SCOTTISH REAL BIOPSY REGISTRY: SURVEY OF NATIVE KIDNEY BIOPSY IN SCOTLAND 2015

Transcription

1 Scottish Renal Registry Report SECTION N SCOTTISH REAL BIOPSY REGISTRY: SURVEY OF NATIVE KIDNEY BIOPSY IN SCOTLAND All centres in Scotland were able to provide date of birth, sex (except centre), indication for biopsy, operator and major complications and main diagnosis for all native renal performed in the calendar year. Diagnosis was selected from the 2 ERA/EDTA primary renal diagnosis codes ( and this year complement 3 glomerulopathy, Kidney biopsy result normal and Insufficient histological evidence from kidney biopsy for diagnosis were added to the list of possible diagnoses. Indication for biopsy, operator and major complications were selected from pre-defined codesets. The total number of reported was 726 in 699 patients giving an incidence of 3. per million population (pmp) per year which is slightly higher than the incidence of 27. pmp in 4. Total number of and total number of patients having native renal biopsy were expressed pmp for each centre based on the populations shown in N. N Number of native kidney by renal unit and NHS Board Renal unit NHS boards ARI GRAM + SHET + ORKN Population Total Second or native subsequent Number patients having biopsy Native pmp/yr Patients having native pmp/yr Mean age at biopsy % Male XH A&A DGRI D&G GLAS GG&C + FV MONK LAN NINE TAY RAIG HIGH + WI RIE LOTH + BORD NA* VHK FIFE Scotland * Sex not available. 89

2 Scottish Renal Registry Report N2 Incidence per million population of native kidney in by renal unit 3 2 Overall pmp -2 SD +2 SD -3 SD +3 SD Native kidney pmp DGRI RAIG NINE XH VHK ARI MONK RIE GLAS Population (millions) N3 Indication for native kidney biopsy in by renal unit % of ARI XH DGRI GLAS MONK NINE RAIG RIE VHK Not specified Other (specify) Normal egfr and no proteinuria Normal egfr and proteinuria Any chronically reduced egfr Nephrotic Syndrome Acute Kidney Injury Indications for native renal biopsy were recorded using pre-defined indication terms. 9

3 Scottish Renal Registry Report Diagnosis Nephrologists were asked to select the diagnosis that was the main explanation for the clinicpathological features. Only 4 had no diagnosis recorded. In 43 cases the diagnosis was recorded as insufficient tissue for diagnosis (most of which had a further biopsy procedure). For 2 the diagnosis was recorded as Chronic kidney disease (CKD) / chronic renal failure (CRF) - aetiology uncertain / unknown - histologically proven. 8 were reported as Kidney biopsy result normal. Of the remainder a total of different ERA/EDTA Primary Renal Diagnosis terms were recorded as the primary explanation for the clinical indication for native kidney biopsy. In a further 7 cases the nephrologists felt that none of the ERA/EDTA terms were sufficient (recorded as other ). The most frequently reported diagnoses are shown in N4 in order of frequency and the frequency of reporting of each diagnosis in 4 is shown for comparison. A complete list of all recorded diagnoses and frequencies in each renal unit can be viewed on the Scottish Renal Registry website: 9

4 Scottish Renal Registry Report N4 Most frequently reported native kidney biopsy diagnoses recorded in by renal unit and compared with incidence 4 ARI XH DGRI GLAS MONK NINE RAIG RIE VHK Scotland Scotland 4 IgA nephropathy Membranous nephropathy - idiopathic Tubulointerstitial nephritis Systemic lupus erythematosus / nephritis Microscopic polyangiitis - histologically proven Diabetic nephropathy in type I or type II diabetes - histologically proven Granulomatosis with polyangiitis Primary focal segmental glomerulosclerosis (FSGS) Minimal change nephropathy Acute kidney injury (acute tubular necrosis) Mesangiocapillary glomerulonephritis - not type 2 Focal and segmental proliferative glomerulonephritis AL amyloid secondary to plasma cell dyscrasia Chronic hypertensive nephropathy Drug-induced tubulointerstitial nephritis Henoch-Schönlein purpura / nephritis Ischaemic nephropathy / microvascular disease Renal amyloidosis a 4 7 Complement component 3 glomerulopathy Glomerulonephritis - histologically indeterminate Myeloma cast nephropathy - histologically proven NA a. Not including AL amyloidosis secondary to plasma cell dyscrasia or AA amyloidosis secondary to chronic inflammation 92

5 Scottish Renal Registry Report The incidences of IgA nephropathy, idiopathic membranous nephropathy and ANCA associated vasculitis (a combination of granulomatosis with polyangiitis, microscopic polyangiitis and Churg Strauss syndrome) were expressed pmp and compared between renal units in N. Funnel plots of the incidence of IgA nephropathy and ANCA associated vasculitis are shown in N6 and N7 respectively. N Incidences per million population of selected biopsy diagnoses 4 3 IgAN Membranous nephropathy-idiopathic ANCA associated vasculitis 3 2 Diagnoses pmp/year ARI XH DGRI GLAS MONK NINE RAIG RIE VHK Scotland N6 Incidence per million population of biopsy diagnosis of IgA nephropathy by renal unit 93

6 Scottish Renal Registry Report 7 IgA nephropathy pmp NINE Overall pmp -3 SD +3 SD -2 SD +2 SD RIE XH GLAS MONK RAIG VHK ARI DGRI Population (millions) N7 Incidence per million population of biopsy diagnosis of ANCA associated vasculitides (AAV) by renal unit Overall pmp -3 SD +3 SD -2 SD +2 SD AAV pmp 3 2 RAIG NINE ARI GLAS DGRI XH VHK MONK RIE Population (millions) N8 Operator performing native kidney by renal unit 94

7 Scottish Renal Registry Report % of Not stated Radiologist Nephrology trainee Consultant nephrologist ARI XH DGRI GLAS MONK NINE RAIG RIE VHK N9 Complication Major complications of native kidney in Number in Arteriography and embolisation 6 Arteriography no embolisation 2 Blood transfusion only 3 Clot obstruction managed conservatively Clot obstruction requiring intervention Death Nephrectomy Other 3 Surgery no nephrectomy Total 6 Major complications were defined as shown in N9. There were 6 major complications (2.2%) including death attributed to bleeding after biopsy. 9