Biopsia renal en pediatría: análisis de la casuística de 28 años. Hospital de Niños de Valencia. Venezuela

Resumen

Introducción: el análisis de los resultados de casuísticas de biopsias renales es importante con fines diagnósticos, terapéuticos y de pronóstico. Objetivo: evaluar la serie de biopsias renales en el Hospital de Niños de Valencia, Venezuela, durante el período 1978-2007. Métodos: Fueron analizadas 421 biopsias renales practicadas en 395 pacientes, de 2 meses a 20 años, 57% varones. El material fue procesado por microscopía óptica, inmunofluorescencia y microscopía electrónica en 98 % de los casos. Resultados: se obtuvo muestra adecuada (más de 10 glomérulos) en 93% de los casos (n=392). Indicaciones clínicas: síndrome nefrótico 199 (50%), síndrome nefrítico atípico 53 (13%), otros: (hematuria/proteinuria, proteinuria, trasplante, enfermedades sistémicas 143 (37%). Resultados histopatológicos: A.- Glomerulonefrítis primaria (GNP) 302 casos (77%) , B.- nefropatías secundarias (NS) 68 casos (17%), c.- riñones trasplantados 28 casos (7%). -diagnósticos en GNP: 1) lesión de cambios mínimos 140 (46%), 2) Glomeruloesclerosis segmentaria y focal 79 (26%), 3) GN proliferativa y/o mesangial 67 (22%), 4) GN Membranosa 16 (5%). -diagnósticos en NS: nefritis lúpica: 20 casos (32.25%), nefropatía IgA: 22 casos (35.50%); otras: 20 casos (32.25%). -diagnósticos en riñones trasplantados: rechazo agudo 50%, necrosis tubular aguda 25%, rechazo crónico 20%, enfermedad recurrente en trasplante 5%. complicaciones: hematuria transitoria: 21 casos (5%), hematoma perirenal: 3(<1%), perforación intestinal: 2 (<0.5%), hemorragia importante: 2 (<0.5%), nefrectomía: 1(0.2%). Conclusiones: la presente es una de las primeras casuísticas de biopsias renales reportadas en latinoamérica y una de las más grandes en el mundo y, de acuerdo a nuestros resultados, es un procedimiento seguro con gran utilidad diagnóstica, pocas complicaciones, sin mortalidad.

Introduction: evaluation and analysis of the results of renal biopsy are important for diagnostic, therapeutic and prognostic matters. Objective: to evaluate a series of renal biopsies performed during the period 1978-2007 in the Hospital de Niños de Valencia, Venezuela. All patients had history of either primary or secondary nephropathies. Methods: 421 biopsies were done in 377 patients, ages 2 months-20 years; 57% boys. 26 patients were re-biopsed. Percutaneous needle biopsy (PNB) was performed in all the patients, except in one who underwent open biopsy because of a solitary kidney. Renal tissue was processed for optical, inmunofluorescence and electronic microscopy in 98% of cases. The biopsy technique, clinical syndromes at presentation, hystopathological pattern, effectiveness and complications are described. Results: Adequate sample was obtained in 392 cases (93%) (more than 10 glomeruli) and inadequate or failed biopsy in 29 (7%). Clinical syndromes at presentation were: nephrotic syndrome: 199 cases (50%), atypical acute nephritic syndrome: 53 (13%), others: hematuria and proteinuria, isolated proteinuria, kidney transplant biopsy or systemic diseases: 143 (37%). The hystopathological pattern obtained was as follows: A.- Primary glomerulonephritis (PG): 302 cases, 77%, B.- secondary nephropathies: 68 cases, 17% , c.- Kidney transplant biopsies: 28 cases, 5 %. Primary Glomerulonephritis diagnosis: minimal change disease: 140 cases, 46%, Focal segmental Glomerulosclerosis: 79 (26%), diffuse proliferative glomerulonephritis / mesangial: 67 (22%), membranous glomerulonephritis: 16 (5%). Secondary nephropathies: lupus nephritis: 20 cases (32.25%), IgA nephropathy: 22 cases (35.50%), others: 20 cases (32.25%). Transplant biopsies: rejection 50%, acute tubular necrosis 25%, chronic rejection 20%, and recurrent disease 5%. complications: transient hematuria: 21 (5%), perirenal hematoma: 3 (<1%), gut perforation (<0.2%), bleeding which required blood transfusion: 2 (<0.5%) and nephrectomy because of incontrollable bleeding 1 (0.2%). Conclusions: this series of renal biopsies is one of the first reported in latin-America and one of the largest in the world. According to our results, renal biopsy is a reliable and safe procedure in pediatric nephrology. Our casuistic shows that it is useful for the diagnosis, prognosis and follow up of patients with various nephropathies, excellent effectiveness and low number of complications, with no mortality.