Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles

Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles Weiji Xie, Jing Xu, Yi Xie, Zhijun Lin, Xiaochang Xu, Yimin Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.13703/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Aug, 2020 Read the published version in BMC Nephrology → Version 1 posted You are reading this latest preprint version Abstract Aim: The study aims to compare the adequacy, complication and pathological classification rates of using 18G vs. 16G needles to perform renal biopsy with ultrasound-guided on native kidneys in Chinese. Methods: We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients who were used by 18G or 16G needles separately from January, 2011 to May, 2017，and verified whether the needle gauge affect the diagnosis of the disease. Results: A total of 270 kidney biopsies were performed. Among them :72 were with 18G needles, and 198 were with16G needles. There was no difference in the number of glomeruli count under light microscope using 18G relative to 16G needles（24±11vs25±11，p=0.265）, whereas more glomeruli count were found for the 16G group using immunofluorescence microscopy(3±2 vs 5±3， p＜0.05).There was no significant difference in the adequate sample rates between 18G group and 16G group (90.28%vs93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs 7.07%, p = 0.57), gross hematuria (4.17% vs 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs1.52%, p = 0.195) were not significantly different for 18G vs 16G group. In 16G group, there was 2 cases of serious complications occurred, including severe gross hematuria requiring blood transfusion, and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, even although there was no significant difference in serious complications rates between the 18G and 16G group (0% vs 1.02%，p = 1). Conclusion: There was no significant difference in the number of glomeruli, adequate sample rates, and complication rates of using the 18G and 16G needles to perform renal biopsy, and the 18G needle with smaller diameter did not affect the pathological diagnosis and classification of IgA nephropathy and lupus nephritis. Urology & Nephrology percutaneous renal biopsy needles complication adequacy Introduction The percutaneous renal biopsy (PRB) is a primary biopsy technique developed by Alwall in 1944 [1] and is an important technique for the diagnosis of kidney disease. Gauge of percutaneous renal biopsy needle vary from 14G to 22G [2–5] . At present, 16G needle or 18G needle is used for percutaneous renal biopsy in China, but there is still controversy about the effect and safety of 18G and 16G biopsy needles with two different diameters. Therefore, we retrospectively studied the number of glomeruli, adequate sample rates, complication rates, disease spectrum and pathological classification in renal biopsy by using 18G group and 16G group to compare the differences of using biopsy needles. Patients and Methods 1. Patients Patients were undergoing PRB at the Sixth Affiliated Hospital of Sun Yat-sen University，Department of Nephrology, and the Second Affiliated Hospital of Shantou University Medical College，Department of Nephrology from January 2011 to May 2017. The present study was approved by the ethics committee of the Sixth Affiliated Hospital of Sun Yat-sen University and adhered to the tenets of the Declaration of Helsinki. 2. Instruments and methods Apply Pajunk Delta Cut Biopsy System using 16G and 18G biopsy needles. The ultrasound, blood routine examination, liver and kidney function, and blood coagulation function were checked before the puncture. No renal biopsy contraindications were identified. Selection of needle gauge: Prior to February 2015, renal biopsies for the patients with relative contraindications（renal insufficiency, coagulopathy, and small size kidneys （ length≤8cm）) were performed by using 18G biopsy needles, and biopsies for other patients were performed with 16G needle. After February 2015, renal biopsies were performed with 18G biopsy needle only. And we removed the 18G needle cases which used it because of relative contraindications. Patients were asked to urinate before PRB. Under the guidance of ultrasound, the lower right renal pole was selected as the biopsy target, and the patient was prone position. First, disinfection and local anesthesia were performed, then a guide was placed, and the tip of the needle reached the renal capsule to trigger biopsy needle and kidney biopsy. Repeat these operations one more time after drawing. After the operation, the renal biopsy tissue was divided into three sections, which were placed under the light microscope, electron microscope, and fluorescent mirror tube to be preserved for pathological examination. Supine 6~8h after surgery and lying in bed 24h. At the same time, the urine color and pain were recorded and the kidney condition was examined by ultrasonography. 3. Observed indicator The numbers of glomeruli were recorded in the 18G and 16G groups, and statistically analyses were performed to evaluate whether the numbers of glomeruli between the two groups were statistically different. The number of glomeruli ≥ 10 as a standard of an adequate sample and then a comparison of adequate sample rates between two groups were made. Statistical data are presented as mean value ± standard deviation (SD). Complications were divided into minor complications and serious complications according to Whittier et al[6, 7].The minor complications were also detected including lumbar or abdominal pain, hematuria, perirenal hematoma as well as serious complications including bleeding requiring surgical intervention or blood transfusion, decline in blood pressure, hemoglobin decline, severe infection etc. The pathological diagnosis and pathological classification in group 18G and 16G were compared. Take to revalue Lee classification and Oxford classifications as the standard of IgA nephropathy classification. Take ISN/RPS2003 classification as the standard of lupus nephritis pathological classification. 4. Statistical Analysis Statistical analysis was performed using the IBM SPSS Statistic 22. Measurement data are presented as mean value ± standard deviation, and the comparison was analyzed by Mann-Whitney U test. The enumeration data were compared with Fisher’s exact test. When P-value less than 0.05, the difference is statistically significant. RESULTS In this study, a total of 270 patients aged 9~85 years with an average of 40 years met the inclusion criteria and including 152 males and 118 females. In the 18G group, 72 patients including 38 males and 34 females participated, with a mean age of 41±16 years and an average of 41 years. In the 16G group,198 patients including 114 males and 84 females participated, with a mean age of 40±16 years and an average age of 40 years. There were no significant differences in age，sex or BMI between the two groups. The level of serum creatinine, hemoglobin, platelet count, PT, APTT and urinary protein also did not differ significantly from two groups before renal biopsy(Table 1). The numbers of glomeruli were similar in 18G group relative to 16G group detected by light microscopy(24±11 vs 25± 11, p = 0.265),whereas fewer numbers of glomeruli were detected in 18G group compared with those in 16G group by for immunofluorescence examination (3±2 vs 5±3, P < 0.05)(Table 2).The adequate sample rates of the 18G group and the 16G group were not significantly different (90.28% vs 93.94%, p = 0.298) (Table 2). The total of complications presented in this study was 12.9%(34/270 individuals) and similarly percentage of complications in the 18G and 16G patients. The incidence of lumbar or abdominal pain in the 18G and 16G patients (4.17% vs 7.07%, p = 0.572), mild gross hematuria (4.17% vs 3.03%, p = 0.729), and the incidence of small hematoma (4.17% vs 1.52%, p = 0.195) were not statistically significant different. In the 16G group, 2 cases of severe complications occurred. One case had severe gross hematuria with the blood transfusion was required, another case had retroperitoneal hematoma required renal artery embolization. Serious complications were not found in the 18G group. In the group that has the 18G needle procedure, there were no serious complications compared with 1.02% in the group with the 16-G needle procedure (0% vs 1.02% ，P = 1) (Table 3). As for the disease spectrum，the proportion of patients with lupus nephritis in the 18G group was significantly higher than that of the 16G group (16.67% vs7.58%, p <0.05). Proportions of other diseases （minor glomerular abnormalities，renal amyloidosis，Ischemic renal injury，immunotactoid glomerulopathy，idiopathic nodularmesangial sclerosrs，Transplant nephropathy，Thrombotic microvascular disease due to scleroderma，Alport syndrome，and Focal necrotic glomerulonephritis)in the 18G group were lower than that those of the 16G group (1.39% vs 9.6%, p <0.05)(Table 4). DISCUSSION Renal biopsy has an irreplaceable important role in the