Laparoscopic-percutaneous kidney biopsy in children—a new approach

Netto, José Murillo Bastos; Portela, Wélida Salles; Choi, Mauro; Filho, Marcello Fonseca Salgado; Toledo, Antônio Carlos Tonelli de; Figueiredo, André Avarese de

doi:10.1016/j.jpedsurg.2009.07.021

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…The transjugular and laparoscopic biopsies are safer procedures for children; however, in most countries, their use is limited by the availability of technical expertise, especially for paediatric patients. 20,21 In general, the open wedge kidney biopsy is considered to have a low complication rate and has even been recommended for children with SLE and APS. Moreover, the duration of immobilization after an open wedge biopsy is generally shorter than after a percutaneous kidney biopsy, and anticoagulation therapy can begin earlier.…”

Section: Discussionmentioning

confidence: 99%

Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome

et al. 2018

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Children with systemic lupus erythematosus (SLE) generally undergo a pretreatment kidney biopsy. However, some of these patients, especially those with antiphospholipid syndrome (APS), may experience serious coagulopathic complications. We report herein two cases of paediatric SLE with APS in which, despite normal blood test results, the disparate coagulopathic complications of haemorrhage and embolism developed following a kidney biopsy. Case 1 was, an 8-year-old male in whom, primary APS was initially diagnosed. Fourteen months later SLE was diagnosed. Based on a percutaneous kidney biopsy, International Society of Nephrology and the Renal Pathology Society (ISN/RPS) class III-A lupus nephritis was histologically diagnosed. On post-biopsy Day 9, a giant haematoma in the fascia of the left kidney developed and was accompanied by changes in the vital signs. Case 2, a 13-year-old male, initially received the diagnosis of SLE with APS and underwent two courses of pulse methylprednisolone therapy. His coagulation abnormalities improved, and a percutaneous needle kidney biopsy was performed, leading to the histological diagnosis of ISN/RPS class III-A lupus nephritis. Furthermore, thrombotic microangiopathy was also detected in the renal histopathology. On post biopsy Day 6, the patient experienced right leg pain. A contrast CT and lower extremity ultrasonography detected a massive deep vein thrombosis and partial left pulmonary artery thrombosis. A kidney biopsy in children with SLE and APS can cause lethal coagulopathic complications, and the risks to such patients should be weighed carefully before the procedure is performed.

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Section: Discussionmentioning

confidence: 99%

Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome

et al. 2018

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“…These include laparoscopic, transurethral or transvenous renal biopsy [ 42 – 44 ]. Recently, a technique has been proposed which combines the laparoscopic approach with a percutaneous needle biopsy [ 45 ]. However, a kidney biopsy allows an accurate diagnosis and an appropriate treatment/prevention of renal function deterioration.…”

Section: Discussionmentioning

confidence: 99%

Nephrotic syndrome and autosomal dominant polycystic kidney disease

Visciano

Pietro

Rossano

et al. 2012

Clinical Kidney Journal

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BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development and growth of cysts in the kidneys and other organs. In ADPKD patients, nephrotic range proteinuria is unusual and needs to be investigated further to exclude coexisting glomerular disease. Among the anecdotal case reports of ADPKD associated with nephrotic syndrome, focal segmental glomerulosclerosis occurs most frequently.MethodsWe report the case of a 26-year-old male with ADPKD and concomitant nephrotic syndrome, in which an ultrasound (US)-guided renal biopsy showed a mesangioproliferative glomerulonephritis. We treated the patient with prednisone 1 mg/kg/day, because of the failure of treatment with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker association.ResultsAfter 6 months of steroid treatment, we observed a stability of his GFR and a reduction of proteinuria.ConclusionThis case report and other cases of the literature underline the importance of a renal biopsy in patients with ADPKD and nephrotic syndrome in order to make an accurate diagnosis and an appropriate treatment/prevention of renal function deterioration.

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“…In fact, the retroperitoneoscopy or transperitoneal approach renal biopsy is now the preferred procedure for pediatric patients [23]. A new approach combining laparoscopy and percutaneous needle biopsy has been proposed [24]. This approach combines the advantages of percutaneous biopsy, with minimal trauma to the kidney and the low morbidity associated with laparoscopy.…”

Section: Discussionmentioning

confidence: 99%

Nephrotic Syndrome and Idiopathic Membranous Nephropathy Associated with Autosomal-Dominant Polycystic Kidney Disease

Peces

Martínez-Ara

Peces

et al. 2011

The Scientific World JOURNAL

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We report the case of a 38-year-old male with autosomal-dominant polycystic kidney disease (ADPKD) and concomitant nephrotic syndrome secondary to membranous nephropathy (MN). A 3-month course of prednisone 60 mg daily and losartan 100 mg daily resulted in resistance. Treatment with chlorambucil 0.2 mg/kg daily, low-dose prednisone, plus an angiotensin-converting enzyme inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) for 6 weeks resulted in partial remission of his nephrotic syndrome for a duration of 10 months. After relapse of the nephrotic syndrome, a 13-month course of mycophenolate mofetil (MFM) 2 g daily and low-dose prednisone produced complete remission for 44 months. After a new relapse, a second 24-month course of MFM and low-dose prednisone produced partial to complete remission of proteinuria with preservation of renal function. Thirty-six months after MFM withdrawal, complete remission of nephrotic-range proteinuria was maintained and renal function was preserved. This case supports the idea that renal biopsy is needed for ADPKD patients with nephrotic-range proteinuria in order to exclude coexisting glomerular disease and for appropriate treatment/prevention of renal function deterioration. To the best of our knowledge, this is the first reported case of nephrotic syndrome due to MN in a patient with ADPKD treated with MFM, with remission of proteinuria and preservation of renal function after more than 10 years. Findings in this patient also suggest that MFM might reduce cystic cell proliferation and fibrosis, preventing progressive renal scarring with preservation of renal function.

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Laparoscopic-percutaneous kidney biopsy in children—a new approach

Cited by 5 publications

References 4 publications

Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome

Coagulopathy as a complication of kidney biopsies in paediatric systemic lupus erythematosus patients with antiphospholipid syndrome

Nephrotic syndrome and autosomal dominant polycystic kidney disease

Nephrotic Syndrome and Idiopathic Membranous Nephropathy Associated with Autosomal-Dominant Polycystic Kidney Disease

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