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rsrapport for Hematuria

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					The Norwegian Kidney Register/National Center in Nephropathology
         Department of Medicine/Department of Pathology
                  Haukeland University Hospital




   Head of the board: Bjarne M. Iversen, professor MD PhD
   Head of pathology: Leif Bostad, associate professor, MD
                                  Annual report 2009
We regret the late arrival of this report which is due to many reasons. On the bright side is the
decline in lacking histological reports to only 21 in 2009. However 73 clinical reports are
missing Most hospitals lack only a few reports but there are some hospitals that have not
filled in the reports for several patients. This may be due to the practice that some
departments, such as rheumatology departments, are ordering kidney biopsy by radiologists
and neither of them are submitting the clinical reports. The local nephrologists should
probably be more involved in this process.
It is still possible to include clinical and morphological data from patients having biopsies in
earlier years making the registry more complete. At the end of 2009, we have nearly 11000
biopsies in the registry and as reported previously, our registry is the oldest active database in
Europe.

The frequency of renal biopsies is still increasing, and the number of renal biopsies per
inhabitant is fairly equal in region Sør-Øst, region Vest and region Midt Norge, while it is
lower in Region Nord. However, some reports from Region Nord are lacking which may
explain the slight difference. It is nice to see that the renal biopsy policy is getting more
uniform in Norway. Ullevål University Hospital has the highest number of renal biopsies in
2009, followed by Rikshospitalet.

The different diagnosis, clinical indications for biopsies are given in the report and the total
number of biopsies as well as the lacking reports are also notified.

Like the last previous years an increasing number of older patients had a renal biopsy. The
biopsy procedure is safe in these patients, but the risk is slightly higher than in young patients.
The overall frequency of complications is low (Page 38-42). There was no cases that needed
surgical intervention following the biopsy, but 5 patients had blood transfusion. .

The registry has got funding to purchase a digital slide scanner (2.1 mill from Mohn
foundation) In collaboration with IKT from Helse Vest and Helse Bergen we have applied for
750 000 kr to operate the system. We intend to buy the slide scanner in the first part of 2011
and to start scanning histological sections from renal biopsies in the second part of 2011. This
has been a difficult and time consuming process that seems to come to an end during the
spring. We plan to integrate the digitalising system with the diagnostic biopsy data base at the
Dpt. of Pathology and hopefully every hospital can get access to their own data when the
“firewall” between regions will be less restrict than it is today. The digitalised renal biopsy
will facilitate teleconferences, consultations, clinical work, education, and research and
improve collaboration between hospitals
Research
Knut Aasarød is still together with several others nephrologists and in collaboration with Leif
Bostad working on a study on renal SLE in a large cohort in Norway. Rune Bjørneklett is
working on IgA nephropathy and will probably finish this work in 2011. Dr.med. Tale
Nordbye Wien, “Nasjonalt Kunnskapsenter for helsetjenesten” will work on a program related
to amyloidosis in the registry. Bjørn Egil Vikse has a large numbers of works on renal disease
and preeclampsia. Studies using proteomics techniques are going on well on experimental
tissue, and can now proceed to human tissue. He has also got a fairly big amount of money to
continue this work. Einar Svarstad, Camilla Tøndel and Leif Bostad are working on Fabrys
disease. Camilla Tøndel is nearly finishing an in depth study of all complications after renal
biopsies since we started the registry in 1988. Kristin Sæle has done a great study on the value
of taking renal biopsies in elderly patients. She needs now to write up the findings.


Administration
Bjarne M.Iversen retired as head of the board from 1/1-11 and Bjørn Egil Vikse is taking his
position. Leif Bostad is a board member and head of the pathology service of the registry.
Anders Hartmann, Knut Aasarød are in the board of the registry as members from the
Norwegian Society of Nephrology, while the Society of Pathology is represented by
Harald Aarset.

The present report has been performed mainly by Else Reimers, the secretary of the
Norwegian Kidney Registry. We are grateful for her skilled collaboration




Leif Bostad                                         Bjarne M.Iversen
Associate professor, MD                            Professor MD, PhD
I Clinical                                                         Number   Number in %

                     Total number of renal biopsies                 633
                     Biopsies lacking clinical form                  73        11,5

Diagnosis            Hematuria                                      217        38,8
                     Hematuria with protenuria<3g/24h                10        1,8
                     Nefrotic syndrom with proteinuria >3g/24h      21         3,8
                     Chronical renal failure                        180        32,1
                     Hypertension BP >140/90                         98        17,5
                     SLE                                            23         4,1

                     Creatinine > 200                               170        30,4
                     Creatinine < 200                               383        68,4

Complications        Non complications                              465        96,1
                     Macroscopical hematuria                        14         2,9
                     Blood transfusion                               5          1,0
                     Surgical intervention                           0          0,0


II Morphology
                     Total number of renal biopsies                 633
                     Biopsies lacking histopathological form        21          3,3

Qality of biopsies   Register pathologist: sufficient material      280        80,5
                     Register pathologist: insufficient material    68         19,5
                     Local pathologist: sufficient material         536        95,2
                     Local pathologist: insufficient material        27         4,8

Diagnosis            Minimal change                                 30         4,9
                     Membranoproliferative GN                        9         1,5
                     Focal segmental sclerosis                       42         6,9
                     Benign nephrosclerosis                         236        38,6
                     Malign nephrosclerosis                          3         0,5
                     Membranous GN                                  44         7,2

                     Mesangioproliferative GN                       132        21,6
                     Mesangioproliferative GN with IgA              78         12,7
                     Mesangioproliferativ GN without IgA            54         8,8
                     Mesangioproliferative GN with SLE               0          0,0

                     Endocap proliferative GN                         4         0,7
                     Cresentic GN                                    17         2,8
                     Diabetic nephropathy                            49         8,0

                     Amyloidosis                                     16         2,6
                     Diffus prol.Lupusnephritis(IV)                   9         1,5

                     Congenital nephropathy                          30         4,9
                     Monoclonal Ig deposition disease                18         2,9
                     Cryoglobulinemia with GN                         0         0,0
    Alphabetical index                                                                 Page

A
    Age and gender, total biopsies                                                       13
C                                                                                        17
    Clinical biopsy indication at different hospitals
    Clinical biosy                                                                       14
    Clinical indication for a renal biopsy (%)                                           15
    Clinical indication in different regions                                             16
    Clinical indications and morphology                                                  26
    Complications to renal biopsy and who performed it                                   40
    Complications to renal biopsy performed by nephrologist                              41
    Complications to renal biopsy performed by radiologist                               42
    Complicatons to renal biopsies                                                       38
    Complicatons to renal biopsies (%)                                                   39
M
    Morphology                                                                           20
    Morphology at different hospitals                                                    25
    Morphology in patients with chronical renal failure                                  30
    Morphology in patients with creatinine <200                                          33
    Morphology in patients with creatinine>200                                           32
    Morphology in patients with Hematuria                                                28
    Morphology in patients with Hematuria and proteinuria <3G/24H                        29
    Morphology in patients with hypertension BP>140/90                                   31
    Morphology in patients with SLE                                                      34
    Morphology in patients with the Nefrotic Syndrome and proteinuria >3g/24H            27
    Morphology, % of all                                                                 21
N
    Number of clinical forms lacking at different hospitals                               5
    Number of histopathological forms lacking at different hospitals                      6
    Number of renal biopsies among different hospitals                                   11
    Number of renal biosies/100000 inhabitans                                            10
    Number of renal biopsies in 2005                                                      2

