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2015年1月23日星期五

Is Renal Biopsy Necessary to Diagnose Chronic Glomerulonephritis

I have a friend who has suffered from chronic glomerulonephritis for two years. His latest urine test shows: occult blood +3, urine protein +2. Doctors suggest him do renal biopsy, but he worries that renal biopsy may also bring trauma to kidney, which may affect his future life. For this reason, he asked me whether renal biopsy is necessary for him.
Actually, whether patients with chronic nephritis need renal biopsy, is based on their illness condition. Renal biopsy is a kind of pathological test, but not a treatment. It is used to make sure which kind of kidney disease patients have. Since kidney diseases are various and their pathogenesises are complicated, sometimes clinical symptoms can not reflect the real histological change in kidneys). Therefore, renal biopsy will be needed to make more exact diagnosis.
At present, the result of renal pathological test has been the gold index to diagnose kidney disease. Normally, the clinical significances of renal biopsy can be listed as follows:
(1)Clearing diagnosis: More than one third clinical diagnosis can be revised by renal biopsy.
(2)Guiding treat: more than one third clinical treatments will be corrected by renal biopsy.
(3)Estimating prognosis: the result of renal biopsy is helpful to estimate patients’ prognosis.
In addition, renal biopsy is needed again for pathological progress, such as crescentic glomerulonephritis, lupus nephritis and IgA kidney diseases.
Patients with Chronic Glomerulonephritis take renal biopsy to clear pathological diagnosis, which is helpful to find suitable treatments. Generallyl, pathological diagnosis of renal biopsy are as follows: MPGSN(includes IgA nephropathy), Membranoproliferative GN, membranous nephropathy(MN), Focal segmental sclerosing glomerulonephritsi. At the same time, it also includes various degrees pathological damage of glomeruli and renal tubules.
In order to have exact diagnosis to guide treatment and estimate prognosis, if there is no contraindication, all kinds of primary or secondary as well as genetic kidney disease patients can be taken renal biopsy in order to make exact diagnosis as well as guide treatment and estimate prognosis.
Secondary or genetic kidney disease nephropathy: Renal biopsy is still needed if the renal pathological change is important to guide the treatment and estimate prognosis, even though the disease is secondary or genetic which has already been diagnosed clinically. Since renal biopsy is a traumatic test, patients are not allowed to take renal biopsy if they have the following conditions:
Absolute contraindication: obvious bleeding tendency, severe high blood pressure (High Blood Pressure and Kidney Disease), mental diseases, solitary kidney, small kidney.
Relative contraindication: active pvelonephritis, nephrotuberculosis, hydronephrosis or pyonephrosis, renal abscess or around renal abscess, renal tumors or renal aneurysms, polycystic kidney or large kidney cysts, the place of the kidneys are too high (the lower pole of the kidney can’t reach the twelfth rib when in deep breath) or nephrospasia, chronic renal failure, obesity, severe ascites, cardiac failure, serious anemia, low blood volume and pregnancy or old people.
Patients with chronic glomerulonephritis should choose renal biopsy cautiously, to sure they care suitable the condition.
Renal biopsy has side effects and there will be trauma after the test. Sometimes, it also aggravates hematuria.

Though it is helpful to clear the pathology of chronic nephritis and is helpful for clinical study, its guiding significance for patients to seek for treatment is little. Since there are so many contraindications of renal biopsy test, experts suggest patients with chronic glomerulonephritis take renal ECT test, which can respond the kidney damage and have vital significance to diagnose and treat the disease.

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