THE STRUCTURE AND FUNCTION OF RENAL GLOMERULAR CAPILLARIES IN HEALTH AND DISEASE

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Abstract
In the belief that sequential studies of the pathology of the kidney might improve our understanding of the pathogenesis of a variety of forms of renal disease in childhood, we began to perform percutaneous renal biopsies in children in 1955. Our studies were stimulated by the pioneering investigations of Iversen and Brun1 in Europe, and Muehrcke, Kark, and Pirani2 in the United States. Our experience3 now includes more than 500 kidney biopsy specimens obtained from approximately 400 children of all ages. The incidence of complications has been low, and the method has proved to be safe enough to justify the small risk entailed. Bleeding into the perirenal tissues, sufficient to cause pain, or a measurable fall in hemoglobin, or the appearance of a mass, has occurred in eight children. Gross hematuria of more than transient nature has occurred in six additional children. There has been no recognized permanent renal functional impairment or other chronic sequelae of these accidents. Surgical exploration of the biopsied kidney has never been necessary and no deaths have occurred as a consequence of the procedure. The confusion which exists regarding classification and diagnosis of many renal diseases arises because of inadequate knowledge of their etiology, and is further compounded by conflicting use of terminology by clinicians and pathologists. The terms nephritis, nephrosis, mixed nephritis-nephrosis, and the modifying terms acute, subacute, and chronic, are, for example, applied by these two groups of physicians in circumstances which differ widely depending upon the experience of the user. Widespread use of the renal biopsy technique over the past 7 years has not eliminated the difficulties in use of terminology, but some progress has been made.

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