R
    Renal biopsies in different regions                                                   7
    Renal biopsies in different regions, related to gender                                8
    Renal biopsy in different regions, by age                                             9
    Renal morphology, local pathologist                                                  18
    Renal morphology, register pathologist                                               19
    Renal pathology in different regions                                             22- 23 - 24
S
    SLE based on clinical form information and on Diffus.prol. Lupusnephritis (IV)       35
T
    Total number of clinical forms lacking at different hospitals                         3
    Total number of histopathological forms lacking at different hospitals                4
    Total number of renal biopsies in males and females                                  12
    Total number of biopsies in The Norwegian Kidney Register                             1

W
    Who performed the renal biopsy in Norway                                             36
    Who performed the renal biopsy at different hospitals                                37
              Total number of biopsies in The Norwegian Kidney Register


  12000




  10000




    8000




    6000




    4000




    2000




       0
              Total number of renal biopsies   Lacking clinical forms   Lacking histopathological forms




Total number of renal biopsies                  10638
Lacking clinical forms                           885
Lacking histopathological forms                 2080




                                                                                                          -1-
                                       Number of renal biopsies 2009


  700




  600




  500




  400




  300




  200




  100




     0
            Total number of renal biopsies       Lacking clinical forms   Lacking histpopathological forms




Total number of renal biopsies                        633
Lacking clinical forms                                73
Lacking histpopathological forms                      21




                                                                                                             -2-
                                                                      Total number of clinical forms lacking at different hospitals

  250



  200



  150



  100



   50



    0
        Akershus Universitetssykehus

                                       Fylkessjukehuset i Haugesund

                                                                      Førde Sentralsjukehus

                                                                                              Haukeland Universitetssykehus

                                                                                                                              Kristiansund sykehus

                                                                                                                                                     Molde sjukehus

                                                                                                                                                                      Nordlandssykehuset

                                                                                                                                                                                           Rikshospitalet

                                                                                                                                                                                                            Ringerike sjukehus

                                                                                                                                                                                                                                 St.Olavs Hospital

                                                                                                                                                                                                                                                     Stavanger Universitetssykehus

                                                                                                                                                                                                                                                                                     Stord sjukehus

                                                                                                                                                                                                                                                                                                      Sykehuset Buskerud

                                                                                                                                                                                                                                                                                                                           Sykehuset Innlandet, Elverum

                                                                                                                                                                                                                                                                                                                                                          Sykehuset Innlandet, Lillehammer

                                                                                                                                                                                                                                                                                                                                                                                             Sykehuset Levanger

                                                                                                                                                                                                                                                                                                                                                                                                                  Sykehuset Telemark

                                                                                                                                                                                                                                                                                                                                                                                                                                       Sykehuset Østfold, Fredrikstad

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Sykehuset Østfold, Sarpsborg

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Sørlandet Sykehus, Arendal

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sørlandet Sykehus, Kristiansand

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Ullevål Universtetssykehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Universitetssykehuset Nord-Norge

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Vestfold Sentralsykehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Volda sjukehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Ålesund sjukehus
Hospital                                                                                                                                                                                                                                                                                                         Number
Akershus Universitetssykehus                                                                                                                                                                                                                                                                                       118
Fylkessjukehuset i Haugesund                                                                                                                                                                                                                                                                                       46
Førde Sentralsjukehus                                                                                                                                                                                                                                                                                               0
Haukeland Universitetssykehus                                                                                                                                                                                                                                                                                       9
Kristiansund sykehus                                                                                                                                                                                                                                                                                                7
Molde sjukehus                                                                                                                                                                                                                                                                                                      2
Nordlandssykehuset                                                                                                                                                                                                                                                                                                 16
Rikshospitalet                                                                                                                                                                                                                                                                                                     86
Ringerike sjukehus                                                                                                                                                                                                                                                                                                  1
St.Olavs Hospital                                                                                                                                                                                                                                                                                                  82
Stavanger Universitetssykehus                                                                                                                                                                                                                                                                                       6
Stord sjukehus                                                                                                                                                                                                                                                                                                     28
Sykehuset Buskerud                                                                                                                                                                                                                                                                                                 232
Sykehuset Innlandet, Elverum                                                                                                                                                                                                                                                                                       28
Sykehuset Innlandet, Lillehammer                                                                                                                                                                                                                                                                                   48
Sykehuset Levanger                                                                                                                                                                                                                                                                                                  0
Sykehuset Telemark                                                                                                                                                                                                                                                                                                  8
Sykehuset Østfold, Fredrikstad                                                                                                                                                                                                                                                                                     19
Sykehuset Østfold, Sarpsborg                                                                                                                                                                                                                                                                                        0
Sørlandet Sykehus, Arendal                                                                                                                                                                                                                                                                                         19
Sørlandet Sykehus, Kristiansand                                                                                                                                                                                                                                                                                    17
Ullevål Universtetssykehus                                                                                                                                                                                                                                                                                         14
Universitetssykehuset Nord-Norge                                                                                                                                                                                                                                                                                   64
Vestfold Sentralsykehus                                                                                                                                                                                                                                                                                             8
Volda sjukehus                                                                                                                                                                                                                                                                                                     16
Ålesund sjukehus                                                                                                                                                                                                                                                                                                   11
                 Total                                                                                                                                                                                                                                                                                             885


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    -3-
                                                                                                                                                     Total number of histopathological forms
                                                                                                                                                           lacking at different hospitals

  300



  250


  200



  150


  100


   50



    0
        Akershus Universitetssykehus

                                       Fylkessjukehuset i Haugesund

                                                                      Førde Sentralsjukehus

                                                                                              Haukeland Universitetssykehus

                                                                                                                              Kristiansund sykehus

                                                                                                                                                     Molde sjukehus

                                                                                                                                                                      Nordlandssykehuset

                                                                                                                                                                                           Rikshospitalet

                                                                                                                                                                                                            Ringerike sjukehus

                                                                                                                                                                                                                                 St.Olavs Hospital

                                                                                                                                                                                                                                                     Stavanger Universitetssykehus

                                                                                                                                                                                                                                                                                     Stord sjukehus

                                                                                                                                                                                                                                                                                                      Sykehuset Buskerud

                                                                                                                                                                                                                                                                                                                           Sykehuset Innlandet, Elverum

                                                                                                                                                                                                                                                                                                                                                          Sykehuset Innlandet, Lillehammer

                                                                                                                                                                                                                                                                                                                                                                                             Sykehuset Levanger

                                                                                                                                                                                                                                                                                                                                                                                                                  Sykehuset Telemark

                                                                                                                                                                                                                                                                                                                                                                                                                                       Sykehuset Østfold, Fredrikstad

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Sykehuset Østfold, Sarpsborg

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Sørlandet Sykehus, Arendal

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sørlandet Sykehus, Kristiansand

