Figure 1: The image was republished 25 years later; commented in the text. Online: HYPERLINK “http://www.moluch.ru/archive/63/9770/” ”http://www.moluch.ru/archive/63/9770/”
Sergei V Jargin*Peoples’ Friendship University of Russia, Moscow, Russia
*Corresponding author: Jargin SV, Peoples’ Friendship University of Russia, Clementovski per 6-82; 115184 Moscow, Russia, E-mail: email@example.com
Insufficient international coordination of medical research can result in repetition of studies performed in other countries. Renal biopsy is a valuable diagnostic method; it was broadly used for research in the former Soviet Union. The number of biopsies has decreased since 1990; but medical research is on the increase today. Therefore, the purpose of this review was to remind that, performing renal biopsy or other invasive procedures, the risk-to-benefit ratio should be kept as low as possible. Renal biopsies were taken for research from patients with glomerulonephritis, pyelonephritis, amyloidosis, renovascular hypertension (in some studies from both kidneys), essential hypertension, alcoholism, diabetes mellitus, in congenital hydronephrosis and other urinary tract anomalies. About one third of the biopsy cylinder was routinely embedded in epoxy resin. The epoxy resin sections were made for research but not used for diagnostics, the latter being performed mainly on the basis of paraffin sections and immunofluorescence. Extensive use of renal biopsies without silver impregnation and electron microscopy was accompanied by over diagnosis of glomerulonephritis and corresponding overtreatment. Furthermore, the concept of hypoplastic renal dysplasia, developed on the basis of renal biopsy, probably interfered with the morphological diagnosis of Alport syndrome.
Renal biopsy; Pyelonephritis; Alport syndrome; Hydronephrosis; Alcoholism
Insufficient international coordination of medical research and partial isolation from the international scientific community can result in repetition of studies performed in other countries. Renal biopsy (RB) is a valuable diagnostic tool; it was broadly used in the former Soviet Union (SU). Today there are more funds for research; and medical science is on the increase. Under these circumstances, the purpose of this review was to recollect some experience from the recent past to ensure more responsible attitude in future and to remind that, performing RB or other invasive procedures, the risk-to-benefit ratio must be kept as low as possible.
RB were taken for research from patients with glomerulonephritis (Gn), pyelonephritis, amyloidosis, renovascular hypertension from both kidneys in some studies [1-6], essential hypertension , in certain studies with mild proteinuria and/or hematuria [7,8], alcoholism [9-17], diabetes mellitus , rheumatoid arthritis , and from children with urinary tract anomalies including those combined with hydronephrosis or pyelonephritis [20-23]. RB for research from both kidneys in renovascular hypertension was commented on previously [24,25].
As discussed below, electron microscopy was infrequently used for diagnostics in the former SU. Nevertheless, about one third of the biopsy cylinder was embedded in epoxy resin. The semi-thin epoxy resin sections were made for research but were not used for diagnostics, the latter being performed mainly on the basis of paraffin sections and immunofluorescence.
In the studies [26,27], excisional RB were sampled during kidneypreserving operations such as lithotomy from patients with chronic or acute (including purulent) pyelonephritis. In the literature, pyelonephritis is not listed among conditions where RB is indicated, while acute inflammation, infection and hydronephrosis are generally considered to be contraindications [28-30]. In the study , RB was taken from patients with chronic pyelonephritis and hydronephrosis, while conclusions were based on linear correlations between ultrastructural morphometric and clinical indices. However, statistical significance of the correlation coefficients in this and some similar studies was overstated. A comparison with the reference tables  demonstrated that many claimed P-values were exceedingly high for the given values of the correlation coefficient and the number of correlation pairs [31,33-35]; more details are in . In a more recent study, “cytomembranes of the interstitial tissue of renal medullary layer” were studied in core RB collected during lithotomies from patients with urolithiasis and secondary pyelonephritis . Core RB in pyelonephritis were taken also by other researchers . Fineneedle RB in acute pyelonephritis was performed and recommended in the recent study .
