老年肾脏病肾活检的诊断价值与风险评估

目的探讨肾活检在老年肾脏病中的诊断价值与风险评估。方法回顾性分析我科住院行肾活检,且年龄≥60岁的123例老年肾脏病患者的临床病理资料及安全性。结果肾活检术成功率100％,肾活检取材肾小球数目均≥10个,共有6例出现轻度并发症,其中一过性肉眼血尿2例（占1．6％）,肾周小血肿4例（占3．2％）,余无严重并发症。123例患者中原发性肾小球疾病为105例（占85．4％）,而继发性肾脏病为18例（占14．6％）。在原发性肾小球疾病中最常见的病理类型是膜性肾病26例（占26．0%）,IgA。肾病25例（占25．0％）,其次为系膜增生性肾小球肾炎19例（占19％）。而继发性肾脏病中病理类型以糖尿病肾脏病11例最多见（占47．8％）。最常见的临床表现是肾病综合征（占39．8oA）和慢性肾小球肾炎（占33．3％）。临床诊断与肾活检结果尚存在差异（P〈0．05）。结论肾活检在老年性肾脏疾病患者中应用的成功率高而并发症少且大多较轻,其病理结果对明确诊断和决定治疗方案具有重要指导意义。     

妊娠时肾脏损害临床和肾组织病理变化的分析研究

目的：为探讨妊娠致肾脏损害的特点及病理特征。方法；对52例妊娠致肾脏损害住院病人进行了临床和肾活检病理的分析研究。结果：52例终止妊娠3个月后仍有蛋白尿，合并肾功能不全者28例（53．85％），肾活检免疫病不示IgG34例，IgA38例，IgM28例及C340例肾小球血管袢及系膜区沉积；病理表现系膜增生性肾炎34例、膜增生性肾炎10例，局灶节段性肾小球硬化6例，膜性肾病2例，52例中合并小球硬化者30列（57．69％）；胎儿死亡40例（75．47％）。结论：妊娠激发了免疫反应导致肾脏病变是肾小球疾病发病机制之一，积极诊治该类病人是临床不可忽视的问题。     

成人无症状性血尿蛋白尿的病理评分与临床关系

目的：定量分析成人无症状性血尿、蛋白尿的病理与临床及预后的关系。方法：30例临床诊断为隐匿性肾炎的患者以尿常规检查分为血尿＋蛋白尿、单纯性蛋白尿、单纯性血尿3组。全部行肾活检术，予以光镜、免疫组化及电镜检查，其结果用Memphis的半定量标准进行评分，同时查24h尿蛋白定量、尿NAG酶、全生化等。结果：肾小球病理评分：0级为0例，1级6例（20％），2级17例（56．7％）。3级7例（23．3％）。肾小管病理评分：0级2例（6．7％），1级6例（20％），2级14例（46．7％），3级8例（26．7％）。肾小球与肾小管病变程度的关系rs=0．85，P〈0．01。肾小管病理改变与病程的关系分析rs=0．563，P〈0．01；与肾功能的关系分析r3=0．661，P〈0．01。结论：肾小球的病变以血尿＋蛋白尿、单纯性蛋白尿组为重，而肾小管病变以血尿＋蛋白尿〉单纯性蛋白尿〉单纯性血尿。肾小球与肾小管病变程度呈等级正相关。病程长，且反复发作，临床表现轻微者也可能存在较严重的肾小球和肾小管损害．宜尽早肾活检．以免贻误治疗。     

小儿急性肾功能衰竭100例临床分析

介绍１００例小儿急性肾功能衰竭（ＡＲＦ）的病因、临床表现、实验室检查、病理及预后。肾前性１３例（１３％），肾性８６例（８６％），其中肾小球疾病６６例（６６％），肾后性１例（１％）。３１例肾活检，病理为９种类型，毛细血管内增生性肾小球肾炎（ＥｎＰＧＮ）８例（２５．８１％），系膜增殖性肾小球肾炎（ＭｓＰＧＮ）４例（１２．９０％），膜增殖性肾小球肾炎（ＭＰＧＮ）Ｉ型５例（１６．１３％），局灶节段性肾小球     