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Ullevål Universtetssykehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Universitetssykehuset Nord-Norge

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Vestfold Sentralsykehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Volda sjukehus

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Ålesund sjukehus
Hospital                                                                                                                                                                                                                                                                   Number
Akershus Universitetssykehus                                                                                                                                                                                                                                                 163
Fylkessjukehuset i Haugesund                                                                                                                                                                                                                                                 10
Førde Sentralsjukehus                                                                                                                                                                                                                                                        29
Haukeland Universitetssykehus                                                                                                                                                                                                                                                170
Kristiansund sykehus                                                                                                                                                                                                                                                          3
Molde sjukehus                                                                                                                                                                                                                                                                9
Nordlandssykehuset                                                                                                                                                                                                                                                           52
Rikshospitalet                                                                                                                                                                                                                                                               236
Ringerike sjukehus                                                                                                                                                                                                                                                            9
St.Olavs Hospital                                                                                                                                                                                                                                                            141
Stavanger Universitetssykehus                                                                                                                                                                                                                                                94
Stord sjukehus                                                                                                                                                                                                                                                                9
Sykehuset Buskerud                                                                                                                                                                                                                                                           137
Sykehuset Innlandet, Elverum                                                                                                                                                                                                                                                 17
Sykehuset Innlandet, Lillehammer                                                                                                                                                                                                                                             156
Sykehuset Levanger                                                                                                                                                                                                                                                           40
Sykehuset Telemark                                                                                                                                                                                                                                                           29
Sykehuset Østfold, Fredrikstad                                                                                                                                                                                                                                               66
Sykehuset Østfold, Sarpsborg                                                                                                                                                                                                                                                  1
Sørlandet Sykehus, Arendal                                                                                                                                                                                                                                                   54
Sørlandet Sykehus, Kristiansand                                                                                                                                                                                                                                              18
Ullevål Universtetssykehus                                                                                                                                                                                                                                                   253
Universitetssykehuset Nord-Norge                                                                                                                                                                                                                                             184
Vestfold Sentralsykehus                                                                                                                                                                                                                                                      128
Volda sjukehus                                                                                                                                                                                                                                                                4
Ålesund sjukehus                                                                                                                                                                                                                                                             68
                 Total                                                                                                                                                                                                                                                      2080

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    -4-
                              Number of clinical forms lacking at different hospitals, 2009


  20


  18


  16


  14


  12


  10


   8


   6


   4


   2


   0
        Universitetssykehus




                              Fylkessjukehuset i


                                                   Kristiansund sykehus


                                                                          Ringerike sykehus


                                                                                              Rikshospitalet


                                                                                                               St.Olavs Hospital


                                                                                                                                      Sykehuset Buskerud



                                                                                                                                                           Sykehuset Innlandet,


                                                                                                                                                                                  Sykehuset Innlandet,


                                                                                                                                                                                                         Sørlandet Sykehus, Arendal


                                                                                                                                                                                                                                      Ullevål Universitetssukehus



                                                                                                                                                                                                                                                                    Universitetssykehuset Nord-


                                                                                                                                                                                                                                                                                                  Ålesund sjukehus
                                 Haugesund




                                                                                                                                                                                     Lillehammer
             Akershus




                                                                                                                                                                Elverum




                                                                                                                                                                                                                                                                               Norge




Total                                                                                                                                73

Hospital                                                                                                                           Number
Akershus Universitetssykehus                                                                                                         10
Fylkessjukehuset i Haugesund                                                                                                         3
Kristiansund sykehus                                                                                                                 2
Ringerike sykehus                                                                                                                    1
Rikshospitalet                                                                                                                       5
St.Olavs Hospital                                                                                                                    11
Sykehuset Buskerud                                                                                                                   1
Sykehuset Innlandet, Elverum                                                                                                         1
Sykehuset Innlandet, Lillehammer                                                                                                     5
Sørlandet Sykehus, Arendal                                                                                                           4
Ullevål Universitetssukehus                                                                                                          8
Universitetssykehuset Nord-Norge                                                                                                     18
Ålesund sjukehus                                                                                                                     4



                                                                                                                                                                                                                                                                                                                     -5-
                      Number of histopathological forms lacking at different hospitals, 2009

                       6



                       5



                       4



                       3



                       2



                       1



                       0




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Total                                         21

Hospital                                   Number
Haukeland Universitetssykehus                1
Nordlandssykehuset                           1
Rikshospitalet                               2
Ringerike sykehus                            1
St.Olavs Hospital                            3
Sykehuset Buskerud                           1
Sykehuset Innlandet, Lillehammer             2
Sykehuset Levanger                           1
Søsrlandet Sykehus, Kristiansand             1
Ullevål Universtetssykehus                   5
Universitetssykehuset Nord-Norge             2
Ålesund sjukehus                             1




                                                                                               -6-
                             Renal biopsies in different regions, 2009

  450



  400



  350



  300



  250



  200



  150



  100



    50



     0
           Region Sør- Øst          Region Vest      Region Midt Norge   Region Nord




Region                Number
Region Sør- Øst         388
Region Vest             135
Region Midt Norge        78
Region Nord              32




                                                                                       -7-
                  Renal biopsies in different regions, male and female, 2009


  450




  400




  350




  300




  250
                                                                                    Male
                                                                                    Female
                                                                                    Total
  200




  150




  100




   50




    0
           Region Sør- Øst          Region Vest   Region Midt Norge   Region Nord




Region                       Male       Female     Total
Region Sør- Øst              221          167       388
Region Vest                   75           60       135
Region Midt Norge             40           38       78
Region Nord                   19           13       32

        Total                355          278       633




                                                                                             -8-
                            Patient age and regions, 2009

90



80



70



60



50



40



30



20



10



 0
     0-9     10 - 19   20 - 29   30 - 39   40 - 49   50 - 59   60 - 69   70 - 79   80 - 89   90 -

                  Region Sør- Øst    Region Vest     Region Midt Norge    Region Nord


 Age       Region Sør- Øst Region Vest           Region Midt Norge       Region Nord
 0-9             11               5                       0                    1
10 - 19          27               14                      8                    2
20 - 29          31               15                     10                    2
30 - 39          56               14                      9                    5
40 - 49          57               18                      9                    3
50 - 59          67               18                     13                    6
60 - 69          77               25                     16                    9
70 - 79          51               18                     10                    1
80 - 89          10               8                       3                    3
 90 -             1               0                       0                    0




                                                                                                    -9-
                    Number of renal biopsies /100000 inhabitans, 2009

  16



  14



  12



  10



   8



   6



   4



   2



   0
         Region Sør- Øst       Region Vest      Region Midt Norge       Region Nord




Region                        Number
Region Sør- Øst                14,3
Region Vest                    13,3
Region Midt Norge              11,6
Region Nord                     6,9




                                                                                      -10-
                                                                                                                     Number of renal biopsies at different hospitals, 2009

  120


  100


   80


   60


   40


   20


    0




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Ullevål Universtetssykehus
                                                                                                                                                                                                                                                                                                                                                                                             Sykehuset Levanger




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Universitetssykehuset Nord-Norge
        Akershus Universitetssykehus




