Value of electron microscopy in the pathological diagnosis of native kidney biopsies in children
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ORIGINAL ARTICLE
Value of electron microscopy in the pathological diagnosis of native kidney biopsies in children Xu Zhang 1 & Jin Xu 1 & Huijie Xiao 2 & Yong Yao 2 & Hui Wang 1 & Yali Ren 1 & Mingming Liu 3,4 & Fang Wang 2 & Xuhui Zhong 2 & Xiaoyu Liu 2 & Baige Su 2 & Ming Cheng 1 & Lijun Chai 1 & Jie Ding 2 & Suxia Wang 1 Received: 19 February 2020 / Revised: 15 June 2020 / Accepted: 17 June 2020 # IPNA 2020
Abstract Background Pediatric native kidney diseases are common worldwide. The pathological diagnosis of kidney lesions is crucial for clinical treatment and prognosis. The aim of the current study was therefore to evaluate the value of electron microscopy (EM) to the final diagnosis of native kidney biopsies in children. Methods A retrospective evaluation of 855 pediatric kidney biopsies obtained from the Department of Pediatrics in Peking University First Hospital between November 2010 and December 2017 was performed to assess the contribution of EM to the final diagnosis. Results The role of EM in the final diagnosis was determined to be crucial in 300 cases (35.1%), important in 280 cases (32.7%), and auxiliary in 275 cases (32.2%). EM is considered most valuable in a large percentage of glomerular diseases, mainly including minimal change disease, early-stage membranous nephropathy, postinfectious glomerulonephritis, Alport syndrome, thin basement membrane nephropathy, and thrombotic microangiopathy. EM also provided helpful diagnostic information in cases of focal segmental glomerulosclerosis, lupus nephritis, IgA nephropathy, and IgA vasculitis (Henoch-Schonlein purpura nephritis). Additionally, EM was crucial in 90.0% of cases of subtle pathological changes observed with light microscopy (LM) and immunofluorescence (IF) and in 69.3% of the IF-negative specimens. Patients with nephrotic syndrome or hematuria also benefit from ultrastructural examination. Conclusions The present study demonstrated the crucial or important role of EM in the diagnosis of a majority of native kidney biopsies in children. The application of EM should be integrated together with LM and IF as a routine method of assessing pediatric kidney specimens.
Keywords Children . Electron microscopy . Kidney biopsy . Glomerulonephritis . Diagnosis
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04681-6) contains supplementary material, which is available to authorized users. * Suxia Wang [email protected] 1
Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, No. 8. Xishiku Street, Xi Cheng District, Beijing 100034, China
2
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
3
Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
4
Diabetes Research Center, Chinese Academy of Medical Science, Beijing 100005, China
Introduction Native kidney diseases are common diseases in the pediatric population worldwide. As in adults, kidney lesio
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