70例隐匿性肾炎临床与病理分析

目的：探讨肾活检在隐匿性肾炎诊断、治疗及预后判断等方面的意义。方法：回顾性分析近5年内收治的70例有完整肾活检资料的隐匿性肾炎病例，对其临床特点、肾脏病理特征，肾活检对诊断、治疗、预后的影响及中医病机特点等进行相关分析。结果：70例隐匿性肾炎患者中，无症状血尿5例（7.14％）、无症状性血尿和蛋白尿60例（85．71％）、无症状性蛋白尿5例（7．14％）。中医辨证分析，本虚证中肺肾气虚占24．29％，脾肾阳虚占10．00％，气阴两虚占61．43％，肝肾阴虚占4．29％；标实证中外感占25．71％，湿浊占10．00％，湿热占87．14％，血瘀占55．71％。病理类型为IgA肾病41例（58．57％）、非IgA系膜增生性肾炎23例（32．86％）、其他6例（8．57％）；肾脏病理损害分级为无病变1例（1．43％）、轻度62例（88．57％）、中度7例（10．00％）、重度0例。肾活检后19例（27．14％）患者改变了主要治疗方法。预后判定为良好3例（4．29％）、较好49例（70．00％）、较差18例（25．71％）、不良反应0例。结论：隐匿性肾炎主要临床表现为无症状性血尿和蛋白尿，中医辨证多属气阴两虚，挟湿热、瘀血。主要病理类型为IgA及非IgA系膜增生性肾炎；大部分患者肾脏病理损害较轻、预后较好，约1／4的患者肾脏病理损害较重、预后较差。隐匿性肾炎患者开展肾活检对明确肾脏病理损害程度、指导治疗及判断预后等具有重要意义。     

马蹄肾合并肾小球病的临床病理分析

也页目的：马蹄肾是先天性肾脏融合畸形,马蹄肾合并肾小球病时,由于担心肾穿刺术后并发症,很少进行肾活检,从而得不到明确的病理诊断,难以得到应有的正确治疗。本文通过总结分析马蹄肾合并肾小球病的临床病理资料,旨在提高其诊断与治疗水平。方法：收集2008年1月~2013年6月在解放军总医院就诊,通过影像学确诊马蹄肾且肾活检病理诊断为肾小球病的病例。回顾分析这些病例的临床资料、实验室检查、影像学检查、肾活检适应证的把握、肾穿刺注意事项、肾活检病理检查结果以及治疗随访的资料。结果：共5例患者影像学检查确诊马蹄肾且肾活检病理诊断为肾小球病。（1）临床上主要表现为夜尿增多、下肢水肿、高血压及尿检异常。（2）尿蛋白定量均〉1 g/24 h,血肌酐正常或偏高。（3）影像检查明确诊断为马蹄肾,均为下极融合。（4）均有肾活检的适应证,没有肾脏大血管畸形等禁忌证,患者血压均控制在140/90 mmHg以下,凝血功能正常;在患者签署知情同意书后,由经验丰富的医生在超声引导下用肾穿刺活检枪在“肾上极”进行肾活检;肾穿刺术后严密观察,患者没有出现术后并发症。（5）肾活检病理诊断分别为局灶节段性肾小球硬化、膜性肾病、原发性IgA肾病、过敏性紫癜肾炎（继发性IgA肾病）、狼疮肾炎。（6）根据肾活检病理结果给予相应的治疗,每月随访1次,随访6个月后结果显示患者尿蛋白定量明显下降、血压及血肌酐趋于稳定。结论：肾小球病是马蹄肾的重要合并症,充分评估其肾活检的意义及风险,明确其病理类型,有助于指导治疗、延缓疾病的进展。     

152例老年肾脏病肾活检术的临床意义

目的探讨实时超声引导下自动活检枪经皮肾穿刺活检术在老年肾脏病中的临床意义及风险评估。方法回顾性分析152例老年肾脏病患者行肾自动活检术的成功率及并发症,并与同期2219例非老年组肾脏病患者进行比较。结果152例老年肾脏病患者肾活检均取得肾组织,其中取材不良6例（3．95％）,取材合格27例（17．76％）,取材良好119例（78．29％）,与非老年患者比较,无统计学差异（P〉0．05）;152例老年患者中21例出现轻度并发症（13．82％）,其中肉眼血尿7例,肾周血肿14例,无出现严重并发症,并发症发生率与非老年组无统计学差异（P〉0．05）;老年组通过。肾活检后修改诊断36例,诊断修正率为23．68％;根据病理结果修正治疗方案47例,治疗修正率为30．92％。结论超声引导自动肾活检术在老年肾脏病患者中应用成功率高且安全;肾活检病理诊断对老年肾脏疾病的诊治有重要价值,值得进一步推广应用。     