diagnosis of kidney disease, treatment options，and the determination of the prognosis of the disease during the clinical work of renal medicine. At present, percutaneous renal biopsy is an essential technique in renal medicine, and the safety and success rates of PRB has been further improved after the introduction of automatic biopsy needles and real-time ultrasound guidance [9–11] . Commonly，puncture needle is divided into two categories, namely negative pressure suction needle and cutting needle. However,，the best needle size for the most widely used Tru-Cut needle has not yet established. In China, the most commonly used needle gauge is 16G (diameter 1.65mm, length 22mm or 15mm), and we generally believe that this size meets the requirements of renal pathological diagnosis. In addition, 18G needle（diameter 1.27mm, Length 22mm or 15mm）has been generally used in patients who has relative contraindications（renal insufficiency, coagulopathy, and small size kidneys etc）. It is controversial regarding whether the smaller diameter 18G biopsy needle is also able to meet the requirements of disease diagnosis and reduce the incidence of complications. The purpose of the retrospective analysis in this study is to clarify this issue. The premise of accurate pathologic diagnosis is to get enough glomeruli such that the glomerular numbers of the 18G- and 16G- group can be compared. It has been reported that 16G had a significant advantage over the 18G needle in terms of the number of acquired glomeruli [12, 13] , while in a prospective study of 14G and 16G biopsy needle， Manno et al [14] found that there was no significant difference in the number of glomeruli obtained by two biopsies of different diameters. We conducted a retrospective analysis and found that under the light microscope, the numbers of glomeruli count between the two groups not significantly different under the same puncture method described by Manno [14] .Under the immunofluorescence examination, the glomeruli count of the 16G group was slightly higher than that of the 18G group. In general, at least 10 intact glomeruli are required for a specimen assessment [15] .Therefore, we set a standard for the samples to obtain accurate result，such as number of glomeruli has to be more than≥ 10 and the adequate sample rates have to be compared between two group. We found that the adequate sample rates of 18G group and 16G group was not significant different. Thus, there is no obvious difference between the two groups in the number of glomeruli. The pathological diagnosis of renal disease depends on the quality of the acquired specimen. When the number of glomeruli in pathological specimens is not enough, it may affect the diagnosis of the renal disease or classification of some diseases, resulting in misdiagnosis. For example, FSGS is characterized by focal segmental distribution and is easily missed in the presence of fewer glomeruli. Therefore, to diagnose a focal disease，greater than 20 glomeruli may be needed [7] . But membranous nephropathy requires only one glomerulus to diagnose [12] . Generally, 16G needle biopsy of renal pathological diagnosis can meet the requirements. In the current study，using pathological diagnosis of group 16G distribution as a standard, we did a comparative analysis of the pathological diagnosis of 18G and 16G needle proportion to assess the impact of the two different needles on the pathological diagnosis and pathological classification. We statistically analyzed the disease spectrum between the two groups and found that the incidence of lupus nephritis was 16.67% in the 18G group, which was much higher than that in the group 16G (7.58%). IgAN, MN, MCD, lupus nephritis, diabetic nephropathy, FSGS, MsPGN, crescentic glomerulonephritis, acute tubulointerstitial injury, hypertension nephropathy, chronic sclerosing glomerulonephritis, endocapillary proliferative glomerulonephritis，and anaphylatic purpura nephritis was found to be in equal proportions in the two groups，whereas the proportion of other rare diseases in the 18G group was smaller than that in the 16G group (Table 4). Because lupus nephritis requires diagnosis in combination with clinical, laboratory, or pathological findings and does not rely solely on pathological diagnosis，our results suggest that the size of the needle may have no significant effect on lupus diagnosis. It is most frequent biopsy finding in the China is IgA nephropathy, marking up 36.3% of all primary glomerulopathies [23] . However, the number of glomeruli may affect classification of IgA nephropathy including Lee and Oxford classifications. Therefore, the difference in the proportion of different classification of IgA nephropathy is most likely related to the small sample size, which may be related to the size of the needle. In order to further analyze the influence of needle size on diagnosis of pathological classification, we comparatively analyzed the pathological classification in the 18G and 16G group (Table 5,6). The proportion of IgA nephropathy Lee grade IV was higher in the 18G group than that in the 16G group ( 48.00%vs24.19%, P < 0.05),whereas there was no significant difference in the proportion of other IgA nephropathy pathological classification between two groups. Similarly, we have chosen the new Oxford classification(MEST-C) which was published in 2017 that added to cellular/fibrocellular crescents score, compared with the older Oxford classification(MEST) which was published in 2009. The results reveal that the proportion of Oxford classifications(MEST-C)of IgA nephropathy of segmental glomerulosclerosis was higher in the 18G group than that in the 16G group（52%vs24.59%, P＜0.05), whereas there was no significant difference in the proportion of other IgA nephropathy pathological index between two groups. Furthermore, we evaluate the size of the needle whether effect lupus nephritis classification and the result show that there was no significant difference in the ratio of lupus nephritis classification between two group. Considering the glomerular count and adequate sample rates of the 18G group and the 16G group, we suggest that the change in needle gauge is not a major cause of change in the proportion of IgA nephropathy in the two groups. In conclusion, through statistical analysis, our results strongly suggest that 18G needle with smaller diameter has no significant impact on the diagnosis and pathological classification of renal diseases. Complications of renal needle biopsy include gross hematuria, lumbar abdominal pain, perirenal hematoma, arteriovenous fistula, infection etc [16] ,with bleeding the most common complication [17] . Most of these complications are not intervened, but severe complications requiring surgical intervention is rare. The incidence of serious complications is about 1 to 7% [6, 14, 18, 19] , and 0.1% of patients died of renal biopsy [20] . A question that needs to be addressed in the field is whether it is possible to use a needle with smaller diameter for PRB to reduce postoperative complications. The correlation between the diameter of needle and the incidence of postoperative complications remains controversial. Corapi et al [21] found that the greater the risk of puncture needle bleeding was higher than that of small diameter puncture needle. Peters et al [13] concluded that 16G needle was superior to 18G in the quality of sampling and postoperative complications. Roth and Mai J et al [17, 22] pointed out that the incidence of postoperative complications was similar in 16G group and 18G group. In our study, abdominal pain, gross hematuria, and perirenal hematoma were common complications of renal biopsy. Notably, there were two case of severe complications in the 16G group. Because the complication rate is relatively rare, the research between the two groups of mild complications and the incidence of serious complications did not show statistically significant difference. Taken together, 16G biopsy needle has no obvious advantage over 18G needle by comparing the number of glomeruli and the adequate sample rate, and the smaller diameter 18G needle do not affect the diagnosis of the disease. Therefore, 18G needle has the same application value as 16G needle. Declarations Funding: This study was funded by the Science and Technology Program of Guangdong Province grant 2016A090922005. Conflict of interest： The authors declared that they have no conflicts of interest to this work. References [1]ALWALL N. Aspiration biopsy of the kidney, including i.a. a report of a case of amyloidosis diagnosed through aspiration biopsy of the kidney in 1944 and investigated at an autopsy in 1950. Acta Med Scand. 1952. 143(6): 430–5. [2]Chunduri S, Whittier WL, Korbet SM. Adequacy and complication rates with 14- vs. 16-gauge automated needles in percutaneous renal biopsy of native kidneys. Semin Dial. 2015. 28(2): E11–4. [3]Nicholson ML, Wheatley TJ, Doughman TM, et al. A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int. 2000. 