Nephrotic syndrome in the elderly: epidemiological aspects, clinical data, and renal biopsy findings

Nephrotic syndrome is the most common clinical presentation of glomerular disease in elderly patients, and renal biopsy is an important diagnostic resource. The aim of this study was to describe nephrotic syndrome among elderly patients in Brazil, focusing on tubulointerstitial and vascular involvement. This was a retrospective study of patients over 65 years of age with nephrotic syndrome who underwent renal biopsy between January 2012 and December 2019. Of the 123 renal biopsies that occurred during the study period, 44 (35.8%) were performed for the investigation of nephrotic syndrome. Among those 44 cases, the main etiologies were membranous nephropathy in 13 cases (29.5%), amyloidosis in ten (22.7%), non-collapsing focal segmental glomerulosclerosis (FSGS) in four (9.1%), and collapsing FSGS in four (9.1%). Patients with minimal change disease (MCD) had the lowest degree of interstitial fibrosis compared with the other glomerulopathies, and histological signs of acute tubular necrosis (ATN) were less common among those with amyloidosis than among those with membranous nephropathy, FSGS, or MCD (P=0.0077). Of the patients with ATN, the frequency of acute kidney injury (AKI) was highest in those with MCD (P<0.001). All patients had some degree of vascular involvement, regardless of the type of glomerulopathy. In conclusion, the second most common cause of nephrotic syndrome in this population was amyloidosis, and acute interstitial tubule involvement was more marked in MCD. Vascular involvement is something that cannot be dissociated from the age of the patient and is not only due to the underlying glomerulopathy.

Analysis of bleeding risk in percutaneous renal biopsy in Tibet / 北京大学学报(医学版)

OBJECTIVE@#To observe the postoperative bleeding after percutaneous renal biopsy (PRB) in Tibet, To analyze and summarize the risk factors associated with bleeding in high altitude patients to improve the safety of surgery.@*METHODS@#A retrospective analysis of 150 cases of PRB in the Department of Nephrology, People's Hospital of Tibet Autonomous Region from May 2016 to May 2018 were carried out, and the correlations between the potential risk factors (gender, age, blood pressure, hemoglobin, platelet, serum creatinine) and postoperative bleeding events were analyzed.@*RESULTS@#During the study period, the 150 patients receiving procedure of PRB were enrolled in our hospital, with an average age of (41.2±15.6) years, of whom 58.7% (88/150) were male, 41.3% (62/150) were female, and major bleeding complications occurred in 12 biopsies (8.0%, 12/150). Six cases for men and women, respectively. The mean age in the bleeding group seemed to be higher than that in the non-bleeding group [(48.3±20.0) years vs. (40.6±15.1) years, P=0.099]. There was no significant difference in the incidence of hypertension, hemoglobinemia, urea nitrogen and prothrombin time between the two groups. The level of serum creatinine in the hemorrhage group seemed to be higher than that in the non-bleeding group (P=0.090), and the time of the hemorrhagic group was longer than that in the non-bleeding group (P=0.069). The platelet count in the bleeding group was significantly lower than that in the non-bleeding group (P < 0.05). Multivariate Logistic regression analysis showed that the prolonged activation of partial prothrombin time and lower platelet count had a relatively high risk of bleeding, which was statistically significant (P=0.079, P=0.082).@*CONCLUSION@#PRB is safe and reliable on the whole in plateau areas; Old age, low platelet count, decreased renal function and prolonged activated partial coagulation time are related to postoperative bleeding of PRB, and hyperhemoglobin is not a risk factor for bleeding. High hemoglobin is not a risk factor for postoperative bleeding of PRB at high altitude.

