[The importance of the pathologist to the clinical decision in glomerular diseases].
The indication to treatment of glomerular diseases in adults can only be based on the morphologic findings by light-, immunofluorescent- and electronmicroscopic examination. The majority of clinically diagnosed glomerulonephritides cannot be successfully treated according to current knowledge. Clinical findings, therefore, must help to decide where a biopsy should be performed or where one can do without histologic evidence without any disadvantage for the patient. The diagnosis of "glomerular disease" can be made by examination of erythrocyte morphology in the urine and from urinary protein pattern by poyacrylic-gel-electrophoreses. Having obtained this diagnosis, the indication for biopsy is possible, if a system of clinically defined stage is applied, as acute-, oligosymptomatic- and chronic progressive glomerulonephritis syndrome. A biopsy should be taken in any case of the nephrotic syndrome and urgently in the case of rapidly progressive renal insufficiency. Combined immunosuppressive treatment eventually in conjunction with plasmaphoresis has improved the prognosis of RPGN essentially and a biopsy should then be taken as soon as possible. It would be desirable, therefore, for the clinician if he could get the pathologists findings even on weekends or on holidays, to avoid any delay in starting the treatment. Special treatment regimes usually are chosen according to morphologically defined subgroups of glomerulonephritides. The valuable help of the pathologist in these normal cases becomes most evident, where a histologic finding can't be ascribed to any defined group and no evaluated treatment regimen is available. This is demonstrated by some clinical cases.
Renner
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D001706:Biopsy; D005921:Glomerulonephritis / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D011507:Proteinuria / Q000175:diagnosis
Die Bedeutung des Pathologen für die klinischen Entscheidungen bei glomerulären Nierenerkrankungen.