Percutaneous renal biopsy is not only the cornerstone for the diagnosis and treatment of glomerular, tubular, interstitial and vascular diseases of the kidneys, but also it is very important diagnostic method for the disorders of the transplanted kidney. Nowadays the renal biopsy has led to relative safe procedure due to recent advances in biopsy techniques, including the use of real-time ultrasonography and the biopsy gun despite occurring in bleeding complications, such macrohematuria and large sized hematoma near the kidney, in much low rate. Correct fixation and processing of the renal biopsy tissue is critical, and the renal biopsy requires light, immunofluorescence and transmission electron microscopy preparations in order to the evaluation of the pathology of renal diseases. Understanding of renal biopsy indications, contraindications, and procedure techniques, monitoring and treatment of pre and post procedure of the renal biopsy are essential for successful performing renal biopsy, and the prevention from serious complications and provide adequate tissue for pathology processing and accurate clinicopathological diagnosis of the renal diseases.

IntroductionAlthough systemic lupus erythematosus (SLE) is a relatively common autoimmune disorder, thebroad range of associated clinical symptoms means that its diagnosis can be diffi cult. Anti-ds-DNAautoantibodies are also considered to play a pathogenic role in inducing renal symptoms in SLE, anda strong correlation has been seen in lupus nephritis (LN) between disease activity and anti-ds-DNAautoantibody levels.GoalThe aim of the study was to compare the prevalence and levels of autoantibodies in the serum ofpatients with Systemic lupus erythematosus.Materials and MethodsThis patient-based descriptive study involved 39 patients with LN and 74 controls with primaryglomerulonephritis (GN). Face to face interview was used to obtain necessary information followed bythe physical examination and autoantibodies (anti-ds-DNA, anti-SS-A/Ro, anti-SS-B/La, c/p-ANCA, anti-Sm) measured by Enzyme-Linked Immunosorbent Assay (Germany, ORGENTEC Diagnostic GmbH).ResultsThe prevalence of anti-ds-DNA 48.7%, anti-SS-A/Ro 56.4%, anti-Smith 38.5%, anti-SS-B/La 12.8%were positive in lupus nephritis group (secondary GN), the prevalence of anti-ds-DNA 6.76%, anti-SS-A/Ro 6.76%, anti-Smith 2.7%, anti-SS-B/La 2.7% were positive in primary GN group.Conclusions: SLE associated with several autoantibodies (anti-ds-DNA, anti-SS-A/Ro, anti-Smith,and anti-SS-B/La) and each of which are very useful in distinguishing patients with SLE from otherautoimmune diseases and GN.

Background: Glomerulonephritis (GN) remains a common cause of end stage kidney failure worldwide. The auto antibodies are useful in the patients prognosing, diagnose and treatment of GN. The aim of the study was to compare the prevalence and levels of auto antibodies in the sera of patients with GN in relation to the clinical activity of disease and auto antibodiesMethods: From a hospital-based population, 90 patients with GN (mean age 37.9±12.7) were recruited. Autoantibodies (C/P-ANCA, anti-dsDNA, anti-Sm, anti-SS-A/Ro, anti-SS-B/La, anti-Scl-70, anti-GBM) measured by Enzyme Immuno Assay (Germany, ORGENTEC Diagnostika GmbH). Renal function was evaluated by the eGFR using the Cockcroft-Gault formula.Results: Patients with GN was significantly younger and primary GN was more common in the male, but frequency of LN was 4 times higher among female. The prevalence of cANCA 2.9%, Sm 4.2%, dsDNA 5.7%, SSA 7.1%, SSB 1.4% were positive in primary GN group, the prevalence of Sm 16.7%, dsDNA 8.3%, SSA 25%, SSB 16.7% were positive in secondary GN group. A higher frequency of anti Sm 25%, anti-dsDNA 25%, anti-SS-A/Ro 75%, anti-SS-B/La 25% was observed in the lupus nephritis group. Conclusion: Lupus nephritis associated with several auto antibodies (anti Sm, anti-dsDNA, anti-SS-A/ Ro, anti-SS-B/La) and each of which are very useful in distinguishing patients with lupus nephritis from other secondary GN.

