KIDNEY BIOPSY IN ADULT IRAQI PATIENTS WITH RENAL IMPAIRMENT. A RETROSPECTIVE STUDY IN SINGLE CENTER IN MEDICAL CITY IN BAGHDAD –IRAQ 2024

Introduction: Acute and progressive chronic kidney diseases are subject to a variety of inflammatory and autoimmune processes, which are often accompanied by degenerative lesions or are also genetically determined. In many cases, the underlying causes cannot be distinguished clinically, nor can they be identified by advanced laboratory tests because they remain confined to the renal parenchyma. Therefore, a renal biopsy is indicated when knowledge of the histological diagnosis is essential for appropriate therapy. Despite advances in non-invasive biochemical and imaging investigations, kidney biopsies play a pivotal role in the diagnosis of kidney disease, so the available evidence suggests that the histological diagnosis of both native and transplanted kidney biopsies has a direct therapeutic impact or significantly influences the patient’s further treatment in about 40–60% of cases. Method: A retrospective study design includes the native and transplanted kidney biopsies performed at the Renal disease and kidney Transplant center in medical city during the 2024. A total of 100 cases of different age groups were biopsied and included in this study. The indications for renal biopsy included patients with, nephritic syndrome, renal insufficiency (failure) due to an unknown etiology, nephrotic syndrome and asymptomatic urinary abnormality. The biopsy procedure followed an established operative protocol. Results: Distribution of diagnosis of patients according to histological finding, FSGS was the highest pathological lesion (18%) encountered in our study. Immunoglobulin A glomerulonephritis (IGA GN) was found to be the second frequent pathology in the our study 14.Lupus nephritis (LN) (12%) and Membranous glomerulonephritis (MGN)(12%) were represents the third most frequent diagnosis among patients with primary glomerular diseases in our study.. The other pathological causes of primary renal disease in our study were: diabetic nephropathy (DN)(3%), Arteriosclerosis (2%), minimal change disease (MCD)(2%), Light change deposition disease (LCDD), (2%)Arterionephroseclrosis (2%), Pausi immune (2%), Amyloidosis (2%),CNI toxicity(2%), Acute tubular injury (ATI)(2%), Normal(2%), Collagen fibrotic glumerularpathy (1%0), Crystalline nephropathy (1%), C3 glumerulopathy (C3GN)(1%). While in transplanted kidney patients the first pathological cause was chronic active antibody mediated rejection (5%) then the second cause was acute T-cell mediated cellular rejection ATMR(4%), while the Focal segmental glumeruloseclorosis (FSGS) was the third cause (3%), and the other pathological causes were: Acute tubular necrosis (ATN) (2%), Immunoglobulin A glomerulonephritis (IGA GN) (2%), CNI toxicity (1%), B.K nephropathy (1%), Acute tubular injury (ATI)(1%), Acute T-cell mediated cellular rejection ATMR+ Immunoglobulin A glomerulonephritis (IGA GN) (1%). Conclusion: Renal biopsy still a gold stander in the diagnosis and management of different renal diseases. It has an essential role in taking histopathological information that cannot be obtained from clinical examination or imaging alone, by renal biopsy we know classification of glomerular, tubular, interstitial, and vascular pathologies, also can follow appropriate treatment strategies and guess prognosis.