58(1): 390–5. [4]Song JH, Cronan JJ. Percutaneous Biopsy in Diffuse Renal Disease: Comparison of 18- and 14-gauge Automated Biopsy Devices ☆. Journal of Vascular & Interventional Radiology. 1998. 9(4): 651–655-. [5] Ocak S, Duplaquet F, Jamart J, et al. Diagnostic Accuracy and Safety of CT-Guided Percutaneous Transthoracic Needle Biopsies: 14-Gauge versus 22-Gauge Needles. J Vasc Interv Radiol. 2016. 27(5): 674–81. [6]Whittier WL, Korbet SM. Timing of complications in percutaneous renal biopsy. Journal of the American Society of Nephrology Jasn. 2004. 15(1): 142-. [7]Whittier WL. Complications of the Percutaneous Kidney Biopsy. Adv Chronic Kidney Dis. 2012. 19(3): 179-. [8]Weening J, D’Agati V, Schwartz M, et al. International Society of Nephrology Working Group on the Classification of Lupus Nephritis; Renal Pathology Society Working Group on the Classification of Lupus Nephritis. The classification of glomerulonephritis in systemic lupus erythematosus revisited. 2004: -. [9]Birnholz JC. An improved technique for ultrasound guided percutaneous renal biopsy. Kidney Int. 1985. 27(1): 80-. [10]Ahmed AM, Anees M, Riaz A, Mueed S. Percutaneous renal biopsy by automated biopsy gun. J Coll Physicians Surg Pak. 2003. 13(5): 263–6-. [11]Lübbers H, Mahlke R, Haake C, Lankisch PG. A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs. Z Gastroenterol. 1993. 31(9): 484-. [12]Arora K, Punia RS, D’Cruz S. Comparison of diagnostic quality of kidney biopsy obtained using 16G and 18G needles in patients with diffuse renal disease. Saudi J Kidney Dis Transpl. 2012. 23(1): 88–92. [13]Peters B, Mölne J, Hadimeri H, Hadimeri U, Stegmayr B. Sixteen Gauge biopsy needles are better and safer than 18 Gauge in native and transplant kidney biopsies. Acta Radiol. 2017. 58(2): 240–248. [14]Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004. 66(4): 1570–7. [15]Racusen LC, Solez K, Colvin RB, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999. 55(2): 713–23. [16]Wang C, Yang Y, Jin L, et al. Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience. J Nephrol. 2015. 28(6): 691–700. [17]Roth R, Parikh S, Makey D, et al. When size matters: diagnostic value of kidney biopsy according to the gauge of the biopsy needle. Am J Nephrol. 2013. 37(3): 249–54. [18]Korbet SM. Nephrology and the Percutaneous Renal Biopsy: A Procedure in Jeopardy of Being Lost Along the Way. Clinical Journal of the American Society of Nephrology Cjasn. 2012. 7(10): 1545–7-. [19]Maixnerova D, Jancova E, Skibova J, et al. Nationwide biopsy survey of renal diseases in the Czech Republic during the years 1994–2011. J Nephrol. 2015. 28(1): 39–49-. [20]Weening JJ, Jennette JC. Historical milestones in renal pathology. 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Tables TABLE 1 Baseline demographic and laboratory features in the 18G and 16G groups 18G 16G p Male 38（53%） 114（58%） Female 34（47%） 84（42%） 0.482 Age 41±16 40±16 0.756 Creatinine(μmol/L) 255±242 216±316 0.11 Hemoglobin(g/L) 116±28 118±26 0.394 Platelets number(*10E9/L) 231±82 248±88 0.084 PT 12±1.8 13±1.2 0.279 APTT 28±5.5 29±4.7 0.466 Proteinuria (g/24 hr) 3.3±4.3 3.2±4.2 0.821 BMI(kg/m 2 ) 4.73±5.19 23.71±4.29 0.991 PT, prothrombin time; APTT, Activated Partial Thromboplastin Time TABLE 2 Adequacy of renal biopsy 18G 16G P LM 24±11 25±11 0.265 IF 3±2 5±3 0.003 LM ≥10 65 （ 90.28% ） 186 （ 93.94% ） 0.298 LM: Light microscopy glomeruli count; IF: Immunofluorescence microscopy glomeruli count TABLE 3 Comparative analysis of biopsy complications N(%) 18G 16G p Minor complications lumbar or abdominal pain 3（4.17%） 14（7.07%） 0.572 gross hematuria 3（4.17%） 6（3.03%） 0.704 perinephric hematoma without symptoms 3（4.17%） 3（1.52%） 0.195 serious complications 0(0%) 2（1.02%） 1 Total complications 9(12.5%) 25(12.63%) 1 Total number 72 198 TABLE 4 Comparative analysis of disease spectrum N(%) 18G 16G p IgA nephropathy 25（34.72%） 62（31.31%） 0.659 Membranous nephropathy 12（16.67%） 42（21.21%） 0.493 Minimal change disease 3（4.17%） 20（10.10%） 0.145 Lupus Nephritis 10（16.67%） 15（7.58%） 0.038 Diabetic nephropathy 5（6.94%） 10（5.05%） 0.554 FSGS 2（2.78%） 8（4.04%） 1 Mesangial proliferative glomerulonephritis 1（1.39%） 6（3.03%） 0.679 Crescentic glomerulonephritis 4（5.56%） 3（1.52%） 0.084 Acute tubulointerstitial injury 2（2.78%） 7（3.54%） 1 Hypertension nephropathy 2（2.78%） 1（0.51%） 0.174 Chronic sclerosing glomerulonephritis 3（4.17%） 2（1.01%） 0.12 Endocapillary proliferative glomerulonephritis 1（1.39%） 2（1.01%） 1 Anaphylatic purpura nephritis 1（1.39%） 1（0.51%） 0.463 Others* 1（1.39%） 19（9.6%） 0.019 *Others ： minor glomerular abnormalities ， renal amyloidosis ， Ischemic renal injury ， immunotactoid glomerulopathy ， idiopathic nodularmesangial sclerosrs ， Transplant nephropathy ， Thrombotic microvascular disease due to scleroderma ， Alport syndrome ， Focal necrotic glomerulonephritis. TABLE 5 Comparative analysis of IgAN classification （ SMK Lee Classifications ） N(%) 18G 16G p GradeⅠ 0 0 GradeⅡ 0 7（11.29%） 0.185 GradeⅢ 8（32%） 26（41.94%） 0.471 GradeⅣ 12（48%） 15（24.19%） 0.041 GradeⅤ 5（20%） 14（22.58%） 1 TABLE 6 Comparative analysis of IgAN classification （ Oxford classifications*,2017 ） N(%) 18G 16G p M1 25(100%) 61(100%) 1 E1 7(28%) 25（40.98%） 0.329 S1 13（52%） 15（24.59%） 0.022 T1 7（28%） 9（14.75%） 0.221 T2 4（16%） 12（19.67%） 0.77 C1 4(16%) 8(13.11%) 0.739 C2 3(12%) 10(16.39%) 0.748 * The Oxford classification consisted of mesangial hypercellularity (M0, mesangial score ≤ 0.5; M1, mesangial score > 0.5), endocapillary hypercellularity (E0, absent; E1,present), segmental glomerulosclerosis (S0, absent; S1, present), tubular atrophy/interstitial fibrosis (T0, ≤25%; T1, 26%-50%; T2, >50%), and cellular/fibrocellular crescents(C0,absent; C1,<25%; C2, ≥ 25%) TABLE 7 Comparative analysis of Lupus Nephritis classification （ The ISN/RPS classification,2003 ） N （ % ） 18G 16G p Class I 0(0%) 0(0%) Class II 0(0%) 3（20%） 0.25 Class III 0(0%) 0(0%) Class IV 2（20%） 3（20%） 1 Class V 0(0%) 2（13.33%） 0.5 Class VI 0(0%) 0(0%) Class III+V 3（30%） 1（6.67%） 0.267 Class IV+V 5（50%） 6（40%） 0.697 Cite Share Download PDF Status: Published Journal Publication published 12 Aug, 2020 Read the published version in BMC Nephrology → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4409","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":142374,"identity":"8d4ae58c-a9ce-48d5-b8f2-4b89d7dc63bc","order_by":1,"name":"Weiji Xie","email":"","orcid":"","institution":"Second Affiliated Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Weiji","middleName":"","lastName":"Xie","suffix":""},{"id":142375,"identity":"4f89640a-2e1e-48c2-bca1-80af42f9a8bf","order_by":2,"name":"Jing Xu","email":"","orcid":"","institution":"Second Affiliated Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Xu","suffix":""},{"id":142376,"identity":"c9ed40eb-a227-4e7c-a775-1b99d56c7630","order_by":3,"name":"Yi Xie","email":"","orcid":"","institution":"Second Affiliated Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Xie","suffix":""},{"id":142377,"identity":"f2d3b0aa-b26e-4a22-ad30-19bed6d59544","order_by":4,"name":"Zhijun Lin","email":"","orcid":"","institution":"Second Affiliated Hospital of Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zhijun","middleName":"","lastName":"Lin","suffix":""},{"id":142378,"identity":"2c8ce1dd-8d9a-4170-8966-e4230af42bab","order_by":5,"name":"Xiaochang Xu","email":"","orcid":"","institution":"Sun Yat-sen University Sixth Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaochang","middleName":"","lastName":"Xu","suffix":""},{"id":142379,"identity":"8d803f79-84cc-4718-9de2-5065b3b3c802","order_by":6,"name":"Yimin Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtUlEQVRIiWNgGAWjYDACZgaGA0AkB2IfeECKFmOwlgQS7DqQ2ACiiNJicJw78XDBnzvp88MOPwTaYien20BIy2HeDYdn8DzL3Xg7zQCoJdnY7AAxWngkDudunJ0A0nIgcRtxWgwOpxvOTv9AipaEwwny0jlE2iIJ1nLgsOEG6ZyCAwkGRPiF7/zZzZ95/hyWl5+dvvnDhwo7OYJaFGAKDMAMAwLKQUC+AZ0xCkbBKBgFowAdAAAOiU0Zr+C95gAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Yimin","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2019-08-26 13:50:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.13703/v1","doiUrl":"https://doi.org/10.21203/rs.2.13703/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-020-01987-3","type":"published","date":"2020-08-12T20:35:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":13472740,"identity":"2562c31c-523d-4dad-b770-48f271a8922e","added_by":"auto","created_at":"2021-09-16 21:16:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":302900,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4409/v1/2a63987a-e9e5-4c22-ac59-045e549a631b.pdf"}],"financialInterests":"","formattedTitle":"Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe percutaneous renal biopsy (PRB) is a primary biopsy technique developed by Alwall in 1944 \u003csup\u003e[1]\u003c/sup\u003e and is an important technique for the diagnosis of kidney disease. Gauge of percutaneous renal biopsy needle vary from 14G to 22G\u003csup\u003e [2–5]\u003c/sup\u003e. At present, 16G needle or 18G needle is used for percutaneous renal biopsy in China, but there is still controversy about the effect and safety of 18G and 16G biopsy needles with two different diameters. Therefore, we retrospectively studied the number of glomeruli, adequate sample rates, complication rates, disease spectrum and pathological classification in renal biopsy by using 18G group and 16G group to compare the differences of using biopsy needles.