                                                                                              Haukeland Universitetssykehus




                                                                                                                                                                                                                                                    Stavanger Universitetssjukehus
                                       Fylkessjukehuset i Haugesund




                                                                                                                                                                                                                                                                                                      Sykehuset Buskerud




                                                                                                                                                                                                                                                                                                                                                                                                                                       Sykehuset Østfold, Fredrikstad

                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Sykehuset Østfold, Sarpsborg



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sørlandet Sykehus, Kristiansand
                                                                                                                                                                                                                                St.Olavs Hospital




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Sørlandet Sykehus, Arendal
                                                                                                                                                                                                                                                                                                                           Sykehuset Innlandet, Elverum
                                                                                                                                                                      Nordlandssykehuset
                                                                                                                              Kristiansund sykehus

                                                                                                                                                     Molde sjukehus




                                                                                                                                                                                                            Ringerike sykehus




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Vestfold Sentralsykehus
                                                                                                                                                                                           Rikshospitalet
                                                                      Førde Sentralsjukehus




                                                                                                                                                                                                                                                                                     Stord sjukehus




                                                                                                                                                                                                                                                                                                                                                                                                                  Sykehuset Telemark




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Ålesund sjukehus
                                                                                                                                                                                                                                                                                                                                                          Sykehuset Innlandet, Lillehammer




Hospital                                                                                                                                                                                                    Number
Akershus Universitetssykehus                                                                                                                                                                                  30
Fylkessjukehuset i Haugesund                                                                                                                                                                                  12
Førde Sentralsjukehus                                                                                                                                                                                          9
Haukeland Universitetssykehus                                                                                                                                                                                 71
Kristiansund sykehus                                                                                                                                                                                           2
Molde sjukehus                                                                                                                                                                                                 2
Nordlandssykehuset                                                                                                                                                                                             8
Rikshospitalet                                                                                                                                                                                                71
Ringerike sykehus                                                                                                                                                                                             15
St.Olavs Hospital                                                                                                                                                                                             37
Stavanger Universitetssjukehus                                                                                                                                                                                35
Stord sjukehus                                                                                                                                                                                                 8
Sykehuset Buskerud                                                                                                                                                                                            32
Sykehuset Innlandet, Elverum                                                                                                                                                                                  10
Sykehuset Innlandet, Lillehammer                                                                                                                                                                              20
Sykehuset Levanger                                                                                                                                                                                            27
Sykehuset Telemark                                                                                                                                                                                            10
Sykehuset Østfold, Fredrikstad                                                                                                                                                                                34
Sykehuset Østfold, Sarpsborg                                                                                                                                                                                   0
Sørlandet Sykehus, Arendal                                                                                                                                                                                    10
Sørlandet Sykehus, Kristiansand                                                                                                                                                                               31
Ullevål Universtetssykehus                                                                                                                                                                                    98
Universitetssykehuset Nord-Norge                                                                                                                                                                              25
Vestfold Sentralsykehus                                                                                                                                                                                       26
Ålesund sjukehus                                                                                                                                                                                              10
Total                                                                                                                                                                                                         633



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   -11-
      Total number of renal biopsies in males and females, 2009

400



350



300



250



200



150



100



50



 0
                Males                              Females




                                           n=633


      Males             355             (56.1%)
      Females           278             (43.9%)




                                                                  -12-
                                    Age and gender, 2009

140




120




100




 80




 60




 40




 20




  0
      0-9   10 - 19 20 - 29   30 - 39   40 - 49 50 - 59    60 - 69 70 - 79   80 - 89   90 -

                                             Male    Female       Total



 Age            Male            Female                    Total
 0-9              9                8                        17
10 - 19          26               25                        51
20 - 29          30               28                        58
30 - 39          50               34                        84
40 - 49          51               36                        87
50 - 59          58               46                       104
60 - 69          74               53                       127
70 - 79          48               32                        80
80 - 89           9               15                        24
 90 -             0                1                          1




                                                                                              -13-
                                 Cinical indications for a renal biopsy, 2009

        450

        400

        350

        300

        250

        200

        150

        100

         50

          0
                    ia




                                                                                                                  E
                                                                                                            0
                                    h




                                                                                 0




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                                                    h



                                                                  re




                                                                                                         20
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                                                                               /9




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Clinical indication                                                 Number
Hematuria                                                             217
Hematuria with proteinuria <3g/24h                                     10
Nefrotic syndrome with proteinuria >3g/24h                             21
Chronic renal failure                                                 180
Hypertension BP >140/90                                                98
Creatinine > 200                                                      170
Creatinine< 200                                                       383
SLE                                                                    23




                                                                                                                      -14-
                               Clinical indication for a renal biopsy (%), 2009

        80


        70


        60


        50


        40


        30


        20


        10


          0
                     ia




                                                                                                                     E
                                                                                                   0
                                      h




                                                     h




                                                                                    0




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                                                                     re




                                                                                                 20
                                    24




                                                   24




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                  ur




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         N




                                                                                                         n=560

Clinical indication                                                            %
Hematuria                                                                    38,8
Hematuria with proteinuria <3g/24h                                           1,8
Nefrotic syndrome with proteinuria >3g/24h                                    3,8
Chronic renal failure                                                        32,1
Hypertension BP >140/90                                                      17,5
Creatinine > 200                                                             30,4
Creatinine< 200                                                              68,4
SLE                                                                           4,1




                                                                                                                         -15-
                                       Clinical indication in different regions, 2009


  300




  250




  200
                                                                                                                                                                         Region Sør-Øst

                                                                                                                                                                         Region Vest
  150
                                                                                                                                                                         Region
                                                                                                                                                                         Midt Norge
                                                                                                                                                                         Region Nord

  100




   50




    0
          Hematuria




                                            Nefrotic syndrome with




                                                                                             Hypertension BP
                      proteinuria <3g/24h




                                                                                                                Creatinine > 200


                                                                                                                                   Creatinine< 200


                                                                                                                                                           SLE
                                                                     Chronic renal failure
                                             proteinuria >3g/24h
                        Hematuria with




                                                                                                >140/90




                                                                                                               Region                        Region               Region         Region
Clinical indication                                                                                            Sør-Øst                        Vest               Midt Norge       Nord
Hematuria                                                                                                        141                                  45            29                 2
Hematuria with proteinuria <3g/24h                                                                                 5                                  0              4                 1
Nefrotic syndrome with proteinuria >3g/24h                                                                        10                                  1              9                 1
Chronic renal failure                                                                                            122                                 41             13                 4
Hypertension BP >140/90                                                                                          60                                  27              9                 2
Creatinine > 200                                                                                                 110                                 28             25                 7
Creatinine< 200                                                                                                  240                                 101            35                 7
SLE                                                                                                                9                                  6              7                 1




                                                                                                                                                                                           -16-
                      Clinical indications at different hospitals, 2009

           Hematuria                                             Hematuria with proteinuria <3g/24h