Hemodialysis before percutaneous renal biopsy on postoperative bleeding complications in patients with acute kidney injury / 中华肾脏病杂志

Objective To evaluate whether hemodialysis before percutaneous renal biopsy (PRB) reduces the risk of bleeding complications in patients with acute kidney injury (AKI).Methods This study was a cohort observational study.Patients who were diagnosed as AKI and received PRB in Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were included in the study.Patients were divided into preoperative dialysis group and preoperative non-dialysis group according to whether PRB patients received hemodialysis treatment.According to whether perirenal hematoma occurred after the operation,the patients were divided into the groups with and without the perirenal hematoma.The baseline clinical data of AKI stage,hemoglobin,coagulation function and renal pathological changes before PRB,and perirenal hemorrhage complications after operation,including the size of perirenal hematoma within 24 hours,gross hematuria,low back pain,decreased hemoglobin value and interventional treatment (such as interventional surgery,blood transfusion,etc) in the two groups were compared.The logistic regression model was used to analyze the risk factors of perirenal hematoma after PRB.Results Ninety patients with AKI were enrolled in this study,including 41 in the preoperative dialysis group and 49 in the preoperative non-dialysis group.The proportion of patients AKI with stage 2-3 in the preoperative dialysis group was significantly higher than that in preoperative non-dialysis group (100.0％ vs 75.5％,P＜0.001).There were no significant differences in coagulation function indexes and platelet counts between the two groups.Renal ultrasound within 24 hours after PRB showed that there were no significant differences in the incidence of postoperative perirenal hematoma (56.1％ vs 63.3％,P=0.489),the incidence of postoperative perirenal large size hematoma (≥5 cm,26.1％ vs 22.6％,P=0.766),and the magnitude of the decrease in hemoglobin (3.7％ vs 1.2％,P=0.505) between the preoperative dialysis group and the preoperative nondialysis group.No blood transfusion,arteriovenous fistula,renal vascular intervention or surgery,and no hospital death occurred in the two groups.The renal pathological manifestations of the patients with and without perirenal hematoma were mainly acute tubular necrosis (ATN) and there were no significant differences between the patients with and without perirenal hematoma in indicators such as age,gender,body mass index,diabetes percentage,hypertension percentage,AKI staging,preoperative dialysis or not,serum creatinine,blood urea nitrogen,hemoglobin,platelet count and renal pathological types.After adjusting for indicators such as preoperative AKI stage and renal pathological changes,logistic regression analysis results showed that perirenal after PRB was not independently correlated with preoperative dialysis (β=0.568,P=0.241);Multivariate logistic regression analysis resluts showed that hematoma (≥5 cm) after PRB was also not independently correlated with preoperative dialysis (β=0.967,P=0.958).Conclusions Preoperative hemodialysis does not reduce the risk of bleeding complications after PRB in patients with AKI.The role of preoperative hemodialysis in reducing the risk of bleeding complications after PRB needs further study and verification.

Hemodialysis before percutaneous renal biopsy on postoperative bleeding complications in patients with acute kidney injury / 中华肾脏病杂志