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003e1. Patients\u003c/p\u003e\n\u003cp\u003ePatients were undergoing PRB at the Sixth Affiliated Hospital of Sun Yat-sen University，Department of Nephrology, and the Second Affiliated Hospital of Shantou University Medical College，Department of Nephrology from January 2011 to May 2017. The present study was approved by the ethics committee of the Sixth Affiliated Hospital of Sun Yat-sen University and adhered to the tenets of the Declaration of Helsinki.\u003c/p\u003e\u003cp\u003e2. Instruments and methods\u003c/p\u003e\n\u003cp\u003eApply Pajunk Delta Cut Biopsy System using 16G and 18G biopsy needles. The ultrasound, blood routine examination, liver and kidney function, and blood coagulation function were checked before the puncture. No renal biopsy contraindications were identified.\u003c/p\u003e\n\u003cp\u003eSelection of needle gauge: Prior to February 2015, renal biopsies for the patients with relative contraindications（renal insufficiency, coagulopathy, and small size kidneys （ length≤8cm）) were performed by using 18G biopsy needles, and biopsies for other patients were performed with 16G needle. After February 2015, renal biopsies were performed with 18G biopsy needle only. And we removed the 18G needle cases which used it because of relative contraindications.\u003c/p\u003e\n\u003cp\u003ePatients were asked to urinate before PRB. Under the guidance of ultrasound, the lower right renal pole was selected as the biopsy target, and the patient was prone position. First, disinfection and local anesthesia were performed, then a guide was placed, and the tip of the needle reached the renal capsule to trigger biopsy needle and kidney biopsy. Repeat these operations one more time after drawing. After the operation, the renal biopsy tissue was divided into three sections, which were placed under the light microscope, electron microscope, and fluorescent mirror tube to be preserved for pathological examination. Supine 6~8h after surgery and lying in bed 24h. At the same time, the urine color and pain were recorded and the kidney condition was examined by ultrasonography.\u003c/p\u003e\u003cp\u003e3. Observed indicator\u003c/p\u003e\u003col\u003e\u003cli\u003eThe numbers of glomeruli were recorded in the 18G and 16G groups, and statistically analyses were performed to evaluate whether the numbers of glomeruli between the two groups were statistically different. The number of glomeruli ≥ 10 as a standard of an adequate sample and then a comparison of adequate sample rates between two groups were made. Statistical data are presented as mean value ± standard deviation (SD).\u003c/li\u003e\u003cli\u003eComplications were divided into minor complications and serious complications according to Whittier et al[6, 7].The minor complications were also detected including lumbar or abdominal pain, hematuria, perirenal hematoma as well as serious complications including bleeding requiring surgical intervention or blood transfusion, decline in blood pressure, hemoglobin decline, severe infection etc.\u003c/li\u003e\u003cli\u003eThe pathological diagnosis and pathological classification in group 18G and 16G were compared. Take to revalue Lee classification and Oxford classifications as the standard of IgA nephropathy classification. Take ISN/RPS2003 classification as the standard of lupus nephritis pathological classification.\u003c/li\u003e\u003c/ol\u003e\n\u003cp\u003e4. Statistical Analysis\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using the IBM SPSS Statistic 22. Measurement data are presented as mean value ± standard deviation, and the comparison was analyzed by Mann-Whitney U test. The enumeration data were compared with Fisher’s exact test. When P-value less than 0.05, the difference is statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn this study, a total of 270 patients aged 9~85 years with an average of 40 years met the inclusion criteria and including 152 males and 118 females. In the 18G group, 72 patients including 38 males and 34 females participated, with a mean age of 41±16 years and an average of 41 years. In the 16G group,198 patients including 114 males and 84 females participated, with a mean age of 40±16 years and an average age of 40 years. There were no significant differences in age，sex or BMI between the two groups. The level of serum creatinine, hemoglobin, platelet count, PT, APTT and urinary protein also did not differ significantly from two groups before renal biopsy(Table 1).\u003c/p\u003e\n\u003cp\u003eThe numbers of glomeruli were similar in 18G group relative to 16G group detected by light microscopy(24±11 vs 25± 11, p = 0.265),whereas fewer numbers of glomeruli were detected in 18G group compared with those in 16G group by for immunofluorescence examination (3±2 vs 5±3, P \u0026lt; 0.05)(Table 2).The adequate sample rates of the 18G group and the 16G group were not significantly different (90.28% vs 93.94%, p = 0.298) (Table 2).\u003c/p\u003e\n\u003cp\u003eThe total of complications presented in this study was 12.9%(34/270 individuals) and similarly percentage of complications in the 18G and 16G patients. The incidence of lumbar or abdominal pain in the 18G and 16G patients (4.17% vs 7.07%, p = 0.572), mild gross hematuria (4.17% vs 3.03%, p = 0.729), and the incidence of small hematoma (4.17% vs 1.52%, p = 0.195) were not statistically significant different. In the 16G group, 2 cases of severe complications occurred. One case had severe gross hematuria with the blood transfusion was required, another case had retroperitoneal hematoma required renal artery embolization. Serious complications were not found in the 18G group. In the group that has the 18G needle procedure, there were no serious complications compared with 1.02% in the group with the 16-G needle procedure (0% vs 1.02% ，P = 1) (Table 3).\u003c/p\u003e\n\u003cp\u003eAs for the disease spectrum，the proportion of patients with lupus nephritis in the 18G group was significantly higher than that of the 16G group (16.67% vs7.58%, p \u0026lt;0.05). Proportions of other diseases （minor glomerular abnormalities，renal amyloidosis，Ischemic renal injury，immunotactoid glomerulopathy，idiopathic nodularmesangial sclerosrs，Transplant nephropathy，Thrombotic microvascular disease due to scleroderma，Alport syndrome，and Focal necrotic glomerulonephritis)in the 18G group were lower than that those of the 16G group (1.39% vs 9.6%, p \u0026lt;0.05)(Table 4).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eRenal biopsy has an irreplaceable important role in the diagnosis of kidney disease, treatment options，and the determination of the prognosis of the disease during the clinical work of renal medicine. At present, percutaneous renal biopsy is an essential technique in renal medicine, and the safety and success rates of PRB has been further improved after the introduction of automatic biopsy needles and real-time ultrasound guidance\u003csup\u003e[9–11]\u003c/sup\u003e. Commonly，puncture needle is divided into two categories, namely negative pressure suction needle and cutting needle. However,，the best needle size for the most widely used Tru-Cut needle has not yet established. In China, the most commonly used needle gauge is 16G (diameter 1.65mm, length 22mm or 15mm), and we generally believe that this size meets the requirements of renal pathological diagnosis. In addition, 18G needle（diameter 1.27mm, Length 22mm or 15mm）has been generally used in patients who has relative contraindications（renal insufficiency, coagulopathy, and small size kidneys etc）. It is controversial regarding whether the smaller diameter 18G biopsy needle is also able to meet the requirements of disease diagnosis and reduce the incidence of complications. The purpose of the retrospective analysis in this study is to clarify this issue.\u003c/p\u003e\n\u003cp\u003eThe premise of accurate pathologic diagnosis is to get enough glomeruli such that the glomerular numbers of the 18G- and 16G- group can be compared. It has been reported that 16G had a significant advantage over the 18G needle in terms of the number of acquired glomeruli\u003csup\u003e [12, 13]\u003c/sup\u003e, while in a prospective study of 14G and 16G biopsy needle， Manno et al\u003csup\u003e[14]\u003c/sup\u003efound that there was no significant difference in the number of glomeruli obtained by two biopsies of different diameters. We conducted a retrospective analysis and found that under the light microscope, the numbers of glomeruli count between the two groups not significantly different under the same puncture method described by Manno\u003csup\u003e[14]\u003c/sup\u003e.Under the immunofluorescence examination, the glomeruli count of the 16G group was slightly higher than that of the 18G group. In general, at least 10 intact glomeruli are required for a specimen assessment \u003csup\u003e[15]\u003c/sup\u003e.Therefore, we set a standard for the samples to obtain accurate result，such as number of glomeruli has to be more than≥ 10 and the adequate sample rates have to be compared between two group. We found that the adequate sample rates of 18G group and 16G group was not significant different. Thus, there is no obvious difference between the two groups in the number of glomeruli.