Recording kidney biopsies: Defining data sets 29 th European Congress of Pathology Amsterdam 2017

Transcription

1 Recording kidney biopsies: Defining data sets 29 th European Congress of Pathology Amsterdam 2017 Sabine Leh Pathologist, PhD Haukeland University Hospital University in Bergen Bergen, Norway Special interests Non-neoplastic renal pathology, GI pathology Digital pathology Structured health data Sabine Leh

2 The Norwegian Kidney Biopsy Registry

3 Workflow

4 Definitions

5 Workflow

6 The Norwegian Kidney Biopsy Registry 107 checkboxes 11 0 Diagnosis: Focal glomerulonephritis with single crescents. A core needle biopsy with cortical kidney tissue. There are up to 11 glomeruli. A glomerulus shows a semi-circular cell proliferate in Bowman's room corresponding to a cellular crescent. Another glomerulus shows a small fibrin presipitate. A third glomerulus shows a segmental sclerosis. Glomeruli show normal mesangial areas, no cell proliferation. The capillaries are patent and the capillary walls are thin. A small group of tubules with thickened basement membrane and dedifferentiated epithelium is seen according to slight tubular atrophy. The interstitium is widened and fibrosed in these areas. Otherwise tubules show epithelial damage with enlarged somewhat pleomorphic nuclei and flattened epithelial cells. Some tubules contain detached cells. Others show casts and erythrocytes. The interstitium is fokal edematous with scattered inflammatory cells. Arteries are normal, arterioles show slight arteriolosclerosis. Congo red stain is negative.?

7 The Norwegian Kidney Biopsy Registry Diagnosis: Focal glomerulonephritis with single crescents. A core needle biopsy with cortical kidney tissue. There are up to 11 glomeruli. A glomerulus shows a semi-circular cell proliferate in Bowman's room corresponding to a cellular crescent. Another glomerulus shows a small fibrin presipitate. A third glomerulus shows a segmental sclerosis. Glomeruli show normal mesangial areas, no cell proliferation. The capillaries are patent and the capillary walls are thin. A small group of tubules with thickened basement membrane and dedifferentiated epithelium is seen according to slight tubular atrophy. The interstitium is widened and fibrosed in these areas. Otherwise tubules show epithelial damage with enlarged somewhat pleomorphic nuclei and flattened epithelial cells. Some tubules contain detached cells. Others show casts and erythrocytes. The interstitium is fokal edematous with scattered inflammatory cells. Arteries are normal, arterioles show slight arteriolosclerosis. Congo red stain is negative.

8 The Norwegian Kidney Biopsy Registry Diagnosis: Focal glomerulonephritis with single crescents. A core needle biopsy with cortical kidney tissue. There are up to 11 glomeruli. A glomerulus shows a semi-circular cell proliferate in Bowman's room corresponding to a cellular crescent. Another glomerulus shows a small fibrin presipitate. A third glomerulus shows a segmental sclerosis. Glomeruli show normal mesangial areas, no cell proliferation. The capillaries are patent and the capillary walls are thin. A small group of tubules with thickened basement membrane and dedifferentiated epithelium is seen according to slight tubular atrophy. The interstitium is widened and fibrosed in these areas. Otherwise tubules show epithelial damage with enlarged somewhat pleomorphic nuclei and flattened epithelial cells. Some tubules contain detached cells. Others show casts and erythrocytes. The interstitium is fokal edematous with scattered inflammatory cells. Arteries are normal, arterioles show slight arteriolosclerosis. Congo red stain is negative.

9 Workflow

10 Workflow

11 To universally and comprehensively describe all possible clinical situations with information models and to make these models accessible in a national library arketyper.no clinical knowledge manager

12 Microscopy renal biopsy non-neoplastic

13 Microscopy renal biopsy non-neoplastic

14 Microscopy renal biopsy non-neoplastic

15 Microscopy renal biopsy non-neoplastic Narrative text!

16 Structured data in U-700 Tubular atrophy Not detected Mild Moderate Severe Equivocal Indeterminate Structure not present

17 Structured data in U-700

18 Structured data in U-700 A core needle biopsy with cortical kidney tissue. There are up to 11 glomeruli. A glomerulus shows a semi-circular cell proliferate in Bowman's room corresponding to a cellular crescent. Another glomerulus shows a small fibrin presipitate. A third glomerulus shows a segmental sclerosis. A small group of tubules with thickened basement membrane and dedifferentiated epithelium is seen according to slight tubular atrophy. The interstitium is widened and fibrosed in these areas. Arteries are normal, arterioles show slight arteriolosclerosis. Congo red stain is negative.

19 Workflow

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21 Knowledge support

22 Clinical Knowledge Manager International repository where clinicians can develop, manage, publish and use archetypes, freely available under a Creative Commons licence. Do-Ocracy An movement where power and respect go to people who get things done. clinical knowledge manager

23 Table

24 Table ADL XML

25 Table ADL XML History

26 Table ADL XML History Discussion

27 Table ADL XML History Discussion Review

28 Table ADL XML History Discussion Review Change

29 Table ADL XML History Discussion Review Change Adopt

30 National governance National editorial committee Define review requirements Approve reviews National coordinators Organize reviews Edit archetypes Manage CKM Clinicians Participate in reviews Start initiatives Modified after Silje Ljosland Bakke, 2015

31 What is still missing? Only some core data electronically structured Rest of data structured text or free text Data and value sets still mostly local, not completely adapted national Proof of principle

32 What is still missing? Flemish Collaborative Glomerulonephritis Group

33 Hospitals and glomeruli: how many glomeruli per biopsy? Ålesund sjukehus 9 Sykehuset Østfold 32 Førde Sentralsjukehus 17 Sørlandet Sykehus Kristiansand 19 Universitetssykehuset Nord-Norge 27 Sykehuset Telemark 20 OUS Ullevål 51 Sykehuset Innlandet, Elverum 9 Vestre Viken Bærum 18 OUS Rikshospitalet 31 Nordlandssykehuset 14 Sykehuset Levanger 17 Sørlandet Sykehus, Arendal 7 Akershus Universitetssykehus 28 Haugesund sjukehus 13 Haukeland universitetssjukehus 92 Vestre Viken Drammen 29 Sykehuset Innlandet, Lillehammer 35 Molde sjukehus 6 Stavanger Universitetssjukehus 53 Sykehuset i Vestfold 42 Vestre Viken Ringerike 3 St.Olavs Hospital 36 22,9 22,0 20,4 20,2 19,6 19,0 18,0 17,1 16,7 16,7 16,1 16,1 15,7 14,8 14,5 14,1 12,9 12,2 12,0 11,8 11,4 11,0 10, Gjennomsnittlig antall glomeruli per biopsi The Norwegian Kidney Biopsy Registry Report 2015