Among persons with alcoholism, biopsies were taken from kidneys, pancreas, liver, lung, salivary glands, stomach and skin, repeatedly in some cases [12,13,17]. It was concluded on the basis of a series of RB studies that a generalized cytoskeleton abnormality with accumulation of intermediary filaments in macrophages, epithelial and other cells is typical for the cell damage by ethanol or the “alcoholic disease” [9,12,13]. It is known that Mallory bodies, seen in alcoholic hepatitis and some other liver conditions, are composed of intermediate filaments; however, generalizations [9,12,13] have never been confirmed. In any case, a cytoskeleton could have been studied in experiments or post mortem. Another example: RB were collected from 40 patients with chronic alcoholism and nephritic symptoms, whereas “intracapillary proliferative glomerulonephritis” was diagnosed in all cases . In another study by the same researchers, the histopathological findings in 40 from 43 patients with alcoholism and nephritic symptoms were morphologically classified as membranoproliferative (mesangiocapillary) Gn; while in 29 from 31 patients with nephritic symptoms without alcoholism “fibroplastic” Gn was diagnosed . The striking difference between the two groups appears to be unusual. Other invasive procedures (celiacography, endoscopic cholangiopancreatography etc.) were applied in alcoholic patients without clear indications . In the author’s opinion, repeated biopsies from different organs, doubtful morphological descriptions and interpretations, give reasons to question the indications for RB at least in a part of the studied patients with alcoholism.
RB were taken without sufficient indications also in some cases of suspected Gn, which is less obvious because in the Russian-language literature RB has been generally regarded to be indicated in suspected Gn [39-41]. In the internationally used handbooks, however, RB in isolated proteinuria and/or microhematuria without abnormal urine sediment or signs of progressive renal disease is generally regarded as not indicated [28,42,43]. Indications for RB are sometimes formulated more liberally ; but an obvious precondition must be a high quality of morphological examination.
In the former SU, RB were sometimes collected from patients with “inactive nephritic” or latent clinical forms of Gn with proteinuria and/ or hematuria [39,44-47]. At the same time, the classification of Gn has been different from that used internationally [30,43,48], which obviously interfered with implementation of practical recommendations from the international literature. For example, Gn classification applied in the former SU did not consider IgA nephropathy as a separate entity [39,49-51]. IgA-nephropathy was not mentioned even in the article from a leading institution dedicated to the “hematuric form” of Gn . IgA nephropathy was usually diagnosed on RB as mesangioproliferative Gn (MG) and sometimes treated with corticosteroids and/or cytotoxic drugs [39,53-60]. In newer handbooks controversies can be found; for example, in the textbook , IgA nephropathy and Berger disease are discussed separately and different treatments are recommended. In the textbook , it is written in one place in regard to the therapy of MG: “Influence of immunosuppressive drugs has not been proven”, and in another place of the same chapter: “Efficiency of cytotoxic drugs has been proven” . In the “National Manual” , probably the most authoritative Russianlanguage edition in nephrology, IgA-nephropathy and MG are discussed in one chapter titled “Mesangioproliferative (IgA) glomerulonephritis” (from Russian): “The term IgA nephropathy is used to designate an entity, the morphological equivalent of which is mesangioproliferative glomerulonephritis” . It is partly at variance with the international literature, according to which glomeruli in IgA nephropathy may be normal at light microscopy or may show segmental mesangial proliferation confined to some glomeruli (focal proliferative Gn), diffuse mesangial proliferation (MG) or, rarely, crescentic Gn. Heeling of focal lesions may produce a picture of focal sclerosis [43,63,64].
The diagnosis of MG was used broadly, encompassing 49-60.8% of all Gn cases diagnosed by RB [50,65,66]. Epoxy resin sections and silver impregnation were not used for the diagnostics, while electron microscopy was applied only occasionally. By means of these methods, the pool of MG could have been partly sorted out, excluding from it the cases morphologically bordering on the norm i.e. isolated proteinuria and/or hematuria without renal or systemic disease, not requiring immunosuppressive therapy. In such cases, histologically are often detected only minor glomerular abnormalities: mild mesangial widening and hypercellularity, scarce deposits of immunoglobulins and the complement . In conditions of insufficient quality of histological specimens, without silver impregnation and electron microscopy, such changes and, correspondingly, Gn, were sometimes overdiagnosed. Data reported in the study, where percentages of glomerular diseases diagnosed by RB were compared between Moscow and Rostock in Germany (Table 1), are suggestive of over diagnosis of Gn and MG in particular. Outdated equipment, such as sledge microtomes from the 1930s, was used in many institutions. The paraffin slides were relatively thick (around 6-7 µm), the thickness being uneven. Suboptimal standardization of the hematoxylineosin, van Gieson and PAS stains used for the diagnostics, occasional over staining, etc. can mimic a glomerular capillary wall thickening. This is apparently a reason why membranous Gn was diagnosed in Moscow more than twice as frequently as in Rostock (Table 1). The author of this review participated in research  using epoxy resin sections cut by an LKB pyramitome with glass knives; after that he found it difficult to evaluate diagnostic paraffin sections, less clearly visualizing basement membranes and mesangial matrix.