近20年肾脏病理谱变化趋势的回顾性分析

目的 通过对近20年肾脏病理类型的回顾性分析,为我国肾脏疾病谱的构成及其演变趋势提供信息.方法 回顾性分析近20年我科因肾脏疾病行肾活检患者4 105例的病理类型,并比较1994年～2003年与2004年～2013年前后10年间肾脏病理类型的变化.病理分型参考WHO1995年肾小球疾病组织学分型方案和2001年在全国肾活检病理诊断研讨会上拟定的肾活检病理诊断标准指导意见,结合临床资料、实验室检查结果、免疫病理及超微结构改变特点明确诊断.结果 本组4 105例肾脏疾病患者行肾活检时的平均年龄（34.5±12.3）岁,男女比例为0.85∶1.本组原发性肾小球疾病者3 410例（占83.0％）,继发性肾小球疾病者516例（占12.6％）,遗传性肾脏疾病者42例（占1.0％）,肾小管间质疾病者76例（占1.9％）,新发现罕见肾脏疾病者10例（占0.2％）,未分类者51例（占1.3％）.原发性肾小球疾病以IgA肾病最为常见1 450例（占42.5％）,最常见的继发性肾脏病是狼疮肾炎254例（占49.2％）.近10年肾活检患者人数明显增加,年龄增高,平均年龄从（31.9±11.2）岁增至（35.1±12.5）岁,40岁以上患者数量明显增多.分析前后10年间各种原发及继发性肾脏病的检出率,证实IgA肾病、膜性肾病、局灶节段性肾小球硬化症、微小病变均增多（均P＜0.01）,而系膜增生性病变、增生硬化性肾小球肾炎、膜增生性肾小球肾炎、硬化性肾小球肾炎则减少（均P＜0.01）.近10年还发现了一些少见的肾脏疾病（如：胶原Ⅲ肾病、纤维性肾小球病、免疫触须样肾小球病、肾小球囊肿病、脂蛋白肾病等）.结论 原发性肾小球疾病仍为我国最常见的肾小球疾病,近10年来,肾脏疾病谱发生了变化,其变化可能与医疗水平的提高和实际发病率的改变有关.     

间质性肾炎19例临床与病理分析

目的 探讨间质性肾炎的临床与病理特点。方法 回顾分析经肾活检证实的急、慢性间质性肾炎完整病历资料19例。结果 本组19例，急性患者7例；慢性患者12例，病因明确9例（47．4％），主要诱发因素是药物（66．7％）；全部病例中以蛋白尿、浮肿、肾功能不全为主要表现，仅部分患者出现肾小管功能损害的临床表现；其病理特点以肾间质的炎性浸润为主，而肾小球、肾小血管基本正常；本组6例急性肾功能不全患者在血透的基础上加用激素治疗，效果良好。结论 间质性肾炎的临床表现不典型，肾小管间质本身损害的临床表现并不突出，其病理的基本特征为：间质的炎性细胞浸润、水肿或纤维化，肾小球、肾小血管基本正常。     

CT监视下穿刺活检在脊柱病变鉴别诊断中的应用

目的：探讨CT监视下穿刺活检在脊柱病变鉴别诊断中的应用价值。方法：467例诊断不明确的脊柱病变患者中男281例，女186例；年龄2～82岁，平均43岁。在CT监视下行病变部位经皮穿刺活检。回顾分析穿刺活检的准确性、安全性。结果：467例患者共行476次穿刺，3例次取材不满意，取材满意率99．4％：4例次（8．4‰）发生轻微并发症，无严重并发症发生。407例416例次经手术或随访证实诊断准确．穿刺活检准确率87．9％；198例行手术治疗，穿刺病理与手术病理符合率为81．8％（162／198）。总的漏诊率、误诊率分别为12．6％和12．8％。结论：CT监视下穿刺脊柱病变活检是诊断准确率高、损伤小的微创检查．在脊柱病变的鉴别诊断中有重要作用。     