Objective@#To evaluate whether hemodialysis before percutaneous renal biopsy (PRB) reduces the risk of bleeding complications in patients with acute kidney injury (AKI).@*Methods@#This study was a cohort observational study. Patients who were diagnosed as AKI and received PRB in Nanfang Hospital of Southern Medical University from January 2015 to December 2018 were included in the study. Patients were divided into preoperative dialysis group and preoperative non-dialysis group according to whether PRB patients received hemodialysis treatment. According to whether perirenal hematoma occurred after the operation, the patients were divided into the groups with and without the perirenal hematoma. The baseline clinical data of AKI stage, hemoglobin, coagulation function and renal pathological changes before PRB, and perirenal hemorrhage complications after operation, including the size of perirenal hematoma within 24 hours, gross hematuria, low back pain, decreased hemoglobin value and interventional treatment (such as interventional surgery, blood transfusion, etc) in the two groups were compared. The logistic regression model was used to analyze the risk factors of perirenal hematoma after PRB.@*Results@#Ninety patients with AKI were enrolled in this study, including 41 in the preoperative dialysis group and 49 in the preoperative non-dialysis group. The proportion of patients AKI with stage 2-3 in the preoperative dialysis group was significantly higher than that in preoperative non-dialysis group (100.0% vs 75.5%, P<0.001). There were no significant differences in coagulation function indexes and platelet counts between the two groups. Renal ultrasound within 24 hours after PRB showed that there were no significant differences in the incidence of postoperative perirenal hematoma (56.1% vs 63.3%, P=0.489), the incidence of postoperative perirenal large size hematoma (≥5 cm, 26.1% vs 22.6%, P=0.766), and the magnitude of the decrease in hemoglobin (3.7% vs 1.2%, P=0.505) between the preoperative dialysis group and the preoperative non-dialysis group. No blood transfusion, arteriovenous fistula, renal vascular intervention or surgery, and no hospital death occurred in the two groups. The renal pathological manifestations of the patients with and without perirenal hematoma were mainly acute tubular necrosis (ATN) and there were no significant differences between the patients with and without perirenal hematoma in indicators such as age, gender, body mass index, diabetes percentage, hypertension percentage, AKI staging, preoperative dialysis or not, serum creatinine, blood urea nitrogen, hemoglobin, platelet count and renal pathological types. After adjusting for indicators such as preoperative AKI stage and renal pathological changes, logistic regression analysis results showed that perirenal after PRB was not independently correlated with preoperative dialysis (β=0.568, P=0.241); Multivariate logistic regression analysis resluts showed that hematoma (≥5 cm) after PRB was also not independently correlated with preoperative dialysis (β=0.967, P=0.958).@*Conclusions@#Preoperative hemodialysis does not reduce the risk of bleeding complications after PRB in patients with AKI. The role of preoperative hemodialysis in reducing the risk of bleeding complications after PRB needs further study and verification.

The role of percutaneous renal biopsy in nephrology / Монголын Анагаах Ухаан

@#Percutaneous renal biopsy is not only the cornerstone for the diagnosis and treatment of glomerular, tubular, interstitial and vascular diseases of the kidneys, but also it is very important diagnostic method for the disorders of the transplanted kidney. Nowadays the renal biopsy has led to relative safe procedure due to recent advances in biopsy techniques, including the use of real-time ultrasonography and the biopsy gun despite occurring in bleeding complications, such macrohematuria and large sized hematoma near the kidney, in much low rate. Correct fixation and processing of the renal biopsy tissue is critical, and the renal biopsy requires light, immunofluorescence and transmission electron microscopy preparations in order to the evaluation of the pathology of renal diseases. Understanding of renal biopsy indications, contraindications, and procedure techniques, monitoring and treatment of pre and post procedure of the renal biopsy are essential for successful performing renal biopsy, and the prevention from serious complications and provide adequate tissue for pathology processing and accurate clinicopathological diagnosis of the renal diseases.

Caracterización de los pacientes sometidos a Biopsia Renal Percutánea en el departamento de Nefrología del Hospital Carlos Andrade Marín, 2010 ­ 2015 / Characterization of patients undergoing percutaneous renal biopsy in the Nephrology Department of Carlos Andrade Marín Hospital, 2010 ­ 2015

Introducción: La biopsia renal ofrece información invaluable y permite establecer la correlación histopatológica con el cuadro clínico de los pacientes con alteraciones renales, sin embargo, su estudio es poco frecuente en nuestro medio. El objetivo del estudio fue determinar las características clínicas y demográficas de los pacientes sometidos a biopsia renal percutánea. Materiales y Métodos: Estudio retrospectivo que incluyó 245 pacientes a quienes se les realizó biopsia renal percutánea en el departamento de Nefrología del Hospital Carlos Andrade Marín durante el período 2010-2015. Resultados: Los diagnósticos histopatológicos más frecuentes fueron: nefritis lúpica (28,4%), glomerulopatía membranosa (16,7%), glomerulonefritis embranoproliferativa (9,4%) y la glomerulonefritis mesangial proliferativa (8,2%). Se analizó la asociación entre los diagnósticos histopatológicos con las variables sociodemográficas y con los antecedentes patológicos de diabetes mellitus tipo 2, hipertensión arterial, lupus eritematoso sistémico, filtración glomerular, hemoglobina prebiopsia-postbiopsia y nivel de proteinuria. Discusión: Los diagnósticos histopatológicos se encuentran asociados a variables sociodemográficas y clínicas, sugiriendo la realización de estudios en otras localidades de nuestra región, para establecer un consenso y guías de manejo de todo paciente sometido a biopsia renal percutánea para la obtención de un diagnóstico histopatológico.

