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Schuler K, Jung IC, Zerlik M, Hahn W, Sedlmayr M, Sedlmayr B. Context factors in clinical decision-making: a scoping review. BMC Med Inform Decis Mak 2025; 25:133. [PMID: 40098142 PMCID: PMC11912758 DOI: 10.1186/s12911-025-02965-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 03/10/2025] [Indexed: 03/19/2025] Open
Abstract
BACKGROUND Clinical decision support systems (CDSS) frequently exhibit insufficient contextual adaptation, diminishing user engagement. To enhance the sensitivity of CDSS to contextual conditions, it is crucial first to develop a comprehensive understanding of the context factors influencing the clinical decision-making process. Therefore, this study aims to systematically identify and provide an extensive overview of contextual factors affecting clinical decision-making from the literature, enabling their consideration in the future implementation of CDSS. METHODS A scoping review was conducted following the PRISMA-ScR guidelines to identify context factors in the clinical decision-making process. Searches were performed across nine databases: PubMed, APA PsycInfo, APA PsyArticles, PSYINDEX, CINAHL, Scopus, Embase, Web of Science, and LIVIVO. The search strategy focused on combined terms related to contextual factors and clinical decision-making. Included articles were original research articles written in English or German that involved empirical investigations related to clinical decision-making. The identified context factors were categorized using the card sorting method to ensure accurate classification. RESULTS The data synthesis included 84 publications, from which 946 context factors were extracted. These factors were assigned to six primary entities through card sorting: patient, physician, patient's family, institution, colleagues, and disease treatment. The majority of the identified context factors pertained to individual characteristics of the patient, such as health status and demographic attributes, as well as individual characteristics of the physician, including demographic data, skills, and knowledge. CONCLUSION This study provides a comprehensive overview of context factors in clinical decision-making previously investigated in the literature, highlighting the complexity and diversity of contextual influences on the decision-making process. By offering a detailed foundation of identified context factors, this study paves the way for future research to develop more effective, context-sensitive CDSS, enhancing personalized medicine and optimizing clinical outcomes with implications for practice and policy.
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Affiliation(s)
- Katharina Schuler
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Ian-C Jung
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Maria Zerlik
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Waldemar Hahn
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
- Center for Scalable Data Analytics and Artificial Intelligence (ScaDS.AI), Dresden/Leipzig, Dresden, Germany
| | - Martin Sedlmayr
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Brita Sedlmayr
- Institute for Medical Informatics and Biometry, Faculty of Medicine, University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
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Toal MP, Hill CJ, Quinn MP, McQuarrie EP, O’Neill CE, Maxwell AP. An International Study of Variation in Attitudes to Kidney Biopsy Practice. Clin J Am Soc Nephrol 2025; 20:377-386. [PMID: 39705236 PMCID: PMC11906007 DOI: 10.2215/cjn.0000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 12/13/2024] [Indexed: 12/22/2024]
Abstract
Key Points Attitudes on kidney biopsy practice vary significantly across the world. Male clinicians, younger clinicians, and individuals who perform biopsies more frequently had an increased propensity to recommend a kidney biopsy. Kidney biopsy was most often recommended in the setting of higher proteinuria levels and preserved kidney function. Background A kidney biopsy is an essential investigation for diagnosis but is invasive and associated with complications. Delaying or missing the opportunity to diagnose kidney disease could result in adverse patient outcomes. The aim of this study was to examine attitudes to kidney biopsy across the world. Methods An online questionnaire for nephrologists was designed on the basis of the existing literature with input from patients. Anonymized data were collected on individual and institutional demographics, indications and contraindications for biopsy, and attitudes and barriers to access. A propensity-to-biopsy score was generated from responses, which allowed clinicians to compare their practice with international colleagues. A higher score was associated with an increased likelihood of recommending biopsy. The questionnaire was disseminated through international nephrology societies, including the National Kidney Foundation, and by social media. Results Participants responding to the questionnaire included 1181 clinicians from 83 countries, making it the largest international study in this area to date. The propensity-to-biopsy scores were significantly different between the 13 countries with over 20 clinicians participating (P < 0.001) and was highest in Mexico and lowest in the Philippines. Kidney biopsy was most often recommended in patients with higher proteinuria levels and most often avoided in patients with small kidneys. An adjusted linear regression model demonstrated that a significantly higher propensity-to-biopsy score was found in male clinicians, younger clinicians, frequent performers of kidney biopsy, increased job seniority, and larger institution size (P = 0.05). Conclusions Kidney biopsy practice is varied internationally and is subject to human and systemic factors. Further research is required to understand the variances behind clinical decision making.
