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Value of electron microscopy in the pathological diagnosis of native kidney biopsies in children

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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.

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Data availability

The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.

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Funding

This study was supported by Scientific Research Seed Fund of Peking University First Hospital (No. 2018SF008).

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Authors and Affiliations

  1. Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, No. 8. Xishiku Street, Xi Cheng District, Beijing, 100034, China

    Xu Zhang, Jin Xu, Hui Wang, Yali Ren, Ming Cheng, Lijun Chai & Suxia Wang

  2. Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China

    Huijie Xiao, Yong Yao, Fang Wang, Xuhui Zhong, Xiaoyu Liu, Baige Su & Jie Ding

  3. Institute of Microcirculation, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, China

    Mingming Liu

  4. Diabetes Research Center, Chinese Academy of Medical Science, Beijing, 100005, China

    Mingming Liu

Authors
  1. Xu Zhang
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  2. Jin Xu
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  3. Huijie Xiao
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  4. Yong Yao
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  5. Hui Wang
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  7. Mingming Liu
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  8. Fang Wang
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  9. Xuhui Zhong
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  10. Xiaoyu Liu
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  11. Baige Su
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  12. Ming Cheng
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  13. Lijun Chai
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  14. Jie Ding
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  15. Suxia Wang
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Contributions

X.Z. and S.X.W. contributed to the study conception and design; X.Z., J.X., H.J.X., Y.Y., F.W., X.H.Z., X.Y.L., and B.G.S. acquired and analyzed data; S.X.W. and J.D. supervised and mentored the manuscript; M.M.L. produced the artwork; X.Z., M.M.L., H.W., Y.L.R, M.C., and L.J.C. contributed intellectual content during the writing or revision of the manuscript and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Suxia Wang.

Ethics declarations

This study was approved by the hospital institutional review boards. Informed consent was obtained from all individual participants involved in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Zhang, X., Xu, J., Xiao, H. et al. Value of electron microscopy in the pathological diagnosis of native kidney biopsies in children. Pediatr Nephrol 35, 2285–2295 (2020). https://doi.org/10.1007/s00467-020-04681-6

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  • DOI: https://doi.org/10.1007/s00467-020-04681-6

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