           Nefrotic syndrom with proteinuria >3g/24h             Chronical renal failure

           Hypertension BP>140/90                                SLE

           Creatinine >200                                       Creatinine < 200



               Ålesund sjukehus


                  Volda sjukehus


         Vestfold Sentralsykehus


Universitetssykehuset Nord-Norge


    Ullevål Universitetssykehus


  Sørlandet sykehus, Kristiansand


      Sørlandet sykehus, Arendal


   Sykehuset Østfold, Sarpsborg


   Sykehuset Østfold, Fredrikstad


            Sykehuset Telemark


             Sykehuset Levanger


Sykehuset Innlandet, Lillehammer


    Sykehuset Innlandet, Elverum


            Sykehuset Buskerud


                  Stord sjukehus


  Stavanger Universitetssjukehus


                St.Olavs Hospital


               Ringerikesykehus


                   Rikshospitalet


             Nordlandssykehuset


                  Molde sjukehus


  Haukeland Universitetssykehus


           Førde Sentralsjukehus


   Fylkessjukehuset i Haugesund


    Akershus Universitetssykehus


                                    0   20      40     60   80       100       120         140    160   180   200




                                                                                                                    -17-
                            Renal morphology, local pathologist, 2009

                                   Representative material   Not representative material


               90

               80

               70

               60

               50

               40

               30

               20

               10

                0




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Hospital                                 Representative material              Not representative material
Akershus Universitetssykehus                       28                                     0
Fylkessjukehuset i Haugesund                       10                                     0
Haukeland Universitetssykehus                     65                                      5
Kristiansund sykehus                               2                                      0
Molde sjukehus                                     2                                      0
Nordlandssykehuset                                 7                                      0
Rikshospitalet                                    61                                      1
Ringerike sykehus                                 13                                      1
St.Olavs Hospital                                 23                                      5
Stavanger Universitetssjukehus                    32                                      3
Stord sjukehus                                      7                                     1
Sykehuset Buskerud                                 28                                     1
Sykehuset Innlandet, Elverum                       10                                     0
Sykehuset Innlandet, Lillehammer                   17                                     0
Sykehuset Levanger                                 24                                     2
Sykehuset Telemark                                 9                                      1
Sykehuset Østfold, Fredrikstad                    32                                      2
Sørlandet Sykehus, Arendal                         9                                      0
Sørlandet Sykehus, Kristiansand                   26                                      2
Ullevål Universitetssykehus                       83                                      2
Universitetssykehuset Nord-Norge                  19                                      0
Vestfold Sentralsykehus                           23                                      1
Ålesund sjukehus                                   6                                      0
Total                                             536                                    27



                                                                                                            -18-
                           Renal morphology, register patologist, 2009

                                     Representative materiale   Not representative materiale

                  60


                  50


                  40


                  30


                  20


                  10


                   0


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Hospital                                 Representative materiale           Not representative materiale
Akershus Universitetssykehus                       22                                    6
Førde Sentralsjukehus                               6                                    2
Kristiansund sykehus                                2                                    0
Rikshospitalet                                     56                                    5
Ringerike sykehus                                   7                                    6
St.Olavs Hospital                                  23                                    8
Sykehuset Buskerud                                 20                                    8
Sykehuset Innlandet, Elverum                        6                                    3
Sykehuset Innlandet, Lillehammer                   15                                    2
Sykehuset Levanger                                 17                                    3
Sørlandet Sykehus, Arendal                          8                                    1
Ullevål Universitetssykehus                        54                                   17
Universitetssykehuset Nord - Norge                 19                                    2
Vestfold Sentralsykehus                            17                                    4
Ålesund sjukehus                                    8                                    1

Total                                                280                                  68




                                                                                                           -19-
                               Histopathology diagnosis, 2009

         250



         200




         150



         100




          50



           0
                                                         N




                                          ph GN
                                                       ge




         an life ativ rat hy




                     l I ital hrit is




                                                        ia
                                                         E
                                                        N




                                                         y
                     d o v e th o A

                                                         A



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                                                        is




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                                    si rop )
                                                        is
                                                        is




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                                            h IV
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                                                     as
                                                     SL
                                                      Ig

                                                      Ig
                                                      G




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                                                      G




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                                      n e ic
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                                                   p



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                                                 le
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                                                th
                                                  h




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  M san esa us sc
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   es




Diagnosis                                 Number
Minimal change                               30
Membranoproliferative GN                      9
Focal segmental sclerosis                    42
Benign nephrosclerosis                      236
Malign nephrosclerosis                        3
Membranous nephropathy                      44
Mesangioproliferative GN                    132
Mesangioproliferative GN with IgA            78
Mesangioproliferative GN without IgA         54
Mesangioproliferative GN with SLE             0
Endocap proliferative GN                      4
Cresentic GN                                 17
Diabeteic nephropathy                        49
Amyloidosis                                  16
Diffus.prol Lupusnephritis (IV)               9
Congenital nephropathy                       30
Monoclonal Ig deposition disease             18
Cryoglobulinemia                             0




                                                                -20-
                      Histopathology diagnosis % of all, 2009

          45,0


          40,0


          35,0


          30,0


          25,0


          20,0


          15,0


          10,0


              5,0


              0,0
             an life ativ era thy




                                      us lo y




                                       og dis y
                                               r a LE
                                                             N




                                     tic en N




                                               bu ase

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                        do ve tho A

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       M san es ous osc sis
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                                              ph GN

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                                                           si
                                                            g




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                                                          G




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                                                    op
                                                    th




                                                   lin
                           l s rol ch




                                                  tiv
                                                  tiv




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                                                 n=612
Diagnosis                               %
Minimal change                         4,9
Membranoproliferative GN                1,5
Focal segmental sclerosis               6,9
Benign nephrosclerosis                 38,6
Malign nephrosclerosis                 0,5
Membranous nephropathy                  7,2
Mesangioproliferative GN               21,6
Mesangioproliferative GN with IgA      12,7
Mesangioproliferative GN without IgA   8,8
Mesangioproliferative GN with SLE      0,0
Endocap proliferative GN                0,7
Cresentic GN                            2,8
Diababetic nephropathy                  8,0
Amyloidosis                            2,6
Diffus.prol Lupusnephritis(IV)          1,5
Congenital nephropathy                  4,9
Monoclonal Ig deposition disease        2,9
Cryoglobulinemia                        0,0



                                                                  -21-
                          Renal pathology in different regions, 2009


            160



            140


            120



            100                                                               Region Sør- Øst

                                                                              Region Vest
             80
                                                                              Region
                                                                              Midt Norge
                                                                              Region Nord
             60



             40



             20



              0
                                                         y
                                                        E
                                                        N



                                                        A


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                                                         s
                                                         s
                                                       is




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                                                      si
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   es
  M




                                       Region     Region    Region      Region
Diagnosis                              Sør- Øst    Vest    Midt Norge    Nord
Focal segmental sclerosis                 21       14          4          3
Benign nephrosclerosis                   145       50         26         15
Malign nephrosclerosis                     3        0          0          0
Mesangioproliferative GN                 80        30         17          5
Mesangioproliferative GN with IgA        47        18         10         3
Mesangioproliferative GN without IgA     33        12          7         2
Mesangioproliferativ GN with SLE          0         0          0         0
Membranous nephropathy                    22       11          8          3




                                                                                                -22-
                                 Renal pathology in different regions, 2009


       40


       35


       30


       25
                                                                                         Region Sør- Øst
                                                                                         Region Vest
       20
                                                                                         Region Midt Norge
                                                                                         Region Nord

