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Organisation and Practice of a Kidney Biopsy Register

Organisation and Practice of a Kidney Biopsy Register. The Italian View. Firenze, 07 September 2009. Cataldo Abaterusso MD, PhD Division of Nephrology University of Verona (Italy). History of Italian Registry of Renal Biopsies (IRRB). Start in 1987 Two Surveys published

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Organisation and Practice of a Kidney Biopsy Register

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  1. Organisation and Practice of a Kidney Biopsy Register The Italian View Firenze, 07 September 2009 Cataldo Abaterusso MD, PhD Division of Nephrology University of Verona (Italy)

  2. History of Italian Registry of Renal Biopsies(IRRB) Start in 1987 Two Surveys published • 1987-1993 (Schena FP. Nephrol Dial Transplant 1997) • 1996-2000 (Gesualdo L et al. Kidney Int 2004)

  3. http://88.59.234.153/irrb/

  4. IRRB 1996-2000 INDICATION TO PERFORM A RENAL BIOPSY: MAIN CLINICAL PICTURE n. Biopsies: 14607 % Biopsies Gesualdo L. Kidney Int 2004

  5. DISTRIBUTION OF HISTOLOGIC GROUPS

  6. IRRB 1996-2000 MAIN PRIMARY GN IN NEPHROTIC SYNDROME Gesualdo L. Kidney Int 2004

  7. IRRB 1987-1993 13.835 renal biopsies 1996-2000 14.607 renal biopsies Since 2001 only 4321 renal biopsies collected The Ending Story

  8. Renal Biopsies Register The Philosphy of Building “You cannot have your cake and eat it” The Variables of Survival of a Renal Biopsies Register: • Development of Customer Loyalty • Unambiguous Data (Diagnosis, Definitions, etc.) • Wealth of Data • Time consuming • Updating / Maintenance of Register • Feedback • Having strongly motivated Collaborators

  9. RTVBR Since 1998 started the “Renal Biopsies Register of TriVeneto” RTVBR collect renal biopsies from: • Adult subjects • Triveneto Area’s Renal Units • Native kidneys • Biopsies of graft not included

  10. North-East of Italy: the Triveneto Area 11.4% Italian Pop. At data of 01 January 2008 Resident Population (age >15yrs) : 5.780.020 persons From ISTAT: http://demo.istat.it/pop2008/

  11. Personal data Age Demographic Ethnicity Biopsy date Blood Pressure Clinical Presentation at Biopsy (SN, AUA, ARF, CRF, etc) Main Treatment Laboratory • s-Creatinine • eGFR • sHb • Proteinuria (g/day) • Hepatitis markers • Complications of Biopsy • Type of histologic analysis • (LM, IF, EM) Unequivocal Renal Diagnosis (from a multiple choice panel)

  12. Renal Biopsy and Histological Data RTVBR 1998-2008 Renal Diagnosis LM + IF more than 85% of biopsies ME about 50% of biopsies http://rtbr.sined.it

  13. Laboratory

  14. Clinical Presentation and Treatment

  15. On-line search into RTVBR

  16. Statistics

  17. Renal Biopsies Register The RTVBR Experience: The Variables of Survival of a Renal Biopsies Register: • Development of Customer Loyalty • Unambiguous Data (Diagnosis, Definitions, etc.) • Wealth of Data • Updating / Maintenance of Register • Time consuming • Feedback (annual report and meetings) • Having strongly motivated Collaborators

  18. The Points of Strenght of a Renal Biopsies Register • Epidemiology of GN • Variation of incidence on time • Renal Biopsy Policy • Identification and collection of rare and uncommon renal disease • Database to perform Surveys/Trials on uncommon nephropathies • Linkage with other Register (i.e Dialysis and Transplant Register)

  19. RESULTS OF RTVBR ANALYSIS DISTRIBUTION OF HISTOLOGIC GROUPS RTVBR 1998-2007

  20. RTVBR 1998 - 2008 INDICATION TO PERFORM A RENAL BIOPSY: MAIN CLINICAL PICTURE N. Biopsies 3701

  21. RTBR 1998 – 2008 INDICATION TO RENAL BIOPSY PER GROUP OF AGE

  22. RTVBR 1998-2008 PRIMARY GLOMERULONEPHRITIS

  23. RTVBR 1998 - 2007 PREVALENCE OF MAIN PRIMARY GLOMERULONEPHRITIS

  24. RTVBR 1998-2008 SECONDARY HISTOLOGIC PICTURES

  25. RTVBR 1998 - 2007 PREVALENCE OF MAIN SECONDARY HISTOLOGIC PICTURES

  26. RTBR 1998 - 2008 ACUTE RENAL FAILURE STRATIFIED FOR AGE N. Cases 485 M: 60% F: 40%

  27. RTBR 1998 - 2008 ACUTE RENAL FAILURE

  28. RTVBR 1998-2008 ACUTE RENAL FAILURE %

  29. RTBR 1998 - 2008 ACUTE RENAL FAILURE Main Histologic Diagnosis

  30. RTBR 1998-2008 NEPHROTIC SYNDROME

  31. RTBR 1998 - 2008 NEPHROTIC SYNDROME N. 1462 biopsies

  32. RTVBR 1998-2008 NEPHROTIC SYNDROME Main Histologic Diagnosis %

  33. RTVBR1998-2008 NEPHROTIC SYNDROME

  34. CONCLUSIONS • The management and survival of a Renal Biopsy Register (RBR) are a compromise solution between multiple conditions • Management demands and time consuming by Collaborators have to be lower than their advantages (feedback) • RBR could facilitate the development of a network of Renal Units • The RBR’s strenght is strictly linked to continuity of providing the data • A RBR well managed could be an effective tool to perform trials and surveys

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