RB were sometimes taken from patients with the “inactive nephritic” or latent clinical types of Gn i.e. with minimal proteinuria and/or hematuria [39,44-47]. In some studies, patients with the inactive or latent clinical types of Gn, isolated proteinuria or hematuria, were treated and recommended to be treated by corticosteroids and/or cytotoxic drugs such as azathioprin, cyclophosphamide or chlorambucil [53-60], which sometimes amounted to overtreatment.
The dubious concept of hypoplastic renal dysplasia was developed on the basis of predominantly pediatric RB. It was described as follows: “Racemosely arranged glomeruli with single capillary loops, abundant rounded cells freely lying in the cavity of a capsule; single mesangial cells; irregular enlargement, loosening, and thinning of the basement membrane”, narrow extracapillary space , glomeruli having irregular form and singular capillary loops  or total absence of capillaries , which has no analogues in the international literature, where the terms “renal hypoplasia” and “dysplasia” are used with a different meaning [70- 73]. In the author’s opinion, the descriptions were at least in part based on tangential sections of glomeruli, which is evident looking at the illustrations [68,69], reproduced : http://www.moluch.ru/archive/63/9770/ (accessed 7/28/2015). Interestingly, the same ultrastructural image (Figure 1)  was reproduced with a similar legend by other authors in the same journal 25 years later  (compare Figure 1 in  available online).
The common feature of these and some other works is presentation of ultrastructural findings without confrontation with light-optical equivalents; whereas variants of the norm and artifacts are sometimes interpreted as characteristic pathological phenomena. For example, hypoplastic dysplasia was diagnosed by electron microscopy in 8 from 34 randomly selected patients aged 9-54 years with nephrotic syndrome and histologically minimal glomerular changes . At the same time, there were no cases of Alport syndrome or thin basement membrane nephropathy (having some morphological feature in common with “hypoplastic dysplasia” [68,69]) among 4440 RB including 2770 cases of glomerular disease overviewed . These two conditions constituted more than 1% of all renal diseases diagnosed by RB in Rostock . The concept of hypoplastic dysplasia, discussed with clinicians performing biopsies, could have interfered with the diagnosis of thin basement membrane nephropathy and Alport syndrome, the latter being of importance because of genetic implications.
Table 1: Percentages of glomerular diseases diagnosed by RB in Moscow and Rostock in the years 1978-1983
Today, the same researchers (or their heirs) apply the term hypoplastic dysplasia to the glomerular changes in congenital hydronephrosis and other renal abnormalities in children, interpreting them as inborn nephropathy affecting a major part of glomeruli [20,22,75,78,79]. Note that a regular combination of two prima facie unrelated conditions: an inborn glomerulopathy affecting a major part of glomeruli, and hydronephrosis related to an abnormality of the ureteropelvic junction, seems to be improbable. For the latter research, 167 intra-operative wedge or core RB from children with urogenital malformations, plus 18 RB for the control group from adult patients undergoing urological operations, were collected .
The same research group collected 60 pancreatic excision biopsies 5 × 5 mm in size  during the surgical operations of “pancreatic blood shunting into the systemic blood flow in insulin-dependent diabetics” . From the same patients, 51 core RB were taken . Apart from several reports from the former SU, we have found in the literature no analogues of this surgical treatment modality of diabetes mellitus discussed . Morphological descriptions of pancreatic and renal biopsies in type 1 diabetes mellitus included the following: islets of Langerhans “containing B-cells with destructive changes” , presence of endocrine-like cells in the acini and among the cells of the inter-acinar ducts [84,85], Gn and mesangiolysis as consecutive stages of diabetic glomerulosclerosis , frequent mesangial interposition with displacement of mesangial cells to the peripheral capillary loops and formation of double-contour glomerular basement membranes [86,87], which is at variance with usual morphological descriptions [88-92]. In particular, the morphological picture of Gn, if detected in a diabetic patient, is usually interpreted as a superimposed condition [90,91]. It should be commented that in diabetes mellitus, RB is generally indicated for patients under the suspicion of a renal disease other than diabetic nephropathy . It is important to identify a non-diabetic renal condition, in particular, membranoproliferative Gn (characterized by mesangial interposition), where immunosuppressive therapy should be considered. Therefore, representing the morphological picture of Gn with mesangial interposition as a characteristic phenomenon or a stage of diabetic nephropathy can be misleading.
