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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13.	陈楠, 徐耀文, 潘晓霞, 等. 胶原Ⅲ肾小球病家系报道[J]. 中华肾脏病杂志, 2005, 21(11) : 645-648.
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15.	李玲, 邹万忠, 王素霞, 等. Ⅲ型胶原肾小球病的形态学观察[J]. 中华病理学杂志, 2005, 34(7) : 385-388.
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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.
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19.	Ordonez NC, Rosai J. Urinary tract[M]//Rosai J, Ackerman L. Surgical pathology. 9 th ed. London: Mosby, 2004: 1218-1219.
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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.

1. 蔡广研, 陈香美. 慢性肾脏病并发症治疗现状及思考[J]. 中国实用内科杂志, 2010, 30(2) : 102-103.
2. 中华人民共和国卫生部. 卫生部办公厅关于印发肾脏内科专业 4个临床路径的通知[EB/OL]. (2009-12-11) [2010-01-01]. http://www.nhfpc.gov.cn/zhuzhan/wsbmgz/201304/1730f243b3254c99862c975ac384d695.shtml.
3. 刘红, 方艺, 许迅辉, 等. 2444例肾活检临床病理分析[J]. 中国临床医学, 2010, 17(4) : 535-539.
4. 陈惠萍, 曾彩虹, 胡伟新, 等. 10594例肾活检病理资料分析[J]. 肾脏病与透析肾移植杂志, 2000, 9(6) : 501-509.
5. 史晓虎, 李文歌, 杨冠男, 等. 肾病综合征的疾病构成: 单中心临床研究[J]. 中日友好医院学报, 2012, 26(4) : 195-198.
6. 杨桢华, 刘倩, 伍巧源, 等. 老年原发性肾小球疾病患者的肾脏病理与临床特征[J]. 广西医科大学学报, 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. 龚如军, 刘志红, 陈朝红, 等. 载脂蛋白E及其基因变异在脂蛋白肾病发病中的作用[J]. 肾脏病与透析肾移植杂志, 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. 贺西南, 向少伟. 脂蛋白肾病的研究现状[J]. 中国中西医结合肾病杂志, 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. 陈楠, 徐耀文, 潘晓霞, 等. 胶原Ⅲ肾小球病家系报道[J]. 中华肾脏病杂志, 2005, 21(11) : 645-648.
14. 周福德, 邹万忠, 黄朝兴, 等. 胶原Ⅲ肾小球病(附二例报告)[J]. 中华肾脏病杂志, 1998, 14(2) : 4-7.
15. 李玲, 邹万忠, 王素霞, 等. Ⅲ型胶原肾小球病的形态学观察[J]. 中华病理学杂志, 2005, 34(7) : 385-388.
16. 陈芳, 吕吟秋, 陈波, 等. Ⅲ型胶原肾小球病二例[J]. 中华肾脏病杂志, 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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