Introduction: Renal biopsy (BR) provides invaluable information and histopathologic correlation to clinical features of patients with renal impairment. However this study is scarce in our population. The main objective was to determine clinical and demographic characteristics of patients undergoing percutaneous renal biopsy. Methods: Retrospective study that included 245 patients who underwent percutaneous renal biopsy at the department of nephrology of Carlos Andrade Marín Hospital. Results: The most frequent histopathologic diagnoses were: lupus nephritis (28.4%), membranous glomerulonephritis (16.7%), membranous-proliferative glomerulonephritis (9.4%) and mesangial proliferative glomerulonephritis (8.2%). We assessed the association between histological diagnosis with sociodemographic variables as well as with clinical variables such as past history of type 2 diabetes mellitus, hypertension, systemic lupus erythematosus, glomerular filtration, prebiopsy and post-biopsy hemoglobin level and proteinuria. Discusion: Histopathologic diagnoses are associated with sociodemographic and clinical variables, suggesting the need to perform studies in other hospitals to build consensus and guidelines for patients that need undergoing percutaneous renal biopsy to reach histopathologic diagnosis.

Causes of the complications of ultrasound-guided percutaneous renal biopsy in children / 医学研究生学报

Objective This study was to analyze the causes of the complications of ultrasound -guided percutaneous renal bi-opsy in children . Methods We retrospectively analyzed the complications of ultrasound-guided percutaneous renal biopsy in 236 children along with the age, sex, sample length, times of puncture, and types of disease of the patients .We used the binary Logistic regression model to analyze the influences of various factors on the post -biopsy complications . Results After renal biopsy , 22 (9.3%) of the patients experienced various degrees of but no severe complications .The incidence of complications was significantly correlated with the sample length (P<0.05), but not with the age, sex, sample length, times of puncture, and types of disease of the patients. Conclusion Ultrasound-guided percutaneous renal biopsy is an effective diagnostic method for children , with a high suc-cess rate and a low incidence of complications .And the incidence of complications can be reduced by improving the skills of puncturing and accuracy of ultrasound positioning .

Influence of nursing intervention on voiding effect in patients after percutaneous renal biopsy / 中国实用护理杂志

Objective To observe the effect of nursing intervention on voiding effect in patients after percutaneous renal biopsy. Methods 80 cases of patients after percutaneous renal biopsy were randomly divided into the control group and the observation group with 40 patients in each group. The control group only received general health education, while the observation group was given specialist care measures pre, during and post operation. The complication after operation was compared between the two groups. Results Postoperative complication of the observation group was lower than that of the control group. Conclusions The whole process nursing intervention can alleviate voiding effect, reduce postoperative complications, and is worthy of clinical application.

Seguridad y eficacia de la biopsia renal percutánea / Safety and efficacy of percutaneous renal biopsy