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Affiliation(s)
- Michael P. Toal
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Christopher J. Hill
- Regional Centre for Nephrology and Transplantation, Belfast City Hospital, Belfast, Northern Ireland
| | - Michael P. Quinn
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Emily P. McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Ciaran E. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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Bhayana S, Schytz PA, Bisgaard Olesen ET, Soh K, Das V. Single-Cell Advances in Investigating and Understanding Chronic Kidney Disease and Diabetic Kidney Disease. THE AMERICAN JOURNAL OF PATHOLOGY 2025; 195:55-68. [PMID: 39097167 DOI: 10.1016/j.ajpath.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 08/05/2024]
Abstract
Chronic kidney disease (CKD) and its subset diabetic kidney disease are progressive conditions that affect >850 million people worldwide. Diabetes, hypertension, and glomerulonephritis are the most common causes of CKD, which is associated with significant patient morbidity and an increased risk of cardiovascular events, such as heart failure, ultimately leading to premature death. Despite newly approved drugs, increasing evidence shows that patients respond to treatment differently given the complexity of disease heterogeneity and complicated pathophysiology. This review article presents an integrative approach to understanding and addressing CKD through the lens of precision medicine and therapeutics. Advancements in single-cell omics technologies and artificial intelligence can be leveraged to explore the intricate cellular mechanisms underlying CKD and diabetic kidney disease pathogenesis. Dissecting the cellular heterogeneity and identifying rare cell populations using single-cell approaches will facilitate uncovering novel therapeutic targets and biomarkers for personalized treatment strategies. Finally, we discuss the potential of artificial intelligence-driven analyses in predicting disease progression and treatment response, thereby paving the way for tailored interventions.
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Affiliation(s)
- Sagar Bhayana
- Kidney Biology, Global Drug Development, Novo Nordisk A/S, Søborg, Denmark
| | - Philip A Schytz
- Cardiovascular, Kidney and Alzheimer Disease, Medical and Science, Novo Nordisk A/S, Søborg, Denmark
| | - Emma T Bisgaard Olesen
- Cardiovascular, Kidney and Alzheimer Disease, Medical and Science, Novo Nordisk A/S, Søborg, Denmark
| | - Keng Soh
- Integrated Omics, AI and Analytics, Development, Novo Nordisk A/S, Søborg, Denmark
| | - Vivek Das
- Integrated Omics, AI and Analytics, Development, Novo Nordisk A/S, Søborg, Denmark.
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Codea AR, Popa R, Sevastre B, Biriș A, Neagu D, Popovici C, Mircean M, Ober C. Effect of Ultrasound-Guided Renal Biopsies on Urinary N-Acetyl-Beta-D-Glucosaminidase Index Activity in Dogs with Diffuse Parenchymal Nephropathies. Life (Basel) 2024; 14:867. [PMID: 39063620 PMCID: PMC11278122 DOI: 10.3390/life14070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/06/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Ultrasound-guided kidney biopsy is an essential diagnostics method that can increase the accuracy of the differential diagnosis between acute and chronic nephropathies. In addition, it will help clinicians perform an etiologic diagnosis, issue a prognosis, and orient therapy for the majority of parenchymal nephropathies. Due to the relative invasiveness and potential adverse effects, the use of kidney biopsies is limited among practitioners. RESULTS Twenty-eight dogs, of mixed breed and variable ages, of which 11 (39, 29%) were males and 17 (60, 71%) were females, were examined and underwent an ultrasound-guided kidney biopsy to establish a definitive diagnosis. The patients were presented with a variety of diffuse nephropathies, such as kidney lymphoma: 1 (3.57%), glomerulonephritis: 13 (46.43%), tubulointerstitial nephritis: 11 (39.29%), and nephrocalcinosis. A total of 3 (10.71%) of 18 (64.29%) were in acute kidney injury, and 10 (35.71%) were CKD patients. The type and the severity of the kidney lesions were correlated with changes in the urinary n-acetyl-beta-d-glucosaminidase index (iNAG. To quantify the side effects of percutaneous kidney biopsy, the magnitude of post-biopsy hematuria and changes in urinary iNAG activity were evaluated. The results indicate a significant post-biopsy increase in the urinary iNAG activity in all the patients that underwent this procedure (100.08 ± 34.45 U/g), with a pre-biopsy iNAG vs. 147.65 ± 33.26 U/g post-biopsy iNAG (p < 0.001), suggesting an intensification in the kidney tubular damage that comes consecutives to kidney puncture and sampling. Transitory macro- or microhematuria were constant findings in all the dogs that underwent ultrasound-guided kidney biopsy, but the magnitude and extent could not be associated with the platelet count (PLT 109/L), aPTT (s), and PT (s) levels in our patients, and they were also resolved after 12-24 h without therapeutic interventions. CONCLUSIONS Ultrasound-guided renal biopsy was shown to be a minimally invasive diagnostic procedure that causes transient and limited effects on kidney structures. Although these effects were minor and resolved without intervention, we feel that the benefit of obtaining higher-quality biopsied tissue outweighs the higher risks associated with this procedure.