INTRODUCTION: In the modern medical practice of Mongolia, autoimmune diseases have notbeen diagnosed in its early stage. The autoantibodies are useful in the patient’s early diagnosis,prognosing, and treatment of autoimmune diseases.GOAL: The aim of the study was to compare the prevalence and levels of autoantibodies in theserum of patients with autoimmune diseases.MATERIALS AND METHODS: This patient-based descriptive study involved 144 participants, withconfirmed diagnosis of autoimmune disease and glomerulonephritis (GN). Face to face interviewwas used to obtain necessary information followed by the physical examination and autoantibodies(anti-SS-A/Ro, anti-SS-B/La, anti-SCL-70, c/p-ANCA, anti-GBM, anti-Sm) measured by Enzyme-Linked Immunosorbent Assay (ELISA).RESULTS: The prevalence of anti-SS-A/Ro 38.6%, anti-Sm 25.7%, anti-SS-B/La 8.6%, c-ANCA7.14%, anti-SCL-70 1.4% were positive in autoimmune disease group (secondary GN), theprevalence of anti-SS-A/Ro 6.8%, anti-Sm 2.7%, anti-SS-B/La 2.7%, c-ANCA 1.4% were positivein primary GN group. A higher frequency of anti-SS-A/Ro 66.4%, anti-SS-B/La 22.8%, and anti-Sm38.4% was observed in the SLE group.CONCLUSIONS: Patients with autoimmune disease was significantly higherly younger and female.SLE associated with several auto antibodies (anti-SS-A/Ro, anti-SS-B/La, and anti-Sm) and eachof which are very useful in distinguishing patients with SLE from other autoimmune diseases.

Background Systemic Lupus Erythematous (SLE) is a multi-systemic autoimmune disease with numerous patterns of clinical and immunological manifestations. Renal disease in SLE occurs in 40–75% of patients, most often within five years of disease onset, and is one of the strongest predictors of a poor outcome. Anti-dsDNA antibodies are reported to be more prevalent in patients with SLE who have renal disease. Anti-Sm, anti SSA and anti SSB antibodies are also considered to play a pathogenic role in inducing renal symptoms in SLE, and a strong correlation has been seen in lupus nephritis (LN) between disease activity and anti-dsDNA antibody levels. Objective The aim of our study is to highlight the clinical and laboratory features in SLE patients. Methods This is a three year hospital based case-control study of patients with renal diseases, who were admitted to the nephrology and rheumatology units of the 1st central Hospital and 3rd central hospital, Mongolia. Standard methods were used for laboratory testing. Autoantibodies (C/P-ANCA, anti-dsDNA, anti-Sm, anti-SS-A/Ro, anti-SS-B/La, anti-Scl-70, anti-GBM) measured by Enzyme Immuno Assay (Germany, ORGENTEC Diagnostika GmbH). Renal function was evaluated by the eGFR (estimated glomerular filtration rate) using the Cockcroft-Gault formula. Result The study included 27 patients with lupus nephritis and 78 controls with other types of GN. There were 85.2% of female patients in the lupus nephritis group. Patients with LN were significantly younger than the controls (mean (SD) 31.9 (10.1) years vs. 37.1 (11.9) years; p=0.036). For the serology, a higher proportion of anti dsDNA (46.1%), anti Sm (29.6%), anti SSA (63%) and anti SSB (11.1%) were seen in the group with lupus nephritis (p=0.001; p=0.043; p<0.0001; p=0.096, respectively). The Pearson’s correlation analysis indicated that the level of anti-dsDNA (r=-0.249, p=0.021) and anti SSA (r=-0.195, p=0.048) were significantly correlated with the renal function (eGFR). All had dipstick proteinuria 1+/2+/3+, more than 10 red blood cells/hpf hematuria (n-12, 44.4%) in lupus nephritis group and renal function (mean eGFR (SD) 88.1 (51.3) ml/min vs. 112.3 (67) ml/min; p=0.05) was more decreased in lupus nephritis patients than controls. Conclusion Notably, rising titers of antibodies to dsDNA, SSA may indicate exacerbations of glomerulonephritis.

