To biopsy or not to biopsy a teenager with idiopathic nephrotic syndrome? Biopsy first

被引:0
作者
Bigatti, Carolina [1 ]
Chiarenza, Decimo S. [1 ]
Angeletti, Andrea [1 ]
机构
[1] IRCCS Ist Giannina Gaslini, Nephrol Dialysis & Transplantat Unit, Via Gaslini 5, I-16147 Genoa, GE, Italy
关键词
Idiopathic nephrotic syndrome; Kidney biopsy; Focal segmental glomerulosclerosis; Minimal change disease; Adolescents; FOCAL SEGMENTAL GLOMERULOSCLEROSIS; MINIMAL CHANGE DISEASE; PERCUTANEOUS RENAL BIOPSY; CLINICAL-SIGNIFICANCE; GLOMERULAR SCLEROSIS; PRESENTING FEATURES; KIDNEY BIOPSY; CHILDREN; NEPHROPATHY; ADOLESCENTS;
D O I
10.1007/s00467-024-06510-6
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Kidney biopsy plays a crucial role in the diagnosis and management of several glomerular diseases. While it is generally considered a routine and safe procedure in children, it should be conducted with the primary objective of addressing the following question: do the prognosis and treatments vary based on the findings of kidney biopsy? In children presenting with idiopathic nephrotic syndrome (INS), guidelines suggest to consider kidney biopsy for individuals older than 12 years, primarily due to the possible increased incidence of different glomerulonephritis compared to younger patients, who predominantly manifest with minimal change disease. However, these guidelines also advocate for uniform therapeutic strategies, typically steroids, irrespective of the age or histological findings. Whether the age of more than 12 years may be a recommendation for performing kidney biopsy at presentation of INS is debatable. Instead, kidney biopsy could be reserved for steroid-resistant cases. On the other hand, when kidney biopsy is performed in INS, particularly in focal segmental glomerulosclerosis, histology may reveal additional lesions, that are strongly associated with a poorer response to treatment and worse clinical outcomes. Therefore, current guidelines on treatments of nephrotic syndrome may appear overly restrictive, despite the relevant findings provided by kidney biopsy. Therefore, in the present manuscript, which is part of a pro-con debate on the management of nephrotic syndrome in adolescents, we emphasize the potential role of performing a kidney biopsy before initiating corticosteroid treatment.
引用
收藏
页码:571 / 578
页数:8
相关论文
共 70 条
[41]   MARKED PROTEINURIA IN HYPERTENSIVE NEPHROSCLEROSIS [J].
MUJAIS, SK ;
EMMANOUEL, DS ;
KASINATH, BS ;
SPARGO, BH .
AMERICAN JOURNAL OF NEPHROLOGY, 1985, 5 (03) :190-195
[42]   IgM nephropathy:: Clinical picture and long-term prognosis [J].
Myllymäki, J ;
Saha, H ;
Mustonen, J ;
Helin, H ;
Pasternack, A .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2003, 41 (02) :343-350
[43]   Machine Learning in Glomerular Diseases: Promise for Precision Medicine [J].
Nadkarni, Girish N. ;
Chaudhary, Kumardeep ;
Coca, Steven G. .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2019, 74 (03) :290-292
[44]   Idiopathic nephrotic syndrome in children [J].
Noone, Damien G. ;
Iijima, Kazumoto ;
Parekh, Rulan .
LANCET, 2018, 392 (10141) :61-74
[45]  
Nyman RS, 1997, ACTA RADIOL, V38, P431
[46]   IgM exacerbates glomerular disease progression in complement-induced glomerulopathy [J].
Panzer, Sarah E. ;
Laskowski, Jennifer ;
Renner, Brandon ;
Kulik, Liudmila ;
Ljubanovic, Danica ;
Huber, Kendra M. ;
Zhong, Weixiong ;
Pickering, Matthew C. ;
Holers, V. Michael ;
Thurman, Joshua M. .
KIDNEY INTERNATIONAL, 2015, 88 (03) :528-537
[47]   A clinicopathological and prognostic study of 18 children with C1q nephropathy and focal segmental glomerulosclerosis: an 18-year experience from a single center [J].
Peng, Yingchao ;
Ju, Tao ;
Gao, Chunlin ;
Xia, Zhengkun ;
Wang, Meiqiu ;
Sun, Xiaoyi ;
Wang, Ren ;
Li, Xiaojie ;
Wei, Yaqin ;
Jia, Lili ;
Chen, Huangyu .
JOURNAL OF NEPHROLOGY, 2023, 36 (06) :1615-1625
[48]   Glomerular capillary C3 deposition as a risk factor for unfavorable renal outcome in pediatric primary focal segmental glomerular sclerosis [J].
Peng, Yingchao ;
Li, Banghai ;
Li, Xiaojie ;
Ju, Tao ;
Zhang, Zhiqiang ;
Wang, Peipei ;
Sun, Tao ;
Shu, Jiaping ;
Wang, Meiqiu ;
Sun, Xiaoyi ;
Chen, Huangyu ;
Gao, Chunlin ;
Xia, Zhengkun .
FRONTIERS IN PEDIATRICS, 2023, 11
[49]  
RICH AR, 1957, B JOHNS HOPKINS HOSP, V100, P173
[50]   Executive summary of the KDIGO 2021 Guideline for the Management of Glomerular Diseases [J].
Rovin, Brad H. ;
Adler, Sharon G. ;
Barratt, Jonathan ;
Bridoux, Frank ;
Burdge, Kelly A. ;
Chan, Tak Mao ;
Cook, H. Terence ;
Fervenza, Fernando C. ;
Gibson, Keisha L. ;
Glassock, Richard J. ;
Jayne, David R. W. ;
Jha, Vivekanand ;
Liew, Adrian ;
Liu, Zhi-Hong ;
Mejia-Vilet, Juan M. ;
Nester, Carla M. ;
Radhakrishnan, Jai ;
Rave, Elizabeth M. ;
Reich, Heather N. ;
Ronco, Pierre ;
Sanders, Jan-Stephan F. ;
Sethi, Sanjeev ;
Suzuki, Yusuke ;
Tang, Sydney C. W. ;
Tesar, Vladimir ;
Vivarelli, Marina ;
Wetzels, Jack F. M. ;
Lytvyn, Lyubov ;
Craig, Jonathan C. ;
Tunnicliffe, David J. ;
Howell, Martin ;
Tonelli, Marcello A. ;
Cheung, Michael ;
Earley, Amy ;
Floege, Jurgen .
KIDNEY INTERNATIONAL, 2021, 100 (04) :753-779