Standardized Classification and Reporting of Glomerulonephritis

Sanjeev Sethi; Fernando C. Fervenza

Disclosures

Nephrol Dial Transplant. 2019;34(2):193-199. 

In This Article

Is It Treatable or Is It too Late to Treat?

The Answer Lies in Correlating the Kidney Biopsy Findings With the Clinical Findings

To answer this question we need to consider both the kidney biopsy and the clinical findings together. The kidney biopsy finding of lesions in different diseases may have different implications. For example, the presence of 15% cellular crescents on a kidney biopsy in a patient with IgA nephropathy presenting with macroscopic hematuria may not have the same implications as a similar finding in a patient with circulating PR3-ANCA. Similarly, a patient with ANCA-associated GN and a creatinine of 5.3 mg/dL, with severe chronic changes on a kidney biopsy, may suggest that immunosuppressive therapy would be futile.[34] However, if the clinical history shows that the serum creatinine was 1.5 mg/dL 3 months previously, the patient has a urinary volume of 1.5 L/day and renal ultrasound shows preserved renal parenchyma, one would be tempted to treat this patient with immunosuppressive therapy, regardless of the severe chronic changes on the kidney biopsy. On the other hand, the decision to treat this patient with immunosuppressive therapy will likely be different if the patient was known to have a serum creatinine of 5 mg/dL 1 year previously. So the timing of the kidney biopsy in relation to the patient's presentation and previous laboratory results need to be taken into consideration. Is the patient young or old? What comorbidities are present? Is there a history of ongoing infection? As such, it is critical that the information provided by the kidney biopsy is integrated with the clinical information available to the nephrologist so that the most appropriate treatment recommendations can be achieved in each individual patient.

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