Se realizó una evaluación de la seguridad y eficacia del procedimiento de la biopsia renal percutánea BRP de riñones nativos bajo control ecográfico simultáneo. Se revisaron las historias clínicas de todos los pacientes que fueron biopsiados en el período comprendido entre enero de 2005 y diciembre de 2008 en el Servicio de Nefrología del Hospital de Pediatría Juan P. Garrahan. Se excluyeron del análisis los procedimientos realizados bajo anestesia general y en riñón transplantado. Se evaluaron 117 procedimientos realizados en 114 pacientes: 59 varones (50.4%) y 55 mujeres (49.6%). Las indicaciones más frecuentes de BRP fueron: proteinuria masiva o significativa con o sin hematuria 45 (38,6%), Lupus Eritematoso Sistémico 32 (27.4%) y síndrome nefrótico cortico-resistente 23 (20%); otras menos frecuentes estuvieron representadas por: Púrpura de Schönlein-Henoch 7 (6%), insuficiencia renal aguda (IRA) 5 (4%) e insuficiencia renal crónica (IRC) 5 (4%). No se produjeron eventos adversos (EA) en 97 (83%) procedimientos. En 20 (17%), se produjeron EA. Los EA no serios fueron 9: microhematuria (n=3), macrohematuria (n=3) y dolor lumbar (n=3). Los 11 restantes fueron EAS (serios) que correspondieron a hematomas perirrenales de los cuales 2 requirieron transfusión de glóbulos rojos. Las muestras obtenidas fueron suficientes para el diagnóstico en 113 procedimientos (97%), con un número de glomérulos de 30 ± 11. Los resultados demostraron que el procedimiento de BRP con disparador automático, anestesia local y control ecográfico simultáneo es seguro y eficaz. El número de EAS registrados en este estudio es similar o menor según las series analizadas. A diferencia de la publicación internacional en nuestro centro se realiza el procedimiento con el paciente despierto (AU)

In this study we evaluated the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB) of native kidneys. The clinical charts of all patients that underwent PRB between January 2005 and December 2008 at the Department of Nephrology of the Pediatric Hospital Juan P. Garrahan were reviewed. Procedures performed under general anesthesia and in transplanted kidneys were excluded from the analysis. We evaluated 117 procedures performed in 114 patients: 59 were male (50.4%) and 55 female (49.6%). The most frequent indications for PRB were: massive or significant proteinuria with or without hematuria 45 (38,6%), systemic lupus erythematosus 32 (27.4%), and steroid-resistant nephrotic syndrome 23 (20%); other less frequent indications were: Henoch-Schönlein purpura 7 (6%), acute renal insufficiency (ARI) 5 (4%), and chronic renal insufficiency (CRI) 5 (4%). No adverse events (AE) were observed in 97 (83%) procedures. AE were seen in 20 (17%). There were 9 minor AE: microhematuria (n=3), gross hematuria (n=3), and lumbar pain (n=3). Serious AE observed were perinephric hematoma in 11 patients of whom 2 required red blood cell transfusions. The sample size was sufficient for diagnosis in 113 procedures (97%), with a number of glomeruli of 30 ± 11. The results show that ultrasoundguided PRB with an automatic trigger and local anesthesia is a safe and effective procedure. The number of serious AE in this study is similar to or lower than reported in previous series. Unlike other international series, at our center the procedure is performed while the patient is awake (AU)

Clinical and Histopathological Analysis of 494 Cases of Percutaneous Renal Biopsies / 대한신장학회잡지

Percutaneous renal biopsy is an essential component for diagnosis and management of glomerular diseases. In order to elucidate clinical and pathological features, 494 renal patients who had undergone renal biopsies at Gil Medical Center from January 1989 to June 1999 were studied retrospectively. The male to female ratio was 1.3 : 1 and average age was 33.2 years. There were 370(83.5%) cases of primary glomerular disease and 58(13.1%) cases of secondary glomerular disease. Among primary glomerular disease, IgA nephropathy was the most common(175 cases), followed by minimal change disease(84 cases), membranous glomerulonephritis(34 cases), and focal segmental glomerulosclerosis(33 cases). In secondary glomerular disease, lupus nephritis was the most common(21 cases), followed by 11 cases of hepatitis B associated glomerulonephritis, 9 cases of Henoch-Sch nlein purpura, and 4 cases of diabetic nephropathy. Among 99 cases of asymptomatic urinary abnormalities, IgA nephropathy was most common(69 cases) followed by 12 cases of thin basement membrane disease, 4 cases of minimal change disease, and 3 cases of focal segmental glomerulosclerosis, membranous glomerulonephritis, nonspecific glomerulonephritis. Among 159 cases of nephrotic syndrome, minimal change disease was most common(60 cases) followed by 25 cases of IgA nephropathy, 23 cases of focal segmental glomerulosclerosis, 21 cases of membranous glomerulonephritis, and 13 cases of lupus nephritis. Documented complication of renal biopsies included 23 cases of gross hematuria, 6 cases of perirenal hematoma, and 4 cases of infection. Death, AV fistula, aneurysm or serious compications that required surgical intervention were not reported. In conclusion, the percutaneous renal biopsy is relatively safe, and useful for diagnosis and management of glomerular diseases. The most common type of primary glomerular disease was IgA nephropathy.

