS), nephrotic+nephritic syndrome, acute renal insufficiency and chronic renal insufficiency while the pathological results were assessed in five groups as primary glomerulonephritis, secondary glomerulonephritis, tubulointerstitial nephritis, chronic renal disease and others. Complications seen after renal biopsy were classified as macroscopic hematuria, perirenal hematoma, arteriovenous fistula (AVF), pseudoanevrism, localized infection or sepsis, damage to surrounding organ or tissues, nephrectomy and death. Symptomatic hematoma, macroscopic hematuria after 72 hours of renal biopsy, AVF, pseudoanevrism, damage to suurounding organs, nephrectomy, sepsis and death were defined as major complications. Results and Conclusion: There were 88 females (45,6 %) and 105 males (54.4 %). The mean biopsy age was between 4 months and 17,5 years (8,62±0,3). The average glomerul numbers obtained from renal biopsy samples were determined as 21.2±0.95. We found sufficient the renal biopsy samples in 187 of our patients (%96.9) for histological diagnosis while glomerul number was not sufficient for diagnosis in 6 patients (3.1 % ). The most frequent indication was NS (48.2%) while most frequent seen renal pathology found minimal change disease (MCD) (26.7%) andfocal segmental glomerulosclerosis (FSGS) (21.4%) in primaryglomerulonephritis and henoch schonlein purpura nephritis (HSP-N) (43.2%)and systemic lupus erythematosus (SLE) nephritis (18.9%) in secondaryglomerulonephritis most frequently. We revealed the relation betweenhistological diagnosis obtained from renal biopsy and variable clinicalconditions.Complication after biopsy was seen in 15.5 percent of our patients.There were minor complicatins in 24 of them while six patient (3.1%) hadmajor complications. In major complications, symptomatic hematoma,macroscopic hematuria after 72 hours of renal biopsy and pseudoanevrismwere seen 1.1 %, 1.5% and 0.5% of the patients, respectively. In contrast toother studies , we found the complications rate lower. The complications ratewere much higher in the chronic renal insufficient patients and it wasstatistically significant (p<0,01). In conclusion, NS was the most frequent reason to make a renalbiopsy for diagnosis. MCD and FSGS were seen most frequently in primaryglomerulonephritis while HSP-N was the most frequently seen histopathology in secondary glomerulonephritis and it was followed by SLE nephritis. We determined also the relation between histopathological results obtained from renal biopsy and different clinical conditions. In contrast to other studies, we found the complications rate lower. The complications rate were much higher in the chronic renal insufficient patients and it was statistically significant (p<0.01) With this study, we determined that renal biopsy done with a guide of renal ultrasonography was a safe and important method for diagnosis and prognosis of renal diseases.
Objective: Renal biopsy is a prodecure of taking a small sample from renal tissue with a definite technique to make histological diagnosis of a renal disease. It is an important method in detremination of diagnosis, teratment and prognosis of renal diseases in children. In this study, we aimed to determine;1) Renal biopsy indications,2) The relation between clinical and histopathological findings and 3) The frequency of complications after renal biopsy done to the children in the department of pediatric nephrology in Uludag University Medical Faculty.Material and methods: The patients who underwent to renal biopsy in pediatric nephrology deparment of Uludag University Medical Faculty between June 1997 and January 2003 were assessed retrospectively. Hundred and ninety three renal biopsies done to 183 patients were examined. The information necessary for the study was obtained from out-patient and in-patient observation cards belonging to each patient. Renal biopsy indications were examined in seven parts as isolated hematuria (IH), asymptomatic proteinuria, nephrotic syndrome (NS), acute nephritic syndrome (ANS), nephrotic+nephritic syndrome, acute renal insufficiency and chronic renal insufficiency while the pathological results were assessed in five groups as primary glomerulonephritis, secondary glomerulonephritis, tubulointerstitial nephritis, chronic renal disease and others. Complications seen after renal biopsy were classified as macroscopic hematuria, perirenal hematoma, arteriovenous fistula (AVF), pseudoanevrism, localized infection or sepsis, damage to surrounding organ or tissues, nephrectomy and death. Symptomatic hematoma, macroscopic hematuria after 72 hours of renal biopsy, AVF, pseudoanevrism, damage to suurounding organs, nephrectomy, sepsis and death were defined as major complications. Results and Conclusion: There were 88 females (45,6 %) and 105 males (54.4 %). The mean biopsy age was between 4 months and 17,5 years (8,62±0,3). The average glomerul numbers obtained from renal biopsy samples were determined as 21.2±0.95. We found sufficient the renal biopsy samples in 187 of our patients (%96.9) for histological diagnosis while glomerul number was not sufficient for diagnosis in 6 patients (3.1 % ). The most frequent indication was NS (48.2%) while most frequent seen renal pathology found minimal change disease (MCD) (26.7%) andfocal segmental glomerulosclerosis (FSGS) (21.4%) in primaryglomerulonephritis and henoch schonlein purpura nephritis (HSP-N) (43.2%)and systemic lupus erythematosus (SLE) nephritis (18.9%) in secondaryglomerulonephritis most frequently. We revealed the relation betweenhistological diagnosis obtained from renal biopsy and variable clinicalconditions.Complication after biopsy was seen in 15.5 percent of our patients.There were minor complicatins in 24 of them while six patient (3.1%) hadmajor complications. In major complications, symptomatic hematoma,macroscopic hematuria after 72 hours of renal biopsy and pseudoanevrismwere seen 1.1 %, 1.5% and 0.5% of the patients, respectively. In contrast toother studies , we found the complications rate lower. The complications ratewere much higher in the chronic renal insufficient patients and it wasstatistically significant (p<0,01). In conclusion, NS was the most frequent reason to make a renalbiopsy for diagnosis. MCD and FSGS were seen most frequently in primaryglomerulonephritis while HSP-N was the most frequently seen histopathology in secondary glomerulonephritis and it was followed by SLE nephritis. We determined also the relation between histopathological results obtained from renal biopsy and different clinical conditions. In contrast to other studies, we found the complications rate lower. The complications rate were much higher in the chronic renal insufficient patients and it was statistically significant (p<0.01) With this study, we determined that renal biopsy done with a guide of renal ultrasonography was a safe and important method for diagnosis and prognosis of renal diseases.
Description
Keywords
Böbrek biyopsisi, Çocuk, Komplikasyon, Renal biopsy, Children, Complication
Citation
Kılıçbay, İ. (2005). Ultrasonografi eşliğinde böbrek biyopsisi yapılan çocukların retrospektif olarak değerlendirilmesi. Yayınlanmamış tıpta uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.