The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical and Histopathological Analysis of the Kidney Biopsies of 2,450 Patients seen over 30 Years at Chungnam National University Hospital

단일기관에서 시행된 30년간의 신생검 결과와 임상상 분석

  • Bae, Hong Jin (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Moon, Kang Ryun (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Kim, Ye Jin (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Choi, Dae Eun (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Na, Ki Ryang (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Lee, Kang Wook (Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Shin, Young Tai (Department of Internal Medicine, Chungnam National University School of Medicine)
  • 배홍진 (충남대학교 의학전문대학원 내과학교실) ;
  • 문강륜 (충남대학교 의학전문대학원 내과학교실) ;
  • 김예진 (충남대학교 의학전문대학원 내과학교실) ;
  • 최대은 (충남대학교 의학전문대학원 내과학교실) ;
  • 나기량 (충남대학교 의학전문대학원 내과학교실) ;
  • 이강욱 (충남대학교 의학전문대학원 내과학교실) ;
  • 신영태 (충남대학교 의학전문대학원 내과학교실)
  • Received : 2012.07.27
  • Accepted : 2012.10.22
  • Published : 2013.03.01
⟨ Previous Next ⟩

Abstract

Background/Aims: This study evaluated the clinical characteristics of patients who underwent kidney biopsies, and the relative changes in pathological diagnosis, according to time periods over the last 30 years (1981-2010). Methods: This study included 3,051 patients who were older than 15 years and underwent kidney biopsies at Chungnam University Hospital between January 1981 and December 2010. For analysis, the patients were grouped into three time periods: I (1981-1990), II (1991-2000), and III (2001-2010). We reviewed the available medical records of 2,450 patients and analyzed the changes in their clinical characteristics over time. Results: The mean patient age was 35.9 (range 15-91) years and the male-to-female ratio was 1.3:1. The most common indication for a kidney biopsy was an asymptomatic urinary abnormality (64.2%) and the proportion with this indication increased significantly over time (p < 0.001). Primary glomerular diseases comprised 65.4% of all pathological diagnoses, followed by secondary (13.6%) and hereditary (12.5%) glomerular diseases. The proportion of primary glomerular diseases decreased significantly with time (p < 0.001), while the proportions of secondary and hereditary glomerular diseases increased correspondingly (p < 0.001). IgA nephropathy was the most common pathological diagnosis (36.7%) overall. The proportion of IgA nephropathy increased significantly with time (p < 0.001), while minimal change disease and acute post-streptococcal glomerulonephritis decreased significantly (p < 0.001 and p = 0.013, respectively). Conclusions: The results demonstrated that the clinical indications and pathological diagnoses in patients who underwent kidney biopsies changed significantly over the last 30 years.

목적: 경피적 신생검은 사구체질환의 진단과 치료에 있어서 필수적인 검사 방법이다. 그러나 인구와 시기별에 따른 사구체 질환의 변화에 대한 대규모 연구는 많지 않다. 경피적 신생검을 시행받은 환자들에서 임상적 적응증과 조직병리 진단의 시대별 변화를 알아보고자 본 연구를 수행하였다. 방법: 1981년부터 2010년까지 충남대학교병원에서 경피적 신생검을 시행받은 15세 이상의 총 3,052명 중 의무기록 검토와 조직진단이 가능했던 2,412명을 대상으로 연령, 성별, 적응증, 신생검 결과 등에 대해서 I기(1981-1990년), II기(1991-2000년), III기(2001-2010년)로 나누어 시기별 변화를 비교 분석하였다. 결과: 대상 환자들의 평균연령은 35.9세였으며, 20-29세가 583명(24.2%)으로 가장 많았다. 시기별로는 1980년대와 1990년대에는 20대가 가장 많았으나 2000년대에는 40-49세에서 가장 많았다. 남 녀 성비는 1.3:1이었다. 경피적 신생검의 적응증으로 무증상 요검사 이상이 64.2%로 가장 많았으며 다음은 신증후군 21.6%, 급성 신장 손상 6.1%, 기타 6.0%, 신이식 후 신기능 이상 2.1% 순이었다. 신생검의 적응증으로 무증상 요검사 이상의 비율은 1980년대에서 2000년대로 오면서 유의하게 증가하였다(p < 0.001). 신생검 당시의 임상상으로 20대에서는 무증상 요이상이 가장 많았고, 나이가 증가하면서 신증후군과 급성 신장손상으로 신생검을 시행했던 경우가 유의하게 많았다(p < 0.001). 신생검 병리진단에서는 전체 대상 환자 중 일차성 사구체질환은 65.4%, 이차성 사구체질환은 13.6%, 유전성 사구체질환은 12.5%를 차지하였다. 일차성 사구체질환은 1980년대에서 1990년대, 2000년대로 오면서 유의하게 감소하였으며(p < 0.001) 이차성 사구체질환과 유전성 사구체질환은 유의하게 증가하였다(p < 0.001, p < 0.001). 전체 대상 환자 중 IgA신증이 37.2%로 가장 많았으며 비박성 사구체 기저막 질환 11.8%, 미세변화증후군 10.1%, 막성 사구체 신염 7.0% 순이었다. IgA신증은 시간이 경과하면서 유의한 차이를 보이며 증가하였으나(p < 0.001), 반면에 미세변화 증후군과 감염 후 사구체신염은 감소하였다(p < 0.001, p = 0.013). 결론: 30년간 단일기관에서 시행한 경피적 신생검을 분석한 결과, 시대에 따라 임상적 적응증과 병리조직검사의 결과에 유의한 변화를 확인할 수 있었다.