Comparative Study of Efficacy on Percutaneous Renal Biopsy Guided by Ultrasound with Two Approaches / 中国医师杂志

Objective To investigate the efficacy of percutaneous automatic renal biopsy guided by ultrasound with two approaches. Methods One hundred and fifty patients who were suspected with diffuse renal disease were divided into two groups randomly: group A (n=74) and group B (n=76). In both groups A and B, an 18G cut needle with automatic biopsy gun was inserted the inferior pole of right kidney from proximal and distal end of transducer, respectively. After accomplishment, the times of puncture, length of sample, number of glomeruli and complications were recorded were recorded. And the number of glomeruli per centimeter was calculated. Results The differentiation of diffuse renal disease was assured by the specimens obtained by biopsy in all the patients. The puncture times in group A was less than those in group B (P0.05), and the number of glomeruli per centimeter in group A was more than that in group B (P

Renal biopsy studies in the nephrotic syndrome among Filipino adults

This is a report of five cases with the nephrotic syndrome. All of these patients were adults whose ages ranged from 17 to 38. The underlying etiological mechanisms responsible for the development of the syndrome remained undisclosed in most of the cases in spite of complete clinical and laboratory work-up. Percutaneous renal biopsy studies were performed on all cases. Biopsy findings revealed changes consistent with Ellis Type II glomerulonephritis in 2 of the cases, whereas no glomerular abnormalities could be seen in 3 of the casesThe limitations of light microscopy to demonstrate early alterations within the glomeruli of subjects suffering from the nephrotic syndrome were discussed. (Summary)

Post-Biopsy Arterio-Venous Fistula: Color Doppler Sonography in Evaluation of Its Incidence and Evolution / 대한신장학회잡지

Arteriovenous fistulae(AVF) are well documented complications of percutaneous renal biopsy. Between August 1995 and April 1997, we prospectively studied 280 consecutive ultransound-guided percutaneous renal biopsies to evaluate the incidence of post-biopsy AVF and its natural course. All biopsies patients were monitored through a routine follow-up echo-color popple sonography at post-biopsy 1, 7, 14 and 30 days. The 28 patients(10%) out of 280 consecutive percutaneous renal biopses were diagnosed to have AVF. There was no differences in the incidence of AVF between native and transplanted kidney biopsy. Most AVF were small(<2cm) and caused minimal or no symptoms. AVF was accompanied with large hematoma(thickness above 2cm) was observed in 9 cases(53%) of 17 native kidneys and none in 10 transplanted kidneys. This difference was statistically significant(P=0.008). At follow-up, AVF resolved spontaneously in 24 cases(87%). In two patients(7.1%) required superselective arterial embolization, one develoved spontaneous rupture of AVF, and one had persistence of AVF over 12 months. We concluded that color Doppler sonography provides a good, non-invasive and safe method for diagnosis and follow up of post-biopsy AVF.