Pattern of renal diseases observed in native renal biopsies in adults in a single centre in Pakistan

Aim: In the absence of a national renal biopsy registry, there is a paucity of information on the pattern of renal disease observed in native renal biopsies in adults in Pakistan. Methods: A retrospective review of native renal biopsies performed in adult patients was undertaken at the Sindh Institute of Urology and Transplantation (SIUT) during the period from July 1995 to December 2008. Renal biopsies were studied by light, immunoflourescence and electron microscopy. The renal biopsy diagnoses were categorized into the following groups: glomerulopathies (GN), tubulointerstitial diseases (TID), renal vascular diseases (VD), and hereditary diseases (HD). Results: A total of 1793 adult patients were included in the study. GN was the commonest diagnosis representing 83.9% of all biopsies. Primary GN (PGN) accounted for 86.9% and secondary GN (SGN) for 13%. When PGN was further analyzed, focal segmental glomerulosclerosis (FSGS) was the leading histopathological diagnosis, found in 29% of PGN, followed by membranous GN (MGN), seen in 23.5% of cases. Among SGN, lupus nephritis (44.1%) was the commonest, followed by amyloidosis (42.1%) and diabetic nephropathy (8.1%). TID comprised 11.6% of all renal biopsy diagnoses. VD and HD were less frequent, found in 3.9% and 0.4%, respectively. Conclusion: The pattern of biopsied renal pathology is similar to that reported recently from other parts of the world with similar biopsy indications.     

The length of superficial temporal artery biopsies

BACKGROUND: To compare temporal artery biopsy specimen lengths from a tertiary care and a community hospital in New South Wales to recommended clinical guidelines in suspected giant cell arteritis. DESIGN: A retrospective observational study of all patients who underwent temporal artery biopsy at Bathurst Base Hospital (BBH) and Royal Prince Alfred Hospital (RPAH) over a 5-year period. METHODS: Patients who underwent temporal artery biopsy during the 5-year period were identified using computerized hospital databases. A retrospective chart review was carried out on all cases. Data were collected regarding patient age, patient sex, length of biopsy specimen, histopathological results and surgical team carrying out the biopsy. RESULTS: During the 5-year period, 157 temporal artery biopsies were carried out at both hospitals, with 38/157(24%) at BBH and 119/157 (76%) at RPAH. There was no significant difference in biopsy length at the two hospitals. The mean specimen length at BBH was 12.1 mm compared with 11.7 mm at RPAH (t=0.35; P=0.73). At RPAH, there was no significant difference in specimen length between the surgical specialties carrying out the biopsy (ANOVA F=1.37; P=0.26). Specimens of length 20 mm or greater were 2.8 times more likely to show features of giant cell arteritis than those less than 20 mm. CONCLUSION: The mean length of temporal artery biopsy specimens at both hospitals was substantially shorter than recommended guidelines of a minimum 20 mm. We recommend all surgeons carrying out temporal artery biopsies ensure a specimen of sufficient length is obtained.     

急性肾功能衰竭误漏诊原因分析及肾活检的意义

目的：探讨急性肾功能衰竭（ARF）误漏诊原因,提高ARF诊断水平。方法：分析入院前诊断与肾活检与肾活检后诊断的符合率,寻找误漏诊原因。结果：经肾活检证实68例ARF病例中20例（29．6％）存在病因误诊,包括急性肾小球肾炎（AGN）、急进性肾炎（RPGN）、 急性肾小管坏死（ATN）、膜增生性肾小球肾炎（MPGN）、原发性肾病综合征伴特发性急性肾功能衰竭（NS＋IARF）、狼疮肾炎（LN）、急性间 质性肾炎（AIN）、慢性肾炎急性发作等之间混淆。有30．9％（21／68）例改变了治疗方案,35．3％（24／68）部分改变了治疗方案,33．8％（23／68）按原方案治疗。结论：临床上有相当部分ARF的病因被误诊,在诊断困难时应及时肾活检,以免延误治疗。     