The RB material used in some studies discussed above was unique e.g. wedge or core biopsies in hydronephrosis, acute and chronic pyelonephritis. Apart from the articles discussed here, no other studies based on RB in hydronephrosis and acute pyelonephritis are known to us, while in chronic pyelonephritis no other studies performed abroad later than in the 1960s have been found. There is an opinion, shared by the author, that, considering potential complications, “RB for research” should not exist as such; it must always be done according to clinical indications. If a patient gives informed consent to research on renal tissue obtained for diagnostic purposes, it can be done, provided that enough tissue remains for the diagnostics, if non-morphological or otherwise suboptimal for the diagnosis research methods, consuming the tissue, are applied. It should be commented that even today, in spite of official regulations; the principle of informed consent is often disregarded. At a reception of some governmental medical institutions a patient is given a form, where he or she must beforehand give a written consent to all diagnostic and therapeutic procedures, which are then sometimes performed in spite of the patient’s objections. In conclusion, high level of integrity, quality of specimens and of their examination must be a precondition for RB research. This review has discussed several studies from the past, but the problem is still with us: invasive procedures performed without sufficient clinical indications and informed consent .
- Romanenko AM, Nosov AT, Pereverzev AS, Zubko VI (1989) Morphologic changes of the kidneys in patients with vasorenal hypertension. Vrach Delo 6: 35-38. [Ref.]
- Shkhvatsabaia IK, Iurenev AP, Kozdoba OA (1986) Lesions of target organs in arterial hypertension. Kardiologiia 26: 75-80. [Ref.]
- Pal’tsev MA, Iargin SV, Krotovskii GS, Turpitko SA, Mamedov DM (1986) Importance of morphologic examination of the kidneys of patients with vasorenal hypertension for predicting the results of surgical treatment. Arkh Patol 48: 34-40. [Ref.]
- Pal’tsev MA, Krotovski GS, Egorova IA, Shcherbiuk AN (1982) State of the neuroendocrine aparatus of the kidney during renovascular hypertension as a criterion of the prognosis of the surgery outcome. Arkh Patol 44: 62-71. [Ref.]
- Turpitko SA, Iargin SV, Petrovskii PF, Klembovskii AA, Gerasimov VB (1989) Angiographic and morphologic criteria of the manifestation of arteriolonephrosclerosis in vasorenal hypertension. Urol Nefrol (Mosk) 34-37. [Ref.]
- Pal’tsev MA, Iargin SV, Krotovskii GS, Turpitko SA, Kazanchan PO (1989) Relation of the effectiveness of surgical treatment of vasorenal hypertension and morphologic changes of the kidneys. Kardiologiya 29: 76-80. [Ref.]
- Arabidze GG, Sokolova RI, Titov VN, Tarasov AV (1989) The diagnosis of hypertension (research on kidney biopsies and microalbuminuria. Ter Arkh 61: 8-12. [Ref.]
- Nichik TE, Kayukov IG, Essaian AM (2006) Morphological alterations to the kidneys in arterial hypertension combined with mild proteinuria. Nefrologiia 10: 66-71.
- Serov VV, Lebedev SP (1985) Clinical morphology of alcoholism. Arkh Patol 47: 3-14. [Ref.]
- Nikolaev Alu, Serov VV, Tareeva IE, Varshavskii VA, Lebedev SP (1986) Clinicomorphological characteristics and prognosis of glomerulonephritis in chronic alcoholism. Ter Arkh 58: 115-120. [Ref.]
- Lebedev SP, Kovtun TI, Sukhova GK (1986) Morphology and various problems of the pathogenesis of alcoholic microangiopathy. Arkh Patol 48: 26-33. [Ref.]
- Lebedev SP, Vinogradova LG, Sukhova GK (1984) Alcoholic hyalin and interstitial filaments as markers of alcoholic damage of internal organs. Arkh Patol 46: 52-58. [Ref.]