       15


       10


           5


           0
                                                                     y




                                                                               E
                                                                    N




                                                                    s
               ge




                                                                   N
                              N




                                                                  th


                                                                  si


                                                                            SL
                                                                 G
                             G




                                                                 G
             an




                                                               do
                                                               pa
                                         e
                            e




                                                              ic
           ch




                                                             oi
                                      tiv
                         iv




                                                            ro
                                                           nt
                       at




                                                          yl
                                                         ph
                                      ra


                                                        se
       al




                                                      Am
                        er


                                   ife
     im




                                                      ne
                                                      re
                     lif


                                ol


                                                     C
   in


                  ro




                                                  tic
                             pr
  M


               op




                                               be
                            p
         an


                         ca




                                            ia
       br




                                           D
                      do
      em


                   En
   M




                                                  Region     Region      Region Midt   Region
Diagnosis                                         Sør- Øst    Vest         Norge        Nord
Minimal change                                       19        8             2           1
Membranoproliferative GN                             4         4             1           0
Endocap proliferative GN                              4        0             0           0
Cresentic GN                                          9        4             2           2
Diabetic nephropathy                                 35        4             5           5
Amyloidosis                                          9         6             1           0
SLE                                                  2         6             1           0




                                                                                                             -23-
                         Renal pathology in different regions, 2009


    18


    16


    14


    12

                                                                              Congenital nephropathy
    10
                                                                              Monoclonal IG deposition
                                                                              disease
      8                                                                       Cryoglobulinemia with GN



      6


      4


      2


      0
                                               e
                st




                            st




                                                               d
                                               g




                                                             or
                          Ve
              r-Ø




                                             or




                                                            N
                                           tN
            Sø




                          n




                                                            n
                        io




                                                          io
                                         id
                      eg
         n




                                                        eg
                                        M
       io




                     R




                                                       R
     eg




                                        n
                                      io
    R




                                    eg
                                   R




                                            Region    Region    Region Midt    Region
Diagnosis                                   Sør-Øst    Vest       Norge         Nord
Congenital nephropathy                        17       11           2              0
Monoclonal IG deposition disease              15        2           1              0
Cryoglobulinemia with GN                       0        0           0              0




                                                                                                         -24-
                                     Morphology at different hospitals, 2009



               Volda sjukehus



      Vestfold Sentralsykehus


  Universitetssykehuset Nord-                                                        Focal segmental sclerosis
             Norge


   Ullevål Universtetssykehus                                                        Benign nephrosclerosis


           Sørlandet sykehus,                                                        Malign nephrosclerosis
              Kristiansand


  Sørlandet sykehus, Arendal                                                         Mesangioproliferative GN


Sykehuset Østfold, Sarpsborg                                                         Mesangioproliferative GN
                                                                                     with IgA

Sykehuset Østfold, Fredrikstad                                                       Mesangioproliferative GN
                                                                                     without IgA

          Sykehuset Telemark                                                         Mesangioproliferativ GN
                                                                                     with SLE

         Sykehuset Levanger                                                          Membranous GN

         Sykehuset Innlandet,
             Lillehammer                                                             Minimal change

Sykehuset Innlandet, Elverum
                                                                                     Membranoproliferative GN

         Sykehuset Buskerud
                                                                                     Endocap proliferative GN

               Stord sjukehus
                                                                                     Cresent GN

             Stavanger
         Universitetssjukehus                                                        Diabetic nephropathy

             St.Olavs Hospital
                                                                                     Amyloidosis

            Ringerike sykehus
                                                                                     Diffus
                                                                                     prol.Lupusnephritis(IV)
                Rikshospitalet
                                                                                     Congenital nefropathy

          Nordlandssykehuset
                                                                                     Monoclonal Ig deposition
                                                                                     disease
              Molde sjukehus
                                                                                     Cryoglobulinemia
         Kristiansund sykehus


              Haukeland
          Universitetssykehus


       Førde Sentralsjukehus


           Fylkessjukehuset i
               Haugesund


Akershus Universitetssykehus



                                 0   20      40      60      80      100       120




                                                                                                                 - 25-
                          Clinical indication with morphology, 2009




   Creatinine< 200




   Creatinine> 200
                                                                         Minimal change

                                                                         Focal segmental sclerosis

                                                                         Diffus prol. Lupusnephritis

              SLE                                                        Endokap prol GN

                                                                         Membranous nephropathy

                                                                         Membranoproliferative GN

      Hypertension                                                       Cresentic GN
       BP>140/90
                                                                         Benign nephrosclerosis

                                                                         Malign nephrosclerosis


    Chronical renal                                                      Diabetic nephropathy
        failure
                                                                         Mesangioproliferative GN

                                                                         Amyloidosis


Nephrotic syndrome
  with proteinuria
      >3g/24h




   Hematuria with
 proteinuria<3g/24h




         Hematura




                      0   50   100   150   200   250   300   350   400




                                                                                                    -26-
                       Morphology in patients with nefrotic syndrom and
                                  proteinuria >3g/24h, 2009



          10


           9


           8


           7


           6


           5


           4


           3


           2


           1


           0
                                         ge




                                            y


                                            s
                                            y

                                          N




                                          N
                                          N




                                           s


                                           s




                                          N




                                            )
                                          is




                                       (IV


                                        th


                                         si
                                        th
                                         si
                                        si




                                        G
                                        G




                                        G


                                        G
                                       os
                                      an




                                     do
                                      ro
                                      ro




                                     pa
                                    pa




                                     is
                                    ic
                                     e


                                     e
                                    er
                                    e




                                   le


                                   le
                                 ch




                                  oi
                                  iv

                                tiv




                                 rit


                                 ro
                                 ro




                                 nt
                                iv


                                cl




                               sc
                              sc




                               at




                               yl
                             ph


                             ph
                             ph




                             se
                              at




                             ra
                             ls
                             al




                          Am
                            ro




                            er
                            ro
                           er




                          ife




                          ne
                          im




                          re
                          ta




                         ne
                         ne


                         lif
                        ph
                        ph
                        lif

                      en




                        C
                       ol
                       in




                      us
                      ro
                     ro




                    tic
                      s
                    ne
                    ne




                    pr
                    M




                   ou
                    m




                   op




                   up
                  op




                  be
                eg




                  p
                  n
                gn




                an


                gi




                .L
              an




               ca
               ig




               ia
             an
             ls


             ni




             ol
             br
             al




             D
           do
            br




           pr
          Be
          ca




          es
          M

         em
        em




        En




       us
       Fo




        M
      M
     M




    iff
   D




Morphology                           Number
Minimal change                         2
Membranoproliferative GN               1
Focal segmental sclerosis              2
Benign nephrosclerosis                 9
Malign nephrosclerosis                 0
Membranous nephropathy                 3
Mesangioproliferative GN               2
Endocap proliferative GN               1
Cresentic GN                           0
Diffus prol.Lupusnephritis(IV)         0
Diabetic nephropathy                   6
Amyloidosis                            0