2型糖尿病合并肾脏损害的病理与临床分析

目的 分析2型糖尿病患者出现肾脏病变时病理诊断与临床表现的关系.探讨肾活检在2型糖尿病伴有肾脏病变诊断的意义.方法 分析52例尿检异常和（或）Scr升高的2型糖尿病患者的临床特征和病理改变特点.结果 52例2型糖尿病患者经肾活检,32例确诊为糖尿病肾病（DN）,占61.5%,其中3例为糖尿病肾病合并非糖尿病性肾脏疾病（NDRD）;余20例为非糖尿病性肾脏疾病,占38.5%.肾活检前后诊断符合率46.15%,误诊率19.23%.两组间除BUN、Scr、糖尿病病程和是否伴有糖尿病性视网膜病变有显著差异外,其他临床表现和实验室检查的差异均无统计学意义.结论 2型糖尿病伴肾脏病变时相当部分是非糖尿病性肾脏病变,单纯依靠临床资料常难以鉴别,肾活检对明确糖尿病伴肾病变的性质具有重要的意义.     

Diagnosis of renal lymphoma by percutaneous image guided biopsy: experience with 11 cases

PURPOSE: We reviewed an institutional experience with image guided percutaneous biopsy of focal renal masses that yielded a diagnosis of lymphoma. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of patients undergoing percutaneous renal biopsy between September 1997 and February 2005. RESULTS: A total of 407 image guided focal renal lesion biopsies were identified. A diagnosis of lymphoma was made in 11 patients (3%). Biopsies were performed under computerized tomography guidance in 9 cases (82%) and under ultrasound guidance in 2 (18%). Core biopsies were performed in 11 cases, while fine needle aspiration was done in 10 (91%). Fine needle aspirations underwent cytological analysis in 10 cases and flow cytometry analysis in 9. The final combined pathological diagnoses were B-cell lymphoma in 10 cases and lymphomatoid granulomatosis in 1. Analysis of core biopsies yielded a diagnosis of B-cell lymphoma in 10 cases (91%) and lymphomatoid granulomatosis in 1. Analysis of fine needle aspirations yielded a diagnosis of B-cell lymphoma in 3 cases (30%), lymphoma in 4 (40%), suspicion of lymphoma in 1 (10%), atypical cells in 1 (10%) and a nondiagnostic sample in 1 (10%). Flow cytometry concurred with cytology in the diagnosis of B-cell lymphoma in 2 cases, allowed the identification of lymphoma subtype, which was not made on cytology, in 4, was insufficient in 2 and identified no abnormality in 1. No patients underwent surgery or an ablative procedure. CONCLUSIONS: Core biopsy has a higher diagnostic yield than fine needle aspiration for diagnosing renal lymphoma. Flow cytometry analysis adds additional diagnostic information to cytological examination of fine needle aspiration samples. Accurate diagnosis of lymphoma in these cases allowed proper treatment without unnecessary surgery or other procedures.     

Renal ultrasound findings in an Australian Aboriginal population with high rates of renal disease

BACKGROUND: Rates of albuminuria and haematuria are extremely high with haematuria prevalence as high as 30-50% in adults of some Aboriginal groups. Dipstick testing of urine is routinely carried out in Aboriginal communities and as part of school screening programmes. Evaluation of the many affected individuals has traditionally included renal ultrasound examination, which involves considerable expense and logistic problems in remote communities. The present study was conducted to evaluate the usefulness of ultrasound in this setting. METHODS: A population survey was conducted in a remote community. Urine dipstick analysis and the albumin:creatinine ratio (ACR; g/mol) were measured in 1440 people over 5 years of age (89% of the eligible population), and a detailed renal ultrasound examination was performed in a random subset of 647 people (41.1% of the whole group), 276 aged 5-19 years and 371 over 20 years of age. RESULTS: Urine dipstick proteinuria (>1+) was present in 8.5% (23/271) of those aged 5-19 years and 37.9% (132/348) in those aged over 20 years; pathological albuminuria (ACR>3.4) was present in 7.6% (21/276) and 54.7% (203/371), respectively, and isolated haematuria was present in 7.7% (21/273) and 11.5% (40/347), respectively. Eight ultrasound abnormalities were found. Ultrasound findings did not change the management of any individual. CONCLUSION: Renal ultrasound added little to the evaluation of people with asymptomatic proteinuria or haematuria in this setting. In this scenario, ultrasound examination could be reserved for the cases with an unusual presentation where findings are likely to influence the prognosis or treatment, or in preparation for a renal biopsy.     