- Serov VV, Lebedev SP (1988) Clinical morphology of visceral alcoholism. Vestn Akad Med Nauk SSSR 48-53. [Ref.]
- Serov VV, Lebedev SP, Vinogradova LG, Mukhin AS, Sukhova GK (1982) Intermediate filaments in the lung macrophages and endothelial cells in chronic alcoholism and supurativedestructive lung diseases. Biull Eksp Biol Med 94: 92-94. [Ref.]
- Tarasova NS, Beloborodova EI (1998) Immunological aspects of circulating immune complexes in kidney diseases in patients with chronic alcoholism. Ter Arkh 70: 61-63. [Ref.]
- Tarasova NS, Beloborodova EI (2003) Hormonal and immunological aspects of renal lesions in patients with chronic alcoholism. Ter Arkh 75: 73-76. [Ref.]
- Makhov VM, Abdullin RG, Gitel’ EL, Zavodnov VIa, Podzolkov VI, et al. (1996) Visceral lesions in alcoholism. Ter Arkh 68: 53-56. [Ref.]
- Mukhin NA, Dedov II, Shestakova MV, Pal’tsev MA, Varshavskii VA, et al. (1990) The functional kidney reserves of diabetics. Ter Arkh 62: 107-110. [Ref.]
- Khamishon LZ, Chichasova NB, Kanevskaia MZ, Varshavskii VA, Semeikina OV, et al. (1989) Glomerulonephritis in rheumatoid arthritis. Revmatologiia 18-23. [Ref.]
- Severgina LO, Leonova LV, Severgina ES, Gurevich AI, Menovshchikova LB, et al. (2011) Coupling between the hemodynamic parameters and the morphological changes in the kidney in children with congenital hydronephrosis. Arkh Patol 73: 14-17. [Ref.]
- Kozhukhova OA, Klembovski AI (1979) Morphological manifestations of disorders of renal tissue differentiation in children. Arkh Patol 41: 6-13. [Ref.]
- Leonova LV, Severgina ES, Popova OP, Konovalov DM, Petruchina IuV, et al. (2007) Transforming growth factor as a marker beta of nephrogenetic disturbance in congenital obstructive uropathies. Arkh Patol 69: 35-38. [Ref.]
- Cheskis AL, Leonova LV, Severgina ES, Ostapko MS, Simonova NA, et al. (2006) Renal development long after correction of primary nonrefluxing forms of megaureter in children. Urologiia 74-80. [Ref.]
- Jargin SV (2013) Renal biopsy research in the former Soviet Union: prevention of a negligent custom. ISRN Nephrol 2013: 980859. [Ref.]
- Jargin SV (2009) Manipulation with statistics in medical research. Dermatopathology: Practical & Conceptual 15: 21.
- Kirillov IuA (1979) Morphogenesis of acute pyelonephritis (electron microscopic study). Arkh Patol 41: 29-36. [Ref.]
- Kirillov IuA (1980) Morphogenesis of chronic pyelonephritis (electron microscopic study). Arkh Patol 42: 38-45. [Ref.]
- Kasiske BL, Keane WF (2000) Laboratory assessment of renal disease: clearance, urinalysis, and renal biopsy. In: Brenner BM (ed) Brenner & Rector’s The Kidney. 6th edition, W.B. Saunders Co., Philadelphia, 129-170. [Ref.]
- Tomson CR (2003) Indications for renal biopsy in chronic kidney disease. Clin Med 3: 513-517. [Ref.]
- Tischer CC, Wilcox CS (1995) Nephrology. 3rd edition, Williams & Wilkins Co., Baltimore.
- Pal’tsev MA (1982) Juxtaglomerular aparatus and interstitial cells of kidney medulla in hydronephrosis and chronic pyelonephritis. Arkh Patol 44: 12-19. [Ref.]
- Lentner C (1980) Wissenschaftliche Tabellen Geigi. CIBA-GEIGI, Basel.
- Serov VV, Pal’tsev MA (1984) Endocrine system of the kidneys in nephrogenic arterial hypertension: functional and morphological analysis. Arkh Patol 46: 5-16. [Ref.]
- Pal’tsev MA, Bespalov DA, Shliapnikov VV, Kutyrina IM, Nikishova TA (1984) Juxtaglomerular aparatus and interstitial cells of the kidney medulla in glomerulonephritis. Arkh Patol 46: 64-70. [Ref.]
