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• W2110157029 abstract "Ideally, the information derived from a renal biopsy should identify a specific diagnosis of the renal disease and its severity, reflect the extent of disease activity, and provide the basis for a decision about specific therapy. On the other hand, biopsy can also be valuable in improving prognostic accuracy and our understanding of the natural history of the various forms of glomerular diseases. Unfortunately, the pathologic findings are often not specific and definitive diagnosis cannot always be made. As a result the prognosis anduor likelihood of response to therapy cannot always be predicted with confidence w1x. Despite these shortcomings renal biopsy is still considered by most nephrologists as an irreplaceable source of information. Apart from making a definitive diagnosis an accurate assessment of the severity of disease is essential for determining the extent of disease activity and the probability that the disease will respond to specific therapy. Prognostic indicators can be derived from a variety of lesions that may be present in a renal biopsy. The good or poor prognosis of renal function will depend on the overall severity of the lesions, the reversibility or irreversibility of the lesions, the pathologic characteristics of individual renal disease and the patient’s response to the treatment w2x. Lesions such as glomerulosclerosis, arteriolosclerosis, and interstitial fibrosis, if severe and diffuse, indicate a poor prognosis because they are irreversible, slowly progressive, and not responsive to treatment. On the other hand, intracapillary proliferative and exudative glomerular hypercellularity, even when pronounced, is often completely reversible and does not necessarily indicate a poor prognosis. Glomerular inflammatory processes when associated with necrosis and destruction of basement membranes are more likely to result in glomerular sclerosis. Large crescents ()50% of the glomerular circumference) that are usually present in rapidly progressive forms of GN are not likely to resolve but will instead gradually become fibrotic, eventually destroying the glomerular tuft. In contrast, glomerular capillary thrombi may resolve without residual damage, even without anticoagulant therapy w3,4x. In the arteries certain changes such as intimal oedema and hyalin insudation seem to be potentially reversible without much residual sclerosis. In contrast, if an arteritic inflammatory process is associated with necrosis, it invariably leads to segmental scarring and destruction of the elastic lamina w3x. These considerations are especially important when recommending potentially toxic treatments. Accurate histologic evaluation of a renal biopsy should identify those patients with poor prognosis. In recent studies, attempts have been made to develop measures of disease activity and reversibility, which are intended to enhance clinical decision-making. This has been studied extensively in systemic lupus erythematosus. Patients with a chronicity index (based especially on the extent of fibrosis and tubular atrophy) of )1 had a significantly greater likelihood of developing renal failure compared to those with a chronicity index of -1; patients with a chronicity index )4 had the worst prognosis. Patients with an activity index of )12 had a significantly worse prognosis than those with an activity index of -12 w5x. However, in a recent multicentre trial in patients with severe lupus nephritis, these results have been challenged by others w6x. Also, more recent studies of patients with lupus nephritis have used more precise quantitative assessment of kidney structural abnormalities for assessment of disease Correspondence and offprint requests to: E. Alexopoulos, Department of Nephrology, Hippokration General Hospital, 50 Papanastasiou Str., 54 640 Thessaloniki, Greece. Nephrol Dial Transplant (2001) 16 wSuppl 6x: 83–85" @default.
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• W2110157029 date "2001-09-25" @default.
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• W2110157029 title "How important is renal biopsy in the management of patients with glomerular diseases?" @default.
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• W2110157029 doi "https://doi.org/10.1093/ndt/16.suppl_6.83" @default.
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