Objective To clarify the relationship between clinical manifestation and pathological features of IgA nephropathy (IgAN) patients with mild proteinuria and/or hematuria.Methods Clinicopathological data from 316 biopsy-proven IgAN cases (proteinuria＜1 g/24 h and/or hematuria, and Scr＜133 μmol/L) from our hospital between January 1993 and October 2009 were studied retrospectively. The renal histopathology was quantified according to Lee's grading and Katafuchi's semi-quantitative standard, and the risk factors for renal pathological lesions were evaluated using multifactor logistic regression analysis. Results Among these 316 patients, 123 were male and 193 patients were female. The mean age at the time of renal biopsy was (33.10±10.69) years old. Clinical features were found as follows: hematuria with proteinuria was found in 267 patients (84.5%), isolated hematuria in 24 patients (7.6%), and isolated proteinuria in 25 patients (7.9%). 16.5% of patients had hypertension. The percentages of CKD stage Ⅰ, Ⅱ, Ⅲ were 76.9%, 20.9% and 2.2%, respectively. 31.3% of patients presented Lee's grade Ⅲ or more severe.52.8% of patients had various degrees of glomerulosclerosis. Crescent formation was observed in 20.3% of patients. 22.5% of patients showed tubular atrophy;16.8% showed interstitial fibrosis and 24.7% also had renal vascular lesions. The extent of glomerulosclerosis was negatively correlated with eGFR levels, but positively correlated with the amount of proteinuria and mean arterial pressure (MAP) level (P＜0.05). The score of tubulointerstitial lesion was positively correlated with the amount of proteinuria and negatively correlated with eGFR and hemoglobin (Hb)level (P＜0.05). The degree of renal vascular lesion was also correlated to MAP level positively and eGFR level negatively (P＜0.05). Multifactor logistic regression analysis revealed that proteinuria, Scr and Hb at the time of renal biopsy were independent risk factors for severe renal pathological lesions (Lee's grade Ⅲ or more severe) with odds ratio of 8.564, 1.031 and 0.975 respectively (all P＜0.01). Conclusions Severe renal histological lesions and decrease of renal function may be seen in some IgAN patients with mild proteinuria and/or hematuria. The levels of proteinuria,Scr and Hb are the independent risk factors for severe renal pathological lesions. Renal biopsy is important in these patients in order to make diagnosis and individual treatment.

Kidney transplantation is the best alternative treatment for end-stage renal disease and health-related quality of life and survival of the patients are improved compared with dialysis. Worldwide, more than 1.4 million patients with CKD receive renal replacement therapy with incidence growing by approximately 8% annually.1 Unfortunately, despite significant improvement in graft function, kidney transplants can still fail due to acute rejection and chronic allograft nephropathy.2 Kidney biopsy after transplantation, which has evaluated by Banff 09 classification is usefull method for diagnose of transplanted kidney disease.3,4Kidney graft rejection was diagnosed in 10 renal allograft biopsy specimens (bs) obtained from transplant patients followed up at our institute between 2015 and 2016. All specimens were evaluated as satisfactory which show more than 8 glomerulus under the light microscopy. Each renal cortical tissue was divided into two tips: one piece for routine H&E stain and special stains, including Masson’s trichrome, and PAS stain; another piece for immunofluorescence by frozen section, which were stained with IgA, IgM, IgG and complement component (C3, C4, C1q, C4d). All the renal biopsies were examined by the same pathologist.Out of 117 transplantations, 10 episodes of rejection selected. Among the 10 patients, 30% had an acute T cell rejection and 70% had a chronic allograft nephropathy. Interstitial inflammation (i1-7) was present in 7 bs (70%), tubulitis (t1-4,t2-2) in 6 bs (60%), transplant glomerulitis (g1-1, g2-2, g3-1) in 4 bs (40%), transplant interstitial fibrosis (ci1-2, ci2-2, ci3-2) in 6 bs (60%), tubular atrophy (ct1-6, ct2-2, ct3-1) in 9 bs (90%), mesangial matrix increase (mm1-5) in 5 bs (50%), vascular fibrosis intimal thickeness (cv1-3) in 3 bs (30%), arteriolar hyaline thickening (ah1-5) in 5 bs (50%), tubulitis (ti1-6, ti2-3, ti3-1) in 10 bs (100%) and peritubular capillaritis (ptc1-1, ptc2-2, ptc3-1) in 4 bs (40%). C4d deposition was present very mild in wall of the vessels and peritubular capillaries. Because of not good working Methenamin silver stain, we couldn’t demostrate glomerular basement membrane changes (cg) fully.We suggest that histopathological changes of transplant glomerulopathy might be accompanied by inflammation of the microvasculature, such as transplant glomerulitis and peritubular capillaritis. C4d deposition in the wall of the vessels and peritubular capillaritis is not always present in biopsy specimens of transplant glomerulopathy.