A Prospective Comparative Study Between Manual and Automated Renal Biopsy by Randomized Sampling / 대한신장학회잡지

OBJECTIVES: Percutaneous renal biopsy may be carried out in several ways. Recently, the use of a spring-loaded biopsy gun has become popularized. There have been much controversies on the tissue adequacy and the incidence of complications when compared to the manual biopsy. The present study was performed to compare tissue adequacy and the incidence of complications between manual biopsy and automated biopsy. METHODS: We have studied 108 patients in whom the method of renal biopsy was assigned to one of the two methods[14G Tru-cut needle manual bx (group I) and 18G automated gun biopsy(group II)] according to their national resident's identification number in a randomized and prospective manner. RESULTS: There were 50 patients in group I and 58 patients in group II. There was no difference in gender, age, hemoglobin, prothrombin time, partial thromboplastin time, diastolic and systolic blood pressure pre-biopsy in group I and II. Indications for biopsies were proteinuria accompained by hematuria (37%), proteinuria(34.3%), acute renal failure (9.3%), SLE (8.3%), chronic renal failure (5.6%), hematuria only (5.6%). In Group I the number of passes was 2.4+/-0.8, the glomeruli obtained were 25.3+/-13.2 and the number of glomeruli per pass were 11.6+/-6.5, and in Group II 3.4+/-1.1, 19.4+/-10.8, and 6.8+/-4.0, respectively. These showed a significant difference (p<0.05). In all cases pathological diagnosis were possible. The histology showed IgA nephropathy in 27.8%, MCNS in 14.8%, lupus nephritis in 11.1, MGN in 11.1%, MPGN in 7.4%, and others. The incidence and area of perinephric hematoma demonstrated on ultrasound 24 hours post-biopsy was increased in group I (24%, 937.7+/-640.0mm2 compared to 10.3%, 372.4+/-327.4mm2 in group II) although no statistically significant difference existed. There was no significant difference in gender, age, prothrombin time, partial thromboplastin time, systolic and diastolic blood pressure between the group with and without hematomas. Hematocrit levels before and after biopsy showed a significant difference (34.5+/-8.2, 33.5+/-8.1, p<0.05) in group I, but no significant difference was observed in group II (34.7+/-6.4, 34.8+/-6.4). CONCLUSION: Both techniques rendered adequate tissue sampling, but the extent of bleeding seems to be more severe with manual 14G Tru-cut needle biopsy.

Psychological Status and Influencing Factors in Patients with Nephritic Syndrome before and after Percutaneous Renal Biopsy / 中国医学伦理学

Objective: To study the psychological status and influencing factors in patients with nephritic syndrome(NS) before and after percutaneous renal biopsy(PRB).Methods: 235 cases of NS were examined by Symptom Check List-90(SCL-90) and STAI 24 hours before and 6 hours after PRB.Results: Before PRB,factorial anxiety and phobic anxiety were higher than norm,while after the procedure,only somatization score was still higher than norm;In men,there was a higher score than that of women after PRB,all indices were seen decreased significantly;Higher scores were seen in under-60 years old than over-60 years old.Conclusions: Before and after PRB,many factors were involved in and responsible for patients' psychological symptoms.

Application of Simple Biopsy Clip by Ultrasound-Guided Percutaneous on Renal Biopsy in Children / 实用儿科临床杂志

Objective To analyze the safety and diagnostic value of ultrasound-guided biopsy with simple biopsy clip in children.Methods Under simple biopsy clip 52 cases were performed percutaneous renal biopsy.Then the curative rate and the incidence rate of complications were evaluated.Results Of 52 cases,49 cases(94.23%) gained enough renal tissue specimen for histological evaluation;Three failed cases occurred at early stage,nothing was found at later stage.The main complication was macroscopic hematuria occurred only once or twice after the operation and perirenal hematoma in 1.92% of the cases.No other severe complications were found.Conclusions The biopsy clip is convenient and sterile,and can guide the biopsy device exactly and safely.The use of 18-gauge biopsy gun and the automated biopsy device in children can decrease the complication rate,which can be easily performed.