\u003c/p\u003e\n\u003cp\u003eThe pathological diagnosis of renal disease depends on the quality of the acquired specimen. When the number of glomeruli in pathological specimens is not enough, it may affect the diagnosis of the renal disease or classification of some diseases, resulting in misdiagnosis. For example, FSGS is characterized by focal segmental distribution and is easily missed in the presence of fewer glomeruli. Therefore, to diagnose a focal disease，greater than 20 glomeruli may be needed\u003csup\u003e[7]\u003c/sup\u003e. But membranous nephropathy requires only one glomerulus to diagnose\u003csup\u003e [12]\u003c/sup\u003e. Generally, 16G needle biopsy of renal pathological diagnosis can meet the requirements. In the current study，using pathological diagnosis of group 16G distribution as a standard, we did a comparative analysis of the pathological diagnosis of 18G and 16G needle proportion to assess the impact of the two different needles on the pathological diagnosis and pathological classification. We statistically analyzed the disease spectrum between the two groups and found that the incidence of lupus nephritis was 16.67% in the 18G group, which was much higher than that in the group 16G (7.58%). IgAN, MN, MCD, lupus nephritis, diabetic nephropathy, FSGS, MsPGN, crescentic glomerulonephritis, acute tubulointerstitial injury, hypertension nephropathy, chronic sclerosing glomerulonephritis, endocapillary proliferative glomerulonephritis，and anaphylatic purpura nephritis was found to be in equal proportions in the two groups，whereas the proportion of other rare diseases in the 18G group was smaller than that in the 16G group (Table 4). Because lupus nephritis requires diagnosis in combination with clinical, laboratory, or pathological findings and does not rely solely on pathological diagnosis，our results suggest that the size of the needle may have no significant effect on lupus diagnosis.\u003c/p\u003e\n\u003cp\u003eIt is most frequent biopsy finding in the China is IgA nephropathy, marking up 36.3% of all primary glomerulopathies\u003csup\u003e[23]\u003c/sup\u003e. However, the number of glomeruli may affect classification of IgA nephropathy including Lee and Oxford classifications. Therefore, the difference in the proportion of different classification of IgA nephropathy is most likely related to the small sample size, which may be related to the size of the needle. In order to further analyze the influence of needle size on diagnosis of pathological classification, we comparatively analyzed the pathological classification in the 18G and 16G group (Table 5,6). The proportion of IgA nephropathy Lee grade IV was higher in the 18G group than that in the 16G group ( 48.00%vs24.19%, P \u0026lt; 0.05),whereas there was no significant difference in the proportion of other IgA nephropathy pathological classification between two groups. Similarly, we have chosen the new Oxford classification(MEST-C) which was published in 2017 that added to cellular/fibrocellular crescents score, compared with the older Oxford classification(MEST) which was published in 2009. The results reveal that the proportion of Oxford classifications(MEST-C)of IgA nephropathy of segmental glomerulosclerosis was higher in the 18G group than that in the 16G group（52%vs24.59%, P＜0.05), whereas there was no significant difference in the proportion of other IgA nephropathy pathological index between two groups. Furthermore, we evaluate the size of the needle whether effect lupus nephritis classification and the result show that there was no significant difference in the ratio of lupus nephritis classification between two group. Considering the glomerular count and adequate sample rates of the 18G group and the 16G group, we suggest that the change in needle gauge is not a major cause of change in the proportion of IgA nephropathy in the two groups. In conclusion, through statistical analysis, our results strongly suggest that 18G needle with smaller diameter has no significant impact on the diagnosis and pathological classification of renal diseases.\u003c/p\u003e\n\u003cp\u003eComplications of renal needle biopsy include gross hematuria, lumbar abdominal pain, perirenal hematoma, arteriovenous fistula, infection etc\u003csup\u003e[16]\u003c/sup\u003e,with bleeding the most common complication\u003csup\u003e[17]\u003c/sup\u003e. Most of these complications are not intervened, but severe complications requiring surgical intervention is rare. The incidence of serious complications is about 1 to 7%\u003csup\u003e[6, 14, 18, 19]\u003c/sup\u003e, and 0.1% of patients died of renal biopsy\u003csup\u003e[20]\u003c/sup\u003e. A question that needs to be addressed in the field is whether it is possible to use a needle with smaller diameter for PRB to reduce postoperative complications. The correlation between the diameter of needle and the incidence of postoperative complications remains controversial. Corapi et al\u003csup\u003e[21]\u003c/sup\u003efound that the greater the risk of puncture needle bleeding was higher than that of small diameter puncture needle. Peters et al\u003csup\u003e[13]\u003c/sup\u003e concluded that 16G needle was superior to 18G in the quality of sampling and postoperative complications. Roth and Mai J et al\u003csup\u003e[17, 22] \u003c/sup\u003epointed out that the incidence of postoperative complications was similar in 16G group and 18G group. In our study, abdominal pain, gross hematuria, and perirenal hematoma were common complications of renal biopsy. Notably, there were two case of severe complications in the 16G group. Because the complication rate is relatively rare, the research between the two groups of mild complications and the incidence of serious complications did not show statistically significant difference.\u003c/p\u003e\n\u003cp\u003eTaken together, 16G biopsy needle has no obvious advantage over 18G needle by comparing the number of glomeruli and the adequate sample rate, and the smaller diameter 18G needle do not affect the diagnosis of the disease. Therefore, 18G needle has the same application value as 16G needle.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eFunding:\u003c/b\u003e This study was funded by the Science and Technology Program of Guangdong Province grant 2016A090922005.\u003c/p\u003e\n\u003cp\u003e\u003cb\u003eConflict of interest：\u003c/b\u003eThe authors declared that they have no conflicts of interest to this work.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e[1]ALWALL N. Aspiration biopsy of the kidney, including i.a. a report of a case of amyloidosis diagnosed through aspiration biopsy of the kidney in 1944 and investigated at an autopsy in 1950. Acta Med Scand. 1952. 143(6): 430–5.\u003c/p\u003e\n\u003cp\u003e[2]Chunduri S, Whittier WL, Korbet SM. Adequacy and complication rates with 14- vs. 16-gauge automated needles in percutaneous renal biopsy of native kidneys. Semin Dial. 2015. 28(2): E11–4.\u003c/p\u003e\n\u003cp\u003e[3]Nicholson ML, Wheatley TJ, Doughman TM, et al. A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int. 2000. 58(1): 390–5.\u003c/p\u003e\n\u003cp\u003e[4]Song JH, Cronan JJ. Percutaneous Biopsy in Diffuse Renal Disease: Comparison of 18- and 14-gauge Automated Biopsy Devices ☆. Journal of Vascular \u0026amp; Interventional Radiology. 1998. 9(4): 651–655-.\u003c/p\u003e\n\u003cp\u003e[5] Ocak S, Duplaquet F, Jamart J, et al. Diagnostic Accuracy and Safety of CT-Guided Percutaneous Transthoracic Needle Biopsies: 14-Gauge versus 22-Gauge Needles. J Vasc Interv Radiol. 2016. 27(5): 674–81.\u003c/p\u003e\n\u003cp\u003e[6]Whittier WL, Korbet SM. Timing of complications in percutaneous renal biopsy. Journal of the American Society of Nephrology Jasn. 2004. 15(1): 142-.\u003c/p\u003e\n\u003cp\u003e[7]Whittier WL. Complications of the Percutaneous Kidney Biopsy. Adv Chronic Kidney Dis. 2012. 19(3): 179-.\u003c/p\u003e\n\u003cp\u003e[8]Weening J, D’Agati V, Schwartz M, et al. International Society of Nephrology Working Group on the Classification of Lupus Nephritis; Renal Pathology Society Working Group on the Classification of Lupus Nephritis. The classification of glomerulonephritis in systemic lupus erythematosus revisited. 2004: -.\u003c/p\u003e\n\u003cp\u003e[9]Birnholz JC. An improved technique for ultrasound guided percutaneous renal biopsy. Kidney Int. 1985. 27(1): 80-.