Computational simulation of renal biopsy accuracy in focal segmental glomerulosclerosis.
Computational simulation of renal biopsy accuracy in focal segmental glomerulosclerosis.
复制标题
局灶节段性肾小球硬化症肾活检准确性的计算模拟。
DOI：
10.1007/s00467-006-0127-1
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Schachter,AsherD
中科院分区：
文献类型：
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作者：
Schachter,AsherD
本研究的目的是评估局灶节段性肾小球硬化（FSGS）肾活检的诊断和预后准确性，说明受累肾小球的局灶性。在一系列FSGS参与的情况下，对总共138，600个虚拟肾脏进行了计算模拟。模拟旨在解决肾活检的诊断准确性，以及准确反映整个肾脏或仅髓质（JM）区域FSGS累及的真实程度所需的活检特征。当10-20%的肾脏受到FSGS影响时，肾活检检测至少一个FSGS肾小球的诊断准确性超过80%。当少于75%的肾脏肾小球受到影响时，需要数百至数千个活检肾小球来可靠地表征FSGS的真实程度。平均20个肾小球的肾活检不能准确反映肾脏中FSGS的程度，直到肾脏中至少80%的肾小球受到影响。靶向JM肾小球并没有导致肾活检的预后性能特征的显着改善。这些结果表明，传统的肾活检可能不足以表征FSGS的程度。
The goal of this study was to estimate the diagnostic and prognostic accuracy of renal biopsies in focal segmental glomerulosclerosis (FSGS), accounting for the focal nature of affected glomeruli. Computational simulations were performed on a total of 138,600 virtual kidneys, across a range of FSGS involvement. Simulations were designed to address the diagnostic accuracy of renal biopsies, and the biopsy characteristics required to reflect accurately the true degree of involvement of FSGS in the entire kidney or just the juxtamedullary (JM) region. The diagnostic accuracy of renal biopsies for the detection of at least one FSGS glomerulus exceeded 80% when 10–20% of the kidney was affected by FSGS. Hundreds to thousands of biopsy glomeruli were required to characterize reliably the true extent of FSGS when fewer than 75% of the kidney’s glomeruli were affected. Renal biopsies with an average of 20 glomeruli did not accurately reflect the extent of FSGS in kidneys until at least 80% of all glomeruli in the kidney were affected. Targeting JM glomeruli did not result in significant improvements in the prognostic performance characteristics of renal biopsies. These findings suggest that conventional renal biopsies might be inadequate for characterizing the extent of FSGS.