Keywords

References

  1. Ball RP. Needle (aspiration) biopsy. J Tenn Med Assoc 1934;27:203-206.
  2. Seok YK. Needle biopsy of kidney. Korean J Med 1960; 3(Suppl 1):32.
  3. Choi IJ, Jeong HJ, Han DS, et al. An analysis of 4,514 cases of renal biopsy in Korea. Yonsei Med J 2001;42:247-254. https://doi.org/10.3349/ymj.2001.42.2.247
  4. Simon P, Ramee MP, Autuly V, et al. Epidemiology of primary glomerular diseases in a French region: variations according to period and age. Kidney Int 1994;46:1192-1198. https://doi.org/10.1038/ki.1994.384
  5. Swaminathan S, Leung N, Lager DJ, et al. Changing incidence of glomerular disease in Olmsted County, Minnesota: a 30-year renal biopsy study. Clin J Am Soc Nephrol 2006;1:483-487. https://doi.org/10.2215/CJN.00710805
  6. Nair R, Walker PD. Is IgA nephropathy the commonest primary glomerulopathy among young adults in the USA? Kidney Int 2006;69:1455-1458. https://doi.org/10.1038/sj.ki.5000292
  7. Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA Jr, Germain MJ. Changing incidence of glomerular diseases in adults. Am J Kidney Dis 2000;35:878-883. https://doi.org/10.1016/S0272-6386(00)70258-7
  8. Stratta P, Segoloni GP, Canavese C, et al. Incidence of biopsy-proven primary glomerulonephritis in an Italian province. Am J Kidney Dis 1996;27:631-639. https://doi.org/10.1016/S0272-6386(96)90096-7
  9. Lee YJ, Chung C, Kim ES, et al. Clinical and histopathological analysis of 494 cases of percutaneous renal biopsies. Korean J Nephrol 2001;20:111-119.
  10. Chang JH, Kim DK, Kim HW, et al. Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience. Nephrol Dial Transplant 2009;24:2406-2410. https://doi.org/10.1093/ndt/gfp091
  11. Rivera F, Lopez-Gomez JM, Perez-Garcia R; Spsnish Registry of Glomerulonephritis. Frequency of renal pathology in Spain 1994-1999. Nephrol Dial Transplant 2002;17:1594-1602. https://doi.org/10.1093/ndt/17.9.1594
  12. Oh YK, Ahn CR, Lee SJ, et al. Adult glomerulonephritis in Korea: analysis of 2,001 cases. Korean J Nephrol 1996;15: 289-299.
  13. Park JH, Kim HK, Oh ES, et al. Long-term follow-up of asymptomatic hematuria and/or proteinuria in adults. Korean J Nephrol 1999;18:543-549.
  14. Research Group on Progressive Chronic Renal Disease. Nationwide and long-term survey of primary glomerulonephritis in Japan as observed in 1,850 biopsied cases: Nephron 1999;82:205-213. https://doi.org/10.1159/000045404
  15. Kim JE, Kang SK. Clinical studies of renal diseases by percutaneous renal biopsy. Korean J Med 1990;39:353-359.
  16. Levy M, Berger J. Worldwide perspective of IgA nephropathy. Am J Kidney Dis 1988;12:340-347. https://doi.org/10.1016/S0272-6386(88)80021-0
  17. Heaf J, Lokkegaard H, Larsen S. The epidemiology and prognosis of glomerulonephritis in Denmark 1985-1997. Nephrol Dial Transplant 1999;14:1889-1897. https://doi.org/10.1093/ndt/14.8.1889
  18. Kim KY, Kwon HC, Kim MB, et al. Analysis of biopsied cases in patients with glomerular diseases. Korean J Med 1995;49:674-682.
  19. Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis 1996;27:647-651. https://doi.org/10.1016/S0272-6386(96)90098-0
  20. Dragovic D, Rosenstock JL, Wahl SJ, Panagopoulos G, DeVita MV, Michelis MF. Increasing incidence of focal segmental glomerulosclerosis and an examination of demographic patterns. Clin Nephrol 2005;63:1-7. https://doi.org/10.5414/CNP63001
  21. I Haas M, Spargo BH, Coventry S. Increasing incidence of focal-segmental glomerulosclerosis among adult nephropathies: a 20-year renal biopsy study. Am J Kidney Dis 1995;26:740-750. https://doi.org/10.1016/0272-6386(95)90437-9
  22. Woo KT, Chiang GS, Pall A, Tan PH, Lau YK, Chin YM. The changing pattern of glomerulonephritis in Singapore over the past two decades. Clin Nephrol 1999;52:96-102.
  23. Al Arrayed A, George SM, Malik AK, et al. Renal biopsy findings in the kingdom of bahrain: a 13-year retrospective study. Saudi J Kidney Dis Transpl 2004;15:503-507.
  24. Parichatikanond P, Chawanasuntorapoj R, Shayakul C, et al. An analysis of 3,555 cases of renal biopsy in Thailand. J Med Assoc Thai 2006;89(Suppl 2):S106-111.
  25. Kim KH. A clinical and histopathological study in the glomerular diseases by renal biopsy. Korean J Med 1988;34:5-11