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Renal maldevelopment: a pediatric renal biopsy study

S M Bonsib1, P Koontz

  • 1Department of Pathology, University of Iowa Hospital, Iowa City, USA.

Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc
|January 22, 1998
PubMed
Summary

Pediatric renal biopsies in patients with kidney or lower urinary tract (LUT) anomalies often reveal renal dysplasia. Progressive kidney disease is likely in cases with bilateral LUT abnormalities or small kidneys.

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Area of Science:

  • Pediatric Nephrology
  • Urology
  • Pathology

Background:

  • Renal insufficiency in children can be associated with congenital anomalies of the kidney and lower urinary tract (LUT).
  • The role of renal biopsy in evaluating these patients is not fully established.

Purpose of the Study:

  • To analyze the histopathological findings of renal biopsies in pediatric patients with renal insufficiency and congenital renal or LUT anomalies.
  • To correlate biopsy findings with clinical outcomes and identify predictors of progressive renal disease.

Main Methods:

  • Retrospective review of 18 pediatric open renal biopsies.
  • Analysis of histopathological findings, including renal dysplasia, glomerulocystic kidney disease, and polycystic kidney disease.
  • Correlation of biopsy results with clinical data, including type of anomaly, presence of extrarenal anomalies, and long-term renal function.

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Main Results:

  • Seventeen of 18 biopsy specimens showed abnormalities, predominantly focal renal dysplasia (15 cases).
  • Glomerulocystic and dominant polycystic kidney disease were each seen in one case.
  • Progressive renal disease developed in 12 of 17 patients, particularly those with bilateral uncorrectable LUT abnormalities or bilateral small kidneys.

Conclusions:

  • Renal biopsy in pediatric patients with renal insufficiency and congenital renal or LUT anomalies frequently demonstrates parenchymal maldevelopment, primarily focal renal dysplasia.
  • Despite the presence of normal nephrons, progressive disease is anticipated in cases with bilateral involvement due to underlying developmental abnormalities and complications.
  • Renal biopsy is valuable in characterizing renal pathology and predicting prognosis in this patient cohort.