- Mukhin NA, Popova EN, Fomin VV, Popova IA, Kuznetsova AV, et al. (2009) Clinical significance of markers of endothelial dysfunction and angiogenesis in progressing of the lung interstitial diseases. Ross Fiziol Zh Im I M Sechenova 95: 1139-1150. [Ref.]
- Kazeko NI, Zhmurov VA, Borovskii AA, Veshkurtsev VV, Khvan OV (2005) Lipids content in renal tissue membranes in patients with urolithiasis and secondary pyelonephritis. Urologiia 56-58. [Ref.]
- Shulutko BI, Kulaeva NN, Ambrozas IV, Shumilkin VR, Anikonova LI (1993) The clinical significance of immunological indices in chronic pyelonephritis. Ter Arkh 65: 11-13. [Ref.]
- Diusiubaev AA, Shalashov VA (2007) Thin needle aspiration biopsy of the kidneys in diagnosis of acute pyelonephritis. Urologiia 29-31. [Ref.]
- Shilov EM, Tareeva IE, Ivanov AA, Troepol’skaia OV, Krasnova TN, et al. (2002) The course and prognosis of mesangioproliferative glomerulonephritis. Ter Arkh 74: 11-18. [Ref.]
- Borisov VV, Vashurina TV, Voznesenskaya TS (2009) Clinical recommendations according to syndromes. In: Mukhin NA, Fomin VV (eds) Nephrology. National Manual. Geotar-media, Moscow 93-161. (Russian)
- Lozinskii EIu (2007) Clinical nephrology. Far Eastern Federal Univ., Vladivostok. (Russian)
- Tisher CC (1989) Clinical indications for kidney biopsy. In: Tisher CC, Brenner BM (eds) Renal pathology. Lipincott, Philadelphia 2-10.
- Black RM (1996) Rose & Black’s clinical problems in nephrology. Little, Brown and Co., Boston.
- Ratner MIa, Fedorova ND, Makurov AI (1997) The tubulointerstitial changes in different clinical and morphological types of chronic glomerulonephritis. Urol Nefrol (Mosk) 16-19. [Ref.]
- Varshavskii VA, Laurinavichius AA, Zhigalin VG (1992) Characteristics of primary glomerulonephritis (on the basis of kidney biopsies of the Pathology Department, I.M. Sechenov Moscow Medical Academy, from 1980 to 1989). Arkh Patol 54: 36-40. [Ref.]
- Ratner M, Serov VV, Warschavski WA, Rosenfeld B, Subkin ML, et al. (1987) Recommendations for a clinical classification of chronic glomerulonephritis. Z Urol Nephrol 80: 271-279. [Ref.]
- Chebotareva NV, Neprintseva NV, Bobkova IN, Kozlovskaia LV (2014). Investigation of 70-kDa heat shock protein in the serum and urine of patients with chronic glomerulonephritis. Ter Arkh 86: 18-23. [Ref.]
- Churg J, Bernstein J, Glassock RJ (1995) Renal disease: Classification and atlas of glomerular diseases. 2nd edition, Igaku-Shoin, New York.
- Serov VV (1990) The purpose of clinical morphology is diagnosis. Klin Med (Mosk) 68: 143-144. [Ref.]
- Ratner MIa, Serov VV, Rozenfel’d BI, Varshavskii VA, Brodskii MA (1983) Clinico-morphological variants and prognosis of chronic glomerulonephritis. Ter Arkh 55: 10-14. [Ref.]
- Serov VV, Varshavsky VA, Schill H, Nizze H (1986) Incidence of glomerular diseases in kidney biopsy materials using WHO classification. Zentralbl Allg Pathol 132: 471-475. [Ref.]
- Ratner MIa, Serov VV, Varshavskii VA, Brodskii MA, Makurov AI (1990) Functional and morphological characteristics of a hematuric form of chronic glomerulonephritis. Klin Med (Mosk) 68: 54-57. [Ref.]
- Ratner MIa, Tomilina NA, Klinkman Kh, Shmitt E, Kreger E (1980) Prolonged treatment of mesangioproliferative glomerulonephritis with a cytostatic agent and prednisolone and a combination of a cytostatic agent, prednisolone an anticoagulant and an antiaggregant. Ter Arkh 52: 106-110. [Ref.]
