Organisation and Practice of a Kidney Biopsy Register

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Organisation and Practice of a Kidney Biopsy
Register
The Italian View
Cataldo Abaterusso MD, PhD Division of
Nephrology University of Verona (Italy)

• Firenze, 07 September 2009

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History of Italian Registry of Renal
Biopsies(IRRB)

• Start in 1987
• Two Surveys published
• 1987-1993 (Schena FP. Nephrol Dial Transplant
  1997)
• 1996-2000 (Gesualdo L et al. Kidney Int 2004)

Periods N. Renal Units N. Biopsies (native kidneys)
1987-1993 74 13.835
1996-2000 128 14.607
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http//88.59.234.153/irrb/
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IRRB 1996-2000
INDICATION TO PERFORM A RENAL BIOPSY MAIN
CLINICAL PICTURE
n. Biopsies 14607
Biopsies
Gesualdo L. Kidney Int 2004
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DISTRIBUTION OF HISTOLOGIC GROUPS
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IRRB 1996-2000
MAIN PRIMARY GN IN NEPHROTIC SYNDROME
Gesualdo L. Kidney Int 2004
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IRRB
1987-1993 13.835 renal biopsies 1996-2000 14.60
7 renal biopsies
Since 2001 only 4321 renal biopsies collected
The Ending Story
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Renal Biopsies Register

• The Philosphy of Building
• You cannot have your cake and eat it
• The Variables of Survival of a Renal Biopsies
  Register
• Development of Customer Loyalty
• Unambiguous Data (Diagnosis, Definitions, etc.)
• Wealth of Data
• Time consuming
• Updating / Maintenance of Register
• Feedback
• Having strongly motivated Collaborators

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RTVBR

• Since 1998 started the Renal Biopsies Register
  of TriVeneto
• RTVBR collect renal biopsies from
• Adult subjects
• Triveneto Areas Renal Units
• Native kidneys
• Biopsies of graft not included

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North-East of Italy the Triveneto Area
11.4 Italian Pop.
At data of 01 January 2008 Resident Population
(age gt15yrs) 5.780.020 persons
From ISTAT http//demo.istat.it/pop2008/
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YEARS Collaborative Group N. Biopsies
1998 19 344
1999 21 343
2000 22 320
2001 23 336
2002 23 316
2003 23 293
2004 23 326
2005 23 332
2006 24 394
2007 24 335
2008 24 362
Total 3701
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• Personal data
• Age
• Demographic
• Ethnicity
• Biopsy date
• Blood Pressure
• Clinical Presentation at Biopsy
• (SN, AUA, ARF, CRF, etc)
• Main Treatment

• Laboratory
• s-Creatinine
• eGFR
• sHb
• Proteinuria (g/day)
• Hepatitis markers
• Complications of Biopsy
• Type of histologic analysis
• (LM, IF, EM)

Unequivocal Renal Diagnosis (from a multiple
choice panel)
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Renal Biopsy and Histological Data
RTVBR 1998-2008 Renal Diagnosis LM IF more
than 85 of biopsies ME about 50 of
biopsies
http//rtbr.sined.it
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Laboratory
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Clinical Presentation and Treatment
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On-line search into RTVBR
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Statistics
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Renal Biopsies Register

• The RTVBR Experience
• The Variables of Survival of a Renal Biopsies
  Register
• Development of Customer Loyalty
• Unambiguous Data (Diagnosis, Definitions, etc.)
• Wealth of Data
• Updating / Maintenance of Register
• Time consuming
• Feedback (annual report and meetings)
• Having strongly motivated Collaborators

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The Points of Strenght of a Renal Biopsies
Register

• Epidemiology of GN
• Variation of incidence on time
• Renal Biopsy Policy
• Identification and collection of rare and
  uncommon renal disease
• Database to perform Surveys/Trials on uncommon
  nephropathies
• Linkage with other Register (i.e Dialysis and
  Transplant Register)

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RESULTS OF RTVBR ANALYSIS
DISTRIBUTION OF HISTOLOGIC GROUPS
RTVBR 1998-2007
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RTVBR 1998 - 2008
INDICATION TO PERFORM A RENAL BIOPSY MAIN
CLINICAL PICTURE
N. Biopsies 3701
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RTBR 1998 2008
INDICATION TO RENAL BIOPSY PER GROUP OF AGE
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PRIMARY GLOMERULONEPHRITIS
RTVBR 1998-2008
DIAGNOSIS
IgAN 31
MGN 25
FSGS 15
Mes. not IgA 11
MCD 7
MPGN 6
Crescentic GN (CGN) 4
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RTVBR 1998 - 2007
PREVALENCE OF MAIN PRIMARY GLOMERULONEPHRITIS
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SECONDARY HISTOLOGIC PICTURES
RTVBR 1998-2008
DIAGNOSIS
SLE 20
DYSGAMMAGL. 20
VASCULITIS 19
DIABETES 15
SHP 5
CRYOGLOB. 4
POST-INFECTIOUS 4
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RTVBR 1998 - 2007
PREVALENCE OF MAIN SECONDARY HISTOLOGIC PICTURES
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RTBR 1998 - 2008
ACUTE RENAL FAILURE STRATIFIED FOR AGE
N. Cases 485 M 60 F 40
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RTBR 1998 - 2008
ACUTE RENAL FAILURE
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RTVBR 1998-2008
ACUTE RENAL FAILURE

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RTBR 1998 - 2008
ACUTE RENAL FAILURE Main Histologic Diagnosis
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RTBR 1998-2008
NEPHROTIC SYNDROME
N Pts 1462
Male () 62
Female () 38
Mean Age (yrsSD) 525
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RTBR 1998 - 2008
NEPHROTIC SYNDROME
N. 1462 biopsies
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RTVBR 1998-2008
NEPHROTIC SYNDROME
Main Histologic Diagnosis

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RTVBR 1998-2008
NEPHROTIC SYNDROME
Class of Age (y) 21 - 40 41 - 65 gt 65
MGN () 22 34 40
FSGS 14 11 8
MCD 13 6 7
IgAN 12 6 3
SLE 10 4 1
MesGN 8 5 4
MPGN 6 4 6
Diabetes 2 8 7
Dysgam. 1 8 11
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CONCLUSIONS

• The management and survival of a Renal Biopsy
  Register (RBR) are a compromise solution between
  multiple conditions
• Management demands and time consuming by
  Collaborators have to be lower than their
  advantages (feedback)
• RBR could facilitate the development of a network
  of Renal Units
• The RBRs strenght is strictly linked to
  continuity of providing the data
• A RBR well managed could be an effective tool to
  perform trials and surveys