                                                                          -27-
                         Morphology in patiens with Hematuria, 2009

       90


       80


       70


       60


       50


       40


       30


       20


       10


         0
                                               N




                                               N
                                              ge




                                                 y




                                                 s
                                               N




                                                y
                                               N
                                                s




                                                 )
                                                s
                                               is




                                            (IV




                                              si
                                             th




                                             th
                                             si
                                             si




                                             G
                                            G




                                            G


                                            G
                                           os
                                          an




                                          do
                                          ro
                                          ro




                                         pa




                                         pa
                                         is
                                         ic
                                          e


                                          e
                                        er
                                        e




                                       le
                                      le
                                     ch




                                      oi
                                      iv


                                    tiv




                                     r it
                                    ro




                                    ro
                                     nt
                                     iv


                                    cl




                                   sc
                                   sc




                                   at




                                   yl
                                 ph
                                 se
                                  at




                                 ph




                                  ta




                                 ph
                                 ls
                                 al




                             Am
                                er
                                ro
                                ro
                               er




                              ife




                            ne
                             im




                              re
                            ne
                             ta




                            ne
                            lif
                           ph
                           ph
                           lif




                           ol


                           C
                         en
                          in




                        us
                         ro
                        ro




                         s




                       tic
                       ne
                       ne




                       pr
                       M




                      ou


                      op
                      m




                     up
                    op




                    be
                    p
                  eg




                    n
                  gn




                 an


                   gi




                  .L
                ca
                an




                 ig




                ia
              an
              ls


              ni




               ol
              br
              al




              D
            do
             br




            pr
           Be
           ca




           es
           M


          em
         em




         En




        us
       Fo




        M
      M
     M




    iff
   D




Morphology                       Number
Minimal change                      6
Membranoproliferative GN           4
Focal segmental sclerosis          14
Benign nephrosclerosis             68
Malign nephrosclerosis             2
Membranous nephropathy             9
Mesangioproliferative GN           83
Endocap prolifetative GN           2
Cresentic GN                       6
Diffus prol.Lupusnephritis(IV)     6
Diabetic nephropathy                9
Amyloidosis                        3




                                                                      -28-
                          Morphology in patients with hematuria
                              and proteinuria <3g/24h, 2009


          5




          4




          3




          2




          1




          0
                                               N




                                               N
                                              ge




                                                 y




                                                 s
                                               N




                                                y
                                               N
                                                s




                                                 )
                                                s
                                               is




                                            (IV




                                              si
                                             th




                                             th
                                             si
                                             si




                                             G
                                            G




                                            G


                                            G
                                           os
                                          an




                                          do
                                          ro
                                          ro




                                         pa




                                         pa
                                         is
                                         ic
                                          e


                                          e
                                        er
                                        e




                                       le
                                      le
                                     ch




                                      oi
                                      iv

                                    tiv




                                     r it
                                    ro




                                    ro
                                     nt
                                     iv


                                    cl




                                  sc
                                  sc




                                  at




                                   yl
                                 ph
                                 se
                                  at




                                ph




                                 ra




                                ph
                                ls
                                 al




                             Am
                               er
                               ro
                               ro
                               er




                             ife




                            ne
                             im




                              re
                            ne
                             ta




                            ne
                            lif
                           ph
                           ph
                           lif




                           C
                          ol
                         en
                          in




                        us
                         ro
                        ro




                         s




                       tic
                       ne
                       ne




                       pr
                       M




                      ou


                      op
                      m




                     up
                    op




                    be
                  eg




                    p
                    n
                  gn




                 an


                   gi




                  .L
                an




                ca
                 ig




                ia
              an
              ls


              ni




               ol
              br
              al




              D
            do
             br




            pr
           Be
           ca




           es
           M

          em
         em




        En




        us
       Fo




        M
      M
     M




    iff
   D




Morphology                                  Number
Minimal change                                0
Membranoproliferative GN                      0
Focal segmental sclerosis                     0
Benign nephrosclerosis                        3
Malign nephrosclerosis                        0
Membranous nephropathy                        1
Mesangioproliferative GN                      4
Endocap proliferative GN                      0
Cresentic GN                                  1
Diffus prol.Lupusnephritis(IV)                0
Diabetic nephropathy                          1
Amyloidosis                                   0




                                                                  -29-
               Morpholigy in patients with chronical renal failure, 2009

     120




     100




       80




       60




       40




       20




        0
                                            y




                                            y
                                          ge




                                            s


                                            s




                                            s
                                           N




                                           N
                                           is




                                           N




                                            )
                                           N


                                        (IV
                                         th




                                         th
                                         si


                                         si




                                         si
                                         G




                                         G
                                        os




                                         G


                                         G
                                       an




                                       ro


                                       ro




                                      do
                                      pa




                                      pa
                                     tis
                                      e


                                     er




                                      e


                                      e


                                     ic
                                    le


                                    le
                                  ch


                                   iv




                                   iv




                                   oi
                                 tiv
                                  ro




                                  ro
                                 nt


                                 fri
                                 cl


                                sc


                                sc
                                at




                                at




                                yl
                              ph




                              ph
                               ra


                              se
                              ls




                              ne
                              al




                          Am
                             er




                             ro


                             ro




                             er


                          if e
                          im




                           ta




                         ne




                         ne
                          re


                         us
                        ph
                         lif




                        ph




                         lif
                      en




                       ol


                        C
                       in


                      ro




                     ro




                   up
                      s




                   t ic
                   ne


                   ne




                   pr
                   M




                  ou
                  m
                 op




                 op




                 .L


               be
              eg




               p
             gn



               n


             an
            an




              gi




              ol
            ca
            ig




            ia
          ls




          an




          pr
           ni




          br
          al
          br




          D
        do
       Be
       ca




        M


     em


       es
     em




       us
    En
   Fo




    M




   iff
   M
   M




  D




Morphology                          Number
Minimal change                          0
Membranoproliferative GN               3
Focal segmental sclerosis              15
Benign nephrosclerosis                105
Malign nephrosclerosis                 0
Membranous nephropathy                 6
Mesangioproliferative GN              25
Endocap proliferative GN               0
Cresentic GN                           3
Diffus prol.Lupusnefritis(IV)          1
Diabetic nephropathy                  31
Amyloidosis                             2




                                                                           -30-
                   Morphology in patients with hypertension BP >140/90, 2009

       60




       50




       40




       30




       20




       10




           0
                                                                 y




                                                                 y
                                                                N
               e




                                                                 s


                                                                 s




                                                                 s
                                                                N
                                                                is




                                                                N




                                                                 )
                                                                N


                                                             (IV
                                                              th




                                                              th
                                                              si


                                                              si




                                                              si
             ng


                                                              G




                                                              G
                                                             os




                                                              G


                                                              G
                                                            ro


                                                            ro




                                                           do
                                                           pa




                                                           pa
                                                           is
           ha




                                                          er




                                                           e


                                                           e


                                                          ic
                      tiv




                                                         le


                                                         le




                                                        iv




                                                        oi
                                                       rit
                                                      tiv
                                                      ro




                                                      ro
                                                      nt
                                                      cl
          c




                                                     sc


                                                     sc
                    ra




                                                    at




                                                     yl
                                                   ph
                                                   ph




