Use of Renal Biopsy to Predict the Clinical Result of Hemodialysis in Chronic Renal Disease

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IN spite of the growing use of hemodialysis and the increasing appreciation of the value of the renal biopsy, we have been unable to find reported series that correlate the two procedures. It has been noted in general, however, that the “worse the glomerulus, the worse the prognosis”.1 When patients in chronic renal failure did not respond to the best medical management we were able to give them, they were considered to be candidates for dialysis. Therefore, we have been able to observe the course of many patients with chronic uremia who received treatment with the artificial kidney. Renal biopsy studies were done in some of those patients and the results are discussed in this report.

Materials and Methods

Seventeen patients who had chronic renal failure for more than one month, and who each required at least one hemodialysis, each had a diagnostic needle biopsy of the kidney soon after initial admission to the hospital. Their ages ranged from 14 to 64 years, with an average of 41 years. Each dialysis was performed with a twin-coil disposable artificial kidney.2

Each renal biopsy specimen was analyzed according to its individual components. The histopathologic changes of the glomeruli were graded from 0 to 3 + as observed with light microscopy: 0, essentially normal glomeruli; 1 +, damage involving at least one of the glomeruli (cellular proliferation, capsular adhesions, or thickening of the basement membrane); 2+, destructive changes involving from one-third to two-thirds of the glomeruli; 3+, destruction of the glomerular . . .