- Ratner MIa, Biriukova LS, Makurov AI (1987) Indications and effectiveness of combined therapy in chronic glomerulonephritis. Ter Arkh 59: 29-34. [Ref.]
- Ratner MIa, Serov VV, Stenina IN, Fedorova ND, Shumakov VI (1996) The importance of the clinical classification of chronic glomerulonephritis for the prognosis of its progression and of the efficacy of therapy. Ter Arkh 68: 10-13. [Ref.]
- Tareeva IE, Gordovskaia NB, Gladskikh OP, Ivanov AA, Krasnova TN (1989) Treatment of chronic glomerulonephritis with cytostatics. Ter Arkh 61: 9-14. [Ref.]
- Ratner MIa, Tomilina NA, Serov VV (1979) Long-term use of a combination of immunosupressants, and antiaggregant and an anticoagulant in the treatment of glomerulonephritis. Ter Arkh 51: 43- 47. [Ref.]
- Serov VV, Pal’tsev MA, Mukhin NA, Tareeva IE, Kozlovskaia (Lysenko) LV, et al. (1992) The key problems of glomerulonephritis. Ter Arkh 64: 5-10. [Ref.]
- Krasnova TN, Shilov EM, Ivanov AA, Samoilov DV, Gordovskaia NB, et al. (1991) The treatment of chronic glomerulonephritis with ultrahigh doses of cyclophosphane. Ter Arkh 63: 115-118. [Ref.]
- Poliantseva LR, Gordovskaia NB, Krasnova TN, Samoilov DV, Shilov EM (1990) Complications induced by cytostatic therapy of glomerulonephritis. Ter Arkh 62: 63-66. [Ref.]
- Stepanov OG (2013) Nephrology. Textbook for postgraduate students. Kucherenko, Maikop. (Russian)
- Shilov EM (2014) Mesangioproliferative (IgA) glomerulonephritis. In: Mukhin NA, Fomin VV (eds) Nephrology. National manual. Short edition. Geotar-media, Moscow 214-222. (Russian)
- Schrier RW (2000) Manual of nephrology. 5th edition, Lipincott Williams & Wilkins, Philadelphia. [Ref.]
- Cotran RS, Kumar V, Robbins SL (1994) Robbins’ Pathologic Basis of Disease. 5th edition, W.B. Saunders Co., Philadelphia.
- Dzhanaliev BR, Varshavskii VA, Laurinavicius AA (2002) Primary glomerulopathies: incidence, dynamics and clinical manifestations of morphological variants. Arkh Patol 64: 32-35. [Ref.]
- Ratner MIa, Serov VV, Varshavskii VA, Novikov ID, Rozenfel’d BI (1987) New classification of chronic glomerulonephritis. Klin Med (Mosk) 65: 6-11. [Ref.]
- Churg J, Sobin LH (1982) Renal disease. Classification and atlas of glomerular diseases. Igaku-Shoin, Tokyo.
- Severgina ES, Pal’tsev MA (1989) Hypoplastic dysplasia as one of the forms of nephropathy. Arkh Patol 51: 58-63. [Ref.]
- Varshavskii VA, Proskurneva EP, Gasanov AB, Severgina LO, Shestakova LA (1999) Subdivision of certain morphological variants of chronic glomerulonephritis. Arkh Patol 61: 40-46. [Ref.]
- Squiers EC, Morden RS, Bernstein J (1987) Renal multicystic dysplasia: an occasional manifestation of the hereditary renal adysplasia syndrome. In: Opitz JM, Bernstein J, Spano LM (eds) Topics in pediatric genetic pathology. Wiley-Liss, Inc., New York 279-284. [Ref.]
- Kakkar N, Menon S, Radotra BD (2006) Histomorphology of renal dysplasia - an autopsy study. Fetal Pediatr Pathol 25: 73-86. [Ref.]
- Woolf AS, Price KL, Scambler PJ, Winyard PJ (2004) Evolving concepts in human renal dysplasia. J Am Soc Nephrol 15: 998-1007. [Ref.]
- Botvin’ev OK, Safinova MP (2014) Clinical and morphological characteristics of renal hypoplasia in children. Arkh Patol 76: 42-44. [Ref.]
- Jargin SV (2014) Pancreatic and renal biopsy for research: back to the indications. Molodoi Uchenyi Young Sci 143-147. [Ref.]
