1

Organisation and Practice of a Kidney Biopsy Register

Firenze, 07 September 2009

Cataldo Abaterusso MD, PhD

Division of Nephrology

University of Verona (Italy)

The Italian View

2

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

3http://88.59.234.153/irrb/

4

0 10 20 30 40 50 60

AUA

NS

CRF

ARF

ANS

RIBR

IRRB 1996-2000

INDICATION TO PERFORM A RENAL BIOPSY:

MAIN CLINICAL PICTUREn. Biopsies:

14607

Gesualdo L. Kidney Int 2004% Biopsies

5

DISTRIBUTION OF HISTOLOGIC GROUPS

0

10

20

30

40

50

60

70

PRIM SECON

1987-1993 1996-2000

6

IRRB 1996-2000

0

5

10

15

20

25

30

35

40

45%

MG

N

FSGS

MCD

MAIN PRIMARY GN IN NEPHROTIC SYNDROME

Gesualdo L. Kidney Int 2004

7

IRRB

The Ending Story

Since 2001 only 4321 renal biopsies collected

1987-1993 13.835 renal biopsies

1996-2000 14.607 renal biopsies

8

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

9

Since 1998 started the “Renal Biopsies Register of TriVeneto”

RTVBR collect renal biopsies from:

• Adult subjects

• Triveneto Area’s Renal Units

• Native kidneys

• Biopsies of graft not included

RTVBR

10

North-East of Italy: the Triveneto Area

At data of 01 January 2008

Resident Population (age >15yrs) : 5.780.020 persons

From ISTAT: http://demo.istat.it/pop2008/

11.4%

Italian Pop.

11

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

12

• 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)

13

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

14

Laboratory

15

Clinical Presentation and Treatment

16

On-line search into RTVBR

17

Statistics

18

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

19

• 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)

The Points of Strenght of a Renal Biopsies Register

20

0

10

20

30

40

50

60

70%

PRIM SECON

1998-2002 2003-2007

DISTRIBUTION OF HISTOLOGIC GROUPS

0

10

20

30

40

50

60

70

PRIM SECON

1987-1994 1996-2000

RTVBR

1998-2007

RESULTS OF RTVBR ANALYSIS

21

RTVBR 1998 - 2008

0

5

10

15

20

25

30

35

40

45%

NSAUA

CRFARF

EMAT.

ANS

INDICATION TO PERFORM A RENAL BIOPSY:

MAIN CLINICAL PICTURE

N. Biopsies 3701

22

RTBR 1998 – 2008

0

10

20

30

40

50

%

<40

41 -

65 >65

AUA

NS

CRF

ARF

EM

INDICATION TO RENAL BIOPSY PER GROUP OF AGE

23

PRIMARY GLOMERULONEPHRITIS

DIAGNOSIS %IgAN 31

MGN 25

FSGS 15

Mes. not IgA 11

MCD 7

MPGN 6

Crescentic GN (CGN) 4

RTVBR 1998-2008

24

RTVBR 1998 - 2007

0

5

10

15

20

25

30

35%

IgAN MGN FSGS MES MCD MCGN

1998-2002

2003-2007

PREVALENCE OF MAIN PRIMARY GLOMERULONEPHRITIS

25

SECONDARY HISTOLOGIC PICTURES

DIAGNOSIS %SLE 20

DYSGAMMAGL. 20

VASCULITIS 19

DIABETES 15

SHP 5

CRYOGLOB. 4

POST-INFECTIOUS 4

RTVBR 1998-2008

26

RTVBR 1998 - 2007

0

5

10

15

20

25%

Vasculit

isSLE

Dysgam

mag

l.

Diabet

es

1998-2002

2003-2007

PREVALENCE OF MAIN SECONDARY HISTOLOGIC PICTURES

27

RTBR 1998 - 2008

0

5

10

15

20

25

30

35

40

45%

< 20 21-40 41-65 > 65

ACUTE RENAL FAILURE STRATIFIED FOR AGE

N. Cases 485

M: 60% F: 40%

28

RTBR 1998 - 2008

0

5

10

15

20

25

30

35

40

45%

SECON PRIM TIN VASC Other

ACUTE RENAL FAILURE

29

RTVBR 1998-2008

ACUTE RENAL FAILURE

0

5

10

15

20

25

30

35

40

45

50

<40 41-65 >65

Age (yrs)

Second

Primit

TIN

Vascul.

%

30

RTBR 1998 - 2008

0

5

10

15

20

25%

Vascu

l.AIN

Dysgam

.

ExGN

IgAN

Other

s

ACUTE RENAL FAILUREMain Histologic Diagnosis

31

RTBR 1998-2008

NEPHROTIC SYNDROME

N° Pts 1462

Male (%) 62

Female (%) 38

Mean Age (yrs±SD)

52±5

32

RTBR 1998 - 2008

0

10

20

30

40

50

60

70

80%

PRIM SEC VASC TIN Other

NEPHROTIC SYNDROME

N. 1462 biopsies

33

RTVBR 1998-2008

NEPHROTIC SYNDROME

0

5

10

15

20

25

30

35

Main Histologic Diagnosis

%

34

RTVBR 1998-2008

NEPHROTIC SYNDROME

Class of Age (y) 21 - 40 41 - 65 > 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

35

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 RBR’s strenght is strictly linked to continuity of providing the data

• A RBR well managed could be an effective tool to perform trials and surveys