\u003c/p\u003e\n\u003cp\u003e[10]Ahmed AM, Anees M, Riaz A, Mueed S. Percutaneous renal biopsy by automated biopsy gun. J Coll Physicians Surg Pak. 2003. 13(5): 263–6-.\u003c/p\u003e\n\u003cp\u003e[11]Lübbers H, Mahlke R, Haake C, Lankisch PG. A new fine needle for easier, single handed, ultrasound-guided biopsies, requiring less advancing forces into solid organs. Z Gastroenterol. 1993. 31(9): 484-.\u003c/p\u003e\n\u003cp\u003e[12]Arora K, Punia RS, D’Cruz S. Comparison of diagnostic quality of kidney biopsy obtained using 16G and 18G needles in patients with diffuse renal disease. Saudi J Kidney Dis Transpl. 2012. 23(1): 88–92.\u003c/p\u003e\n\u003cp\u003e[13]Peters B, Mölne J, Hadimeri H, Hadimeri U, Stegmayr B. Sixteen Gauge biopsy needles are better and safer than 18 Gauge in native and transplant kidney biopsies. Acta Radiol. 2017. 58(2): 240–248.\u003c/p\u003e\n\u003cp\u003e[14]Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004. 66(4): 1570–7.\u003c/p\u003e\n\u003cp\u003e[15]Racusen LC, Solez K, Colvin RB, et al. The Banff 97 working classification of renal allograft pathology. Kidney Int. 1999. 55(2): 713–23.\u003c/p\u003e\n\u003cp\u003e[16]Wang C, Yang Y, Jin L, et al. Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience. J Nephrol. 2015. 28(6): 691–700.\u003c/p\u003e\n\u003cp\u003e[17]Roth R, Parikh S, Makey D, et al. When size matters: diagnostic value of kidney biopsy according to the gauge of the biopsy needle. Am J Nephrol. 2013. 37(3): 249–54.\u003c/p\u003e\n\u003cp\u003e[18]Korbet SM. Nephrology and the Percutaneous Renal Biopsy: A Procedure in Jeopardy of Being Lost Along the Way. Clinical Journal of the American Society of Nephrology Cjasn. 2012. 7(10): 1545–7-.\u003c/p\u003e\n\u003cp\u003e[19]Maixnerova D, Jancova E, Skibova J, et al. Nationwide biopsy survey of renal diseases in the Czech Republic during the years 1994–2011. J Nephrol. 2015. 28(1): 39–49-.\u003c/p\u003e\n\u003cp\u003e[20]Weening JJ, Jennette JC. Historical milestones in renal pathology. Virchows Arch. 2012. 461(1): 3–11-.\u003c/p\u003e\n\u003cp\u003e[21]Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis. 2012. 60(1): 62–73.\u003c/p\u003e\n\u003cp\u003e[22]Mai J, Yong J, Dixson H, et al. Is bigger better? A retrospective analysis of native renal biopsies with 16 Gauge versus 18 Gauge automatic needles. Nephrology (Carlton). 2013. 18(7): 525–30.\u003c/p\u003e\n\u003cp\u003e[23] Xu X, Wang G, Chen N, et al. Long-Term Exposure to Air Pollution and Increased Risk of Membranous Nephropathy in China. J Am Soc Nephrol. 2016. 27(12): 3739–3746.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 1 Baseline demographic and laboratory features in the 18G and 16G groups\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 4.65pt; border-collapse: collapse;\" width=\"581\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 13.6pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 13.6pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 13.6pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 13.6pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 13.6pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ep\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eMale\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e38（53%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e114（58%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eFemale\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e34（47%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e84（42%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.482\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eAge\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e41\u0026plusmn;16\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e40\u0026plusmn;16\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.756\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eCreatinine(\u0026mu;mol/L)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e255\u0026plusmn;242\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e216\u0026plusmn;316\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.11\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eHemoglobin(g/L)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e116\u0026plusmn;28\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e118\u0026plusmn;26\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.394\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ePlatelets number(*10E9/L)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e231\u0026plusmn;82\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e248\u0026plusmn;88\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.084\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ePT\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e12\u0026plusmn;1.8\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e13\u0026plusmn;1.2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.279\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eAPTT\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e28\u0026plusmn;5.5\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e29\u0026plusmn;4.7\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.466\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eProteinuria (g/24 hr)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e3.3\u0026plusmn;4.3\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e3.2\u0026plusmn;4.2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.821\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 12.85pt;\"\u003e\n\u003ctd style=\"width: 104.5pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 151.15pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"202\"\u003e\n\u003cp\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp;4.73\u0026plusmn;5.19\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 120.05pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"160\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e23.71\u0026plusmn;4.29\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 60.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 12.85pt;\" width=\"80\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.991\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: left; text-indent: 15.0pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003ePT, \u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eprothrombin time; APTT, Activated Partial Thromboplastin Time\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 2\u0026nbsp;\u0026nbsp; Adequacy of renal biopsy\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 50.65pt; border-collapse: collapse;\" width=\"443\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.45pt;\"\u003e\n\u003ctd style=\"width: 114.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" colspan=\"2\" width=\"152\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" colspan=\"2\" width=\"128\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79.55pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 42.55pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"57\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003eP\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.45pt;\"\u003e\n\u003ctd style=\"width: 107.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"143\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003eLM\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.85pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" colspan=\"3\" width=\"137\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e24\u0026plusmn;11\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79.55pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e25\u0026plusmn;11\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 42.55pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"57\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e0.265\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.45pt;\"\u003e\n\u003ctd style=\"width: 107.15pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"143\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003eIF \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.85pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" colspan=\"3\" width=\"137\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e3\u0026plusmn;2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 79.55pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"106\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e5\u0026plusmn;3\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 42.55pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.45pt;\" width=\"57\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e0.003\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 15.25pt;\"\u003e\n\u003ctd style=\"width: 107.15pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 15.25pt;\" width=\"143\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003eLM \u0026ge;10\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 