- Severgina LO, Gurevich SI (2014) Ultrastructural assessment of the role of dysangiogenesis in congenital hydronephrosis. Arkh Patol 76: 51-55. [Ref.]
- Severgina ES (1991) Ultrastructural heterogeneity of “minimal changes” in the kidney glomeruli, detected by light optics. Arkh Patol 53: 53-58. [Ref.]
- Nizze H, Mann E, Stropahl G, Schmidt W (2003) Glomerular diseases in renal biopsy. Correlation of clinical syndromes with histological types. Pathologe 24: 421-432. [Ref.]
- Cheskis AL, Severgina ES, Leonova LV, Ostapko MS (2002) Status and development of the kidney after surgical treatment of hydronephrosis in children. Urologiia 39-43. [Ref.]
- Severgina LO (2014) The role of dysangiogenesis in malformations of the urogenital system. Higher doctorate thesis, I.M. Sechenov Medical University, Moscow.
- Severgina ES (1995) Morphology and pathogenesis of insulindependent diabetes mellitus. Higher doctorate thesis, I.M. Sechenov Medical Academy, Moscow.
- Galperin EI, Diuzheva TG, Petrovsky PF, Chevokin AYu, Dokuchayev KV, et al. (1996) Results of pancreatic blood shunting into the systemic blood flow in insulin-dependent diabetics. HPB Surg 9: 191-197. [Ref.]
- Jargin SV (2014) Invasive procedures with questionable indications. Ann Med Surg (Lond) 3: 126-129. [Ref.]
- Severgina ES, Diuzheva TG (1996) Morphologic and functional changers in B-cells and vessels of the islands of Langerhans in patients with insulin-dependent diabetes mellitus. Arkh Patol 58: 40-47. [Ref.]
- Severgina ES, Diuzheva TG, Razgulina LE, Stakheev IB (1992) Is localization of B-cells in the acini a normal condition or the sign of compensatory process in insulin-dependent diabetes mellitus? Arkh Patol 54: 18-23. [Ref.]
- Severgina E, Dyuzheva T, Paltsev M (1993) Acinar B-cells in pancreas in insulin-dependent diabetic patients. The right to exist. Pathol Res Pract 189: 298-299. [Ref.]
- Severgina ES, Ponomarev AB, Diuzheva TG, Shestakova MV, Maiorova EM (1994) Diabetic glomerulonephritis - the first stage of diabetic glomerulopathy. Arkh Patol 56: 44-50. [Ref.]
- Severgina ES, Ponomarev AB, Diuzheva TG, Shestakova MV, Maiorova EM (1994) Diabetic glomerulosclerosis - a prolonged stage of diabetic glomerulopathy. Arkh Patol 56: 50-55. [Ref.]
- Spencer J, Peakman M (2009) Post-mortem analysis of islet pathology in type 1 diabetes illuminates the life and death of the beta cell. Clin Exp Immunol 155: 125-127. [Ref.]
- Richardson SJ, Morgan NG, Foulis AK (2014) Pancreatic Pathology in Type 1 Diabetes Mellitus. Endocr Pathol 25: 80-92. [Ref.]
- Dizdar O, Kahraman S, Gençtoy G, Ertoy D, Arici M, et al. (2004) Membranoproliferative glomerulonephritis associated with type 1 diabetes mellitus and Hashimoto’s thyroiditis. Nephrol Dial Transplant 19: 988-989. [Ref.]
- Hironaka K, Makino H, Ikeda S, Haramoto T, Ota Z (1991) Nondiabetic renal disease complicating diabetic nephropathy. J Diabet Complications 5: 148-149. [Ref.]
- Hanafusa T, Miyazaki A, Miyagawa J, Tamura S, Inada M, et al. (1990) Examination of islets in the pancreas biopsy specimens from newly diagnosed type 1 (insulin-dependent) diabetic patients. Diabetologia 33: 105-111. [Ref.]
- Gonzalez Suarez ML, Thomas DB, Barisoni L, Fornoni A (2013) Diabetic nephropathy: Is it time yet for routine kidney biopsy? World J Diabetes 4: 245-255. [Ref.]
Download Provisional PDF Here
Aritcle Type: Review Article
Citation: Jargin SV (2015) Some Aspects of Renal Biopsy for Research. Int J Nephrol Kidney Failure 1(2): doi http://dx.doi.org/10.16966/2380-5498.108
Copyright:© 2015 Jargin SV. This is an openaccess article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.