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Affiliation(s)
- Andrei Răzvan Codea
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Romeo Popa
- Department of Pharmacology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Bogdan Sevastre
- Department of Surgery, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania;
| | - Alexandra Biriș
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Daniela Neagu
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Cristian Popovici
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Mircea Mircean
- Department of Internal Medicine, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania; (A.R.C.); (D.N.); (C.P.); (M.M.)
| | - Ciprian Ober
- Department of Pathology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania;
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Kanjanabuch T, Isaranuwatchai S, Nopsopon T, Thammathiwat T, Pooprasert T, Puapatanakul P, Pongpirul K, Chawanasuntorapoj R, Kittiskulnam P, Eiam-Ong S, Tungsanga K, Chusil S, Ophascharoensuk V, Vanichakarn S, Sitprija V, Boonpucknavig V. Exploring hospital practice types and their impact on glomerular pathologic patterns: Insights from the largest kidney biopsy cohort in Thailand. Nephrology (Carlton) 2023; 28 Suppl 1:24-34. [PMID: 37534843 DOI: 10.1111/nep.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND This study aims to investigate the influence of different kidney biopsy practices on the prevalence of glomerular pathologic patterns in the largest kidney biopsy registry in Thailand. METHODS We conducted a retrospective review of kidney biopsy records from the period between 2000 and 2014. The records were obtained from 2 major institutions: King Chulalongkorn Memorial Hospital, a large university-based hospital, and the Kidney Center Bangkok Hospital, which provides pathology services to hospitals throughout Thailand. The study included native kidney biopsies from all provinces in Thailand, excluding paediatric patients, kidney transplant recipients, and cases of inadequate and repeated biopsies. Patient demographics, indications for biopsy, and final glomerular diagnoses were compared across different hospital practice settings: university (UVH), private (PVH) and public (PBH). RESULTS A total of 5893 eligible native kidney biopsies were identified from a pool of 7005 biopsies conducted over a 15-year period in 25 provinces throughout Thailand. The 3 most common indications for biopsy were suspected kidney involvement in systemic lupus erythematosus (SLE) (29%), nephrotic syndrome (NS) (29%), and acute glomerulonephritis (AGN)/rapidly progressive glomerulonephritis (RPGN) (13%). The leading indication for biopsy differed across practice types, with suspected kidney involvement in SLE being the primary indication in UVH, while NS took precedence in both PBH and PVH practices. Notably, UVH performed fewer kidney biopsies for asymptomatic urinary abnormalities and diabetes-related indications compared with PVH and PBH. The leading glomerular diagnoses correlated with the biopsy indications, with lupus nephritis (LN) being the most common diagnosis in UVH and PBH practices, whiles immunoglobulin A nephropathy was the predominant diagnosis in PVH practice. CONCLUSION Hospital practice types significantly impact the prevalence of glomerular pathologic diagnosis patterns in kidney biopsy data, highlighting the importance of considering this influence in epidemiological comparisons.