15.25pt;\" colspan=\"2\" width=\"128\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003e65\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e（\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e90.28%\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e）\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 1.2in; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 15.25pt;\" colspan=\"2\" width=\"115\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003e186\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e（\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e93.94%\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e）\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 42.55pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 15.25pt;\" width=\"57\"\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"font-size: 10pt; line-height: 150%; font-family: verdana, geneva; color: #000000;\"\u003e0.298\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"border: none;\" width=\"143\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"9\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"119\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"9\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"106\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd style=\"border: none;\" width=\"57\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003eLM:\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e Light microscopy glomeruli count; IF: Immunofluorescence microscopy glomeruli count\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 3 Comparative analysis of biopsy complications N(%)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 4.65pt; border-collapse: collapse;\" width=\"561\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ep\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eMinor complications\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u0026nbsp; lumbar or abdominal pain\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（4.17%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e14（7.07%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.572\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u0026nbsp; gross hematuria\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（4.17%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e6（3.03%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.704\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"223\"\u003e\n\u003cp style=\"margin-left: 16.5pt; text-align: left; text-indent: -16.5pt;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u0026nbsp; perinephric hematoma without symptoms\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（4.17%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（1.52%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.195\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eserious complications\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0(0%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（1.02%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eTotal complications\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e9(12.5%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e25(12.63%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 167.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"223\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eTotal number\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 88.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"117\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e72\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 113.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"151\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e198\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 53.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"71\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 4 Comparative analysis of\u003c/strong\u003e\u003cstrong\u003e disease spectrum\u0026nbsp; N(%)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 4.65pt; border-collapse: collapse;\" width=\"621\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e \u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ep\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eIgA nephropathy\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e25（34.72%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e62（31.31%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.659\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eMembranous nephropathy\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e12（16.67%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e42（21.21%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.493\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eMinimal change disease\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（4.17%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e20（10.10%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.145\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eLupus Nephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e10（16.67%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e15（7.58%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.038\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eDiabetic nephropathy\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e5（6.94%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e10（5.05%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.554\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eFSGS\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（2.78%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e8（4.04%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eMesangial proliferative glomerulonephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（1.39%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e6（3.03%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.679\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eCrescentic glomerulonephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e4（5.56%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（1.52%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.084\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eAcute tubulointerstitial injury\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（2.78%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e7（3.54%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eHypertension\u0026nbsp;nephropathy\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（2.78%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（0.51%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.174\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eChronic sclerosing glomerulonephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e3（4.17%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（1.01%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.12\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;Endocapillary\u0026nbsp;proliferative\u0026nbsp;glomerulonephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（1.39%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e2（1.01%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eAnaphylatic purpura nephritis\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（1.39%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（0.51%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.463\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 158.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"211\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eOthers*\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"139\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e1（1.39%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e19（9.6%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102.0pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"136\"\u003e\n\u003cp style=\"text-align: left;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.019\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"text-align: left; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003e*Others\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e：\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eminor glomerular abnormalities\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003erenal amyloidosis\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eIschemic renal injury\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eimmunotactoid glomerulopathy\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eidiopathic nodularmesangial sclerosrs\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eTransplant nephropathy\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eThrombotic microvascular disease due to scleroderma\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eAlport syndrome\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e，\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eFocal necrotic glomerulonephritis.