Long-term outcome of adult patients with minimal urinary abnormalities and normal renal function.

AIM: To define the long-term outcome of patients with minimal urinary abnormalities (defined by the presence of microscopic hematuria with no or less than 1 gm/day proteinuria), and normal renal function (defined by a serum creatinine < 1.3 mg/dl), we retrospectively studied patients who fulfilled the above criteria and had a kidney biopsy done before the year of 1992 (i.e. at least followed up for 5 years), with a definite pathological diagnosis. METHODS: A total of 41 cases among 719 cases of primary glomerulonephritis (5.7%) were enrolled into the study. There were 19 males and 22 females with a mean age of 35.4+/-14.7 years at biopsy. The duration of renal disease was 116.0+/-60.5 months and the duration of follow-up post biopsy was 100.2+/-38.1 months. The pathological diagnosis was: IgA nephropathy (21 cases), focal glomerulosclerosis (9 cases), mesangial proliferative glomerulonephritis (8 cases), membranous glomerulonephritis (2 cases) and acute glomerulonephritis (1 case). RESULTS: At the end of follow-up, 8 cases (19.5%) had a certain degree of renal insufficiency including 2 (4.9%) in end-stage renal disease. The other cases were either in complete remission (6 cases) or stable condition (27 cases) with persistent microscopic hematuria and normal renal function. The long-term outcome was not correlated with any of the following parameters: age, sex, disease duration, serum creatinine at presentation, daily protein loss at presentation, degree of glomerular change and degree of interstitial inflammatory cell infiltration. However, a poor long-term outcome was correlated with tubular atrophy (p < 0.05) and interstitial fibrosis (p < 0.05). CONCLUSION: We conclude that a minimal urinary abnormality with normal renal function at presentation does not necessarily imply a favorable long-term outcome in certain patients. Tubular atrophy and interstitial fibrosis but not glomerular change correlates with a worse prognosis. This further emphasizes the importance of renal biopsy in such cases.     

Renal histological lesions and clinical syndromes in multiple myeloma. Renal Immunopathology Group

This retrospective multicenter study, based on 42 patients affected by renal damage due to multiple myeloma, analyzes the renal biopsy results, the clinical data at the time of biopsy and the subsequent renal outcome in order to clarify the correlations existing between clinical and histological changes. Plasmocytoma components were Bence Jones alone in 55% of the patients and light-chain excretion was present in over 90%. Rapidly progressive renal failure was the most frequent clinical presentation (27 cases). The histological lesions directly attributable to multiple myeloma were subdivided into 3 basic categories: related to light-chains, direct tumor involvement of renal parenchyma and attributable to systemic effects of neoplastic disease. Light-chains seemed to cause renal lesions in 59.4% of the cases. Myeloma cast nephropathy was the prominent bioptic diagnosis established (20 cases). Among the clinical, laboratory and histological parameters studied, only the degree of tubular-interstitial damage was significantly correlated to the renal outcome in the 32 patients who had an adequately documented follow-up period.     

Surgical procedures for melanoma in public and private New South Wales hospitals, 2001-2002

BACKGROUND: Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost-ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high-quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined. METHODS: Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001-2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined. RESULTS: During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty-seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0-53%). Eight hundred and fifty-eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0-47%). CONCLUSION: Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.     

Clinical utility of kidney biopsies in the diagnosis and management of renal disease

A prospective study was undertaken to assess the utility of the renal biopsy as a tool in the clinical practice of nephrology. Nephrologists performing this procedure were surveyed concerning prebiopsy diagnosis, plans for therapy and estimation of prognosis, before and after biopsy results were disclosed. On the basis of 108 specimens from both academic centers and community hospitals, clinical and pathological diagnoses differed in 63% and therapeutic approach was altered in 34% of the cases. These results were greatest for nephrotic syndrome and for renal failure of rapid onset. The change in treatment was frequently of major consequence: decisions for the use of corticosteroids, cytotoxic agents and/or plasma exchange were altered based upon biopsy diagnoses. There were no differences either in diagnostic acumen or therapeutic approach between academic and community nephrologists. We conclude that renal biopsies are an important and frequently used part of the nephrologists' approach to patient care.