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Affiliation(s)
- Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suramath Isaranuwatchai
- Division of Nephrology, Department of Medicine, Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanawin Nopsopon
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Thitipong Pooprasert
- Department of Internal medicine department, Uttaradit Hospital, Uttaradit, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Ratana Chawanasuntorapoj
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kring Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Saowaluck Chusil
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vuddhidej Ophascharoensuk
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Visith Sitprija
- Queen Saovabha Memorial Institute, Thai Red Cross Society, Bangkok, Thailand
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Basu M, Pulai S, Neogi S, Banerjee M, Bhattacharyya NP, Sengupta S, Mukhopadhyay P, Ray Chaudhury A, Ghosh S. Prevalence of non-diabetic kidney disease and inability of clinical predictors to differentiate it from diabetic kidney disease: results from a prospectively performed renal biopsy study. BMJ Open Diabetes Res Care 2022; 10:10/6/e003058. [PMID: 36517108 PMCID: PMC9756194 DOI: 10.1136/bmjdrc-2022-003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Renal involvement in type 2 diabetes mellitus (T2DM) may be due to diabetes (diabetic kidney disease (DKD)), causes other than diabetes (non-diabetic kidney disease (NDKD)) or overlap of DKD and NDKD (mixed kidney disease group). Prevalence of NDKD and predictive value of clinical or biochemical indicators have been explored in retrospective cohorts with preselection biases warranting the need for prospectively conducted unbiased renal biopsy study. RESEARCH DESIGN AND METHODS Consecutive subjects aged >18 years with T2DM and renal involvement with estimated glomerular filtration rate of 30-60 mL/min/m2 and/or albumin:creatinine ratio of >300 mg/g were offered renal biopsy. Prevalence of DKD, NDKD and mixed kidney disease was documented. Clinical/laboratory parameters of subjects were recorded and compared between groups and were tested for ability to predict histopathological diagnosis. RESULTS We screened 6247 subjects with T2DM of which 869 fulfilled inclusion criteria for biopsy. Of the 869 subjects, biopsy was feasible in 818 subjects. Out of 818, we recruited first 110 subjects who agreed to undergo renal biopsy. Among those 110 subjects, 73 (66.4%) had DKD; 20 (18.2 %) had NDKD; and 17 (15.4 %) had mixed kidney disease. Subjects with NDKD as compared with DKD had shorter duration of diabetes (p<0.001), absence of retinopathy (p<0.001) and absence of neuropathy (p<0.001). Logistic regression revealed that only presence of retinopathy and duration of diabetes were statistically significant to predict histopathological diagnosis of DKD. 30% of DKD did not have retinopathy, thereby limiting the utility of the same as a discriminator. Use of traditional indicators of biopsy would have indicated a need for renal biopsy in 87.2% of subjects, though 64.5% of the subjects had DKD, who would not have benefitted from biopsy. CONCLUSION NDKD and mixed kidney disease in T2DM with renal involvement are very common and traditionally used parameters to select biopsies are of limited value in clinical decision making.
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Affiliation(s)
- Madhurima Basu
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Smartya Pulai
- Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Subhasis Neogi
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Mainak Banerjee
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Nitai P Bhattacharyya
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | - Pradip Mukhopadhyay
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Arpita Ray Chaudhury
- Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Sujoy Ghosh
- Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Kolkata, India
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Virmani S, Kumar A. The Transplant Kidney Biopsy: In Whose Hands? KIDNEY360 2022; 3:1662-1663. [PMID: 36514728 PMCID: PMC9717671 DOI: 10.34067/kid.0005382022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Sarthak Virmani
- Department of Nephrology, Yale School of Medicine, New Haven, Connecticut
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Molnár A, Thomas MJ, Fintha A, Kardos M, Dobi D, Tislér A, Ledó N. Kidney biopsy-based epidemiologic analysis shows growing biopsy rate among the elderly. Sci Rep 2021; 11:24479. [PMID: 34966177 PMCID: PMC8716536 DOI: 10.1038/s41598-021-04274-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
AbstractSystematic registration and examination of biopsy-related data in Central and Eastern Europe are scarce, while the health condition of the population is worse compared to other more developed countries. We aim to create a database and analyze the distribution and temporal variation of the renal biopsy diagnoses in Hungary, including the effect of the recent coronavirus pandemic. The diagnoses were standardized according to the recommendation of the European Renal Association. Native biopsy samples processed between January 1, 2006, and December 31, 2020, were analyzed. During the 15 years, 2140 native kidney biopsies were performed. The number of samples increased from 24.5 to 57.9 per million person-years and the median age from 37 to 51 years (p < 0.0001). The predominance of glomerular diseases was stable. The most frequent glomerulopathy was IgA nephropathy (21.5%), followed by focal segmental glomerulosclerosis (17.7%), and membranous nephropathy (15.7%). Trends showed the rise of ANCA-associated vasculitis. During the coronavirus pandemic, there was a decrease in the number of kidney biopsies and the proportion of membranous nephropathies. The diagnostic trends in our database showed increasing biopsy rates among the elderly and the growing frequencies of age-related diseases, which emphasizes the importance of altering medical focus according to demographic changes in this area.
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