\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 5 Comparative analysis of IgAN classification\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eSMK Lee Classifications\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003e N(%)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 39.55pt; border-collapse: collapse;\" width=\"449\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ep\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003eGradeⅠ\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003eGradeⅡ\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e7（11.29%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.185\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003eGradeⅢ\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e8（32%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e26（41.94%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.471\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003eGradeⅣ\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e12（48%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e15（24.19%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.041\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003eGradeⅤ\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e5（20%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e14（22.58%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp style=\"text-align: center; text-indent: 21.1pt; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE \u003c/strong\u003e\u003cstrong\u003e6 Comparative analysis of IgAN classification\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eOxford classifications*,2017\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003e N(%)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 39.55pt; border-collapse: collapse;\" width=\"449\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e16G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003ep\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eM1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e25(100%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e61(100%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eE1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e7(28%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e25（40.98%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.329\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 13.5pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eS1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e13（52%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e15（24.59%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 13.5pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.022\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eT1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e7（28%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e9（14.75%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.221\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eT2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e4（16%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e12（19.67%）\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.77\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eC1\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e4(16%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e8(13.11%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.739\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 80.95pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"108\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003eC2\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 69.05pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"92\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e3(12%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 127.7pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"170\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e10(16.39%)\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 59.3pt; border: none; border-bottom: solid windowtext 1.0pt; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"79\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e0.748\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cspan style=\"line-height: 150%;\"\u003e*\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003eThe Oxford classification consisted of mesangial hypercellularity (M0, mesangial score \u0026le; 0.5; M1, mesangial score \u0026gt; 0.5), endocapillary hypercellularity (E0, absent; E1,present), segmental glomerulosclerosis (S0, absent; S1, present), tubular atrophy/interstitial fibrosis (T0, \u0026le;25%; T1, 26%-50%; T2, \u0026gt;50%), and cellular/fibrocellular crescents(C0,absent; C1,\u0026lt;25%; C2,\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e\u0026ge;\u003c/span\u003e\u003cspan style=\"line-height: 150%;\"\u003e25%)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"text-align: center; line-height: 150%;\"\u003e\u003cspan style=\"color: #000000; font-family: verdana, geneva; font-size: 10pt;\"\u003e\u003cstrong\u003eTABLE 7\u0026nbsp; Comparative analysis of Lupus Nephritis classification\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eThe ISN/RPS classification,2003\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003cstrong\u003e N\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable style=\"margin-left: 4.65pt; border-collapse: collapse;\" width=\"571\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 14.25pt;\"\u003e\n\u003ctd style=\"width: 151.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"201\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 71.0pt; border-top: solid windowtext 1.0pt; border-left: none; border-bottom: solid windowtext 1.0pt; border-right: none; padding: 0in 5.4pt 0in 5.4pt; height: 14.25pt;\" width=\"95\"\u003e\n\u003cp style=\"text-align: center;\"\u003e\u003cspan style=\"font-size: 10pt; font-family: verdana, geneva; color: #000000;\"\u003e18G\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 104.0pt; border-top: solid windowtext 1.0pt; border-left: none; 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font-family: verdana, geneva; color: #000000;\"\u003e0.697\u003c/span\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"percutaneous, renal biopsy, needles, complication, adequacy","lastPublishedDoi":"10.21203/rs.2.13703/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.13703/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAim: The study aims to compare the adequacy, complication and pathological classification rates of using 18G vs. 16G needles to perform renal biopsy with ultrasound-guided on native kidneys in Chinese. Methods: We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients who were used by 18G or 16G needles separately from January, 2011 to May, 2017，and verified whether the needle gauge affect the diagnosis of the disease. Results: A total of 270 kidney biopsies were performed. Among them :72 were with 18G needles, and 198 were with16G needles. There was no difference in the number of glomeruli count under light microscope using 18G relative to 16G needles（24±11vs25±11，p=0.265）, whereas more glomeruli count were found for the 16G group using immunofluorescence microscopy(3±2 vs 5±3， p＜0.05).There was no significant difference in the adequate sample rates between 18G group and 16G group (90.28%vs93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs 7.07%, p = 0.57), gross hematuria (4.17% vs 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs1.52%, p = 0.195) were not significantly different for 18G vs 16G group. In 16G group, there was 2 cases of serious complications occurred, including severe gross hematuria requiring blood transfusion, and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, even although there was no significant difference in serious complications rates between the 18G and 16G group (0% vs 1.02%，p = 1). Conclusion: There was no significant difference in the number of glomeruli, adequate sample rates, and complication rates of using the 18G and 16G needles to perform renal biopsy, and the 18G needle with smaller diameter did not affect the pathological diagnosis and classification of IgA nephropathy and lupus nephritis.\u003c/p\u003e","manuscriptTitle":"Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-08-31 01:29:57","doi":"10.21203/rs.2.13703/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0079edf-b1fe-426f-a701-1b2f2e75aad7","owner":[],"postedDate":"August 31st, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":23554,"name":"Urology \u0026 Nephrology"}],"tags":[],"updatedAt":"2021-07-22T20:35:56+00:00","versionOfRecord":{"articleIdentity":"rs-4409","link":"https://doi.org/10.1186/s12882-020-01987-3","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2020-08-12 20:35:56","publishedOnDateReadable":"August 12th, 2020"},"versionCreatedAt":"2019-08-31 01:29:57","video":"","vorDoi":"10.1186/s12882-020-01987-3","vorDoiUrl":"https://doi.org/10.1186/s12882-020-01987-3","workflowStages":[]},"version":"v1","identity":"rs-4409","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-4409","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}