                                                   ph
                                                   ra


                                                   se
                                                   ls
       al




                                               Am
                                                  ro


                                                  ro




                                                  er
                if e




                                               if e




                                              ne
      im




                                               ta




                                              ne




                                              ne
                                               re
                                             ph


                                             ph




                                              lif
               ol


                                            en




                                            ol


                                             C
    in




                                           us
                                           ro
             pr




                                            s




                                         t ic
                                         ne


                                         ne




                                         pr
   M




                                        ou
                      gm




                                        op




                                       up
           no




                                      be
                                       p
                                gn



                                       n


                                    an


                                     gi




                                     .L
                    se
         a




                                   ca
                                   ig




                                   ia
                                 an
       br




                              ni




                                  ol
                                 br
                                 al




                                 D
                                do
                   l

                            Be




                                pr
     em


                 ca




                                M


                              em


                               es


                             En
               Fo




                             us
                             M
    M




                           M




                         iff
                        D




Morphology                               Number
Minimal change                             4
Membranoproliferativ GN                    1
Focal segmental sclerosis                  14
Benign nephrosclerosis                     49
Malign nephrosclerosis                      3
Membranous nephropathy                      8
Mesangioproliferative GN                   11
Endocap proliferative GN                   1
Cresentic GN                                0
Diffus prol.Lupusnephritis(IV)             6
Diabetic nephropathy                       11
Amyloidosis                                 2




                                                                               -31-
                   Morphology in patients with creatinine >200, 2009

         90


         80


         70


         60


         50


         40


         30


         20


         10


          0
                                              N




                                              N
                                             ge




                                                y




                                                s
                                              N




                                               y
                                              N
                                               s




                                                )
                                               s
                                              is




                                           (IV




                                             si
                                            th




                                            th
                                            si
                                            si
                                            G




                                            G
                                           G


                                           G
                                          os
                                         an




                                         do
                                         ro
                                         ro




                                        pa




                                        pa
                                        is
                                        ic
                                         e




                                         e


                                         e
                                       er




                                      le
                                     le
                                   ch


                                     iv




                                    oi
                                     iv


                                   tiv




                                    r it
                                   ro




                                   ro
                                   nt
                                   cl




                                 sc
                                 sc
                                  at




                                 at




                                  yl
                                ph
                                se
                                ph




                                ra




                                ph
                                ls
                                al




                            Am
                               er




                              er
                              ro
                              ro




                            ife




                           ne
                            im




                             re
                           ne
                            ta




                           ne
                           lif




                           lif
                          ph
                          ph




                          C
                         ol
                        en
                         in




                       us
                        ro




                        ro
                        s




                      tic
                      ne
                      ne




                      pr
                      M




                     ou
                     op




                     op
                     m




                    up

                   be
                 eg




                   p
                   n
                 gn




                an
                an




                  gi




                 .L
               ca
               ig




               ia
             an
             ls


             ni




              ol
            br
            br




            al




            D
           do




           pr
          Be
          ca




          es
           M

         em
         em




        En




        us
       Fo




        M
      M
      M




    iff
   D




Morphology                         Number
Minimal change                       30
Membranoproliferative GN             1
Focal segmental sclerosis            11
Benign nephrosclerosis               84
Malign nephrosclerosis                2
Membranous nephropathy                2
Mesangioproliferative GN             22
Endocap proliferative GN              1
Cresentic GN                          9
Diffus prol.Lupusnephritis(IV)       1
Diabetic nephropathy                 20
Amyloidosis                          4




                                                                       -32-
                   Morphology in patients with creatinine <200, 2009

       140



       120



       100



        80



        60



        40



        20



         0
                                              N




                                              N
                                             ge




                                                y




                                                s
                                              N




                                               y
                                              N
                                               s




                                                )
                                               s
                                              is




                                           (IV




                                             si
                                            th




                                            th
                                            si
                                            si
                                            G




                                            G
                                           G


                                           G
                                          os
                                         an




                                         do
                                         ro
                                         ro




                                        pa




                                        pa
                                        is
                                        ic
                                         e




                                         e
                                       er




                                       e
                                      le
                                     le
                                   ch


                                     iv




                                    oi
                                     iv




                                    r it
                                   ro




                                   ro
                                   nt
                                  tiv
                                   cl




                                 sc
                                 sc
                                  at




                                 at




                                  yl
                                ph
                                se
                                ph




                                ph
                                ls
                                al




                               ra




                            Am
                               er




                              er
                              ro
                              ro




                            ne
                            im




                             re
                           ne
                            ta




                           ne
                           ife
                           lif




                           lif
                          ph
                          ph




                          C
                        en
                         in




                       us
                        ro




                        ro


                        ol
                        s




                      tic
                      ne
                      ne
                      M




                     ou




                     pr
                     op




                     op
                     m




                    up


                   be
                 eg




                   n
                 gn




                an
                an




                  gi


                  p




                 .L
               ig




               ia
              ca
             an
             ls


             ni




              ol
            br
            br




            al




            D
           do




           pr
          Be
          ca




          es
           M

         em
         em




       En




        us
       Fo




        M
      M
      M




    iff
   D




Morphology                          Number
Minimal change                        24
Membranoproliferative GN               6
Focal segmental sclerosis              28
Benign nephrosclerosis                127
Malign nephrosclerosis                  1
Membranous nephropathy                 38
Mesangioproliferative GN               97
Endocap proliferative GN               3
Cresentic GN                            3
Diffus prol.Lupusnephritis(IV)         8
Diabetic nephropathy                  25
Amyloidosis                            11




                                                                       -33-
                             Morphology in patients with SLE, 2009

         9


         8


         7


         6


         5


         4


         3


         2


         1


         0
                                              N




                                              N
                                             ge




                                                y




                                                s
                                              N




                                               y
                                              N
                                               s




                                                )
                                               s
                                              is




                                           (IV




                                             si
                                            th




                                            th
                                            si
                                            si
                                            G




                                            G
                                           G


                                           G
                                          os
                                         an




                                         do
                                         ro
                                         ro




                                        pa




                                        pa
                                        is
                                        ic
                                         e




                                         e


                                         e
                                       er




                                      le
                                     le
                                   ch


                                     iv




                                    oi
                                     iv


                                   tiv




                                    r it
                                   ro




                                   ro
                                   nt
                                   cl




                                 sc
                                 sc
                                  at




                                 at




                                  yl
                                ph
                                se
                                ph




                                ra




                                ph
                                ls
                                al




                            Am
                               er




                              er
                              ro
                              ro




                            ife




                           ne
                            im




                             re
                           ne
                            ta




                           ne
                           lif




                           lif
                          ph
                          ph




                          C
                         ol
                        en
                         in




                       us
                        ro




                        ro
                        s




                      tic
                      ne
                      ne




                      pr
                      M




                     ou
                     op




                     op
                     m




                    up


                   be
                 eg




                   p
                   n
                 gn




                an
                an




                  gi




                 .L
               ca
               ig




               ia
             an
             ls


             ni




              ol
            br
            br




            al




            D
           do




           pr
          Be
          ca




          es
           M


         em
         em




        En




        us
       Fo




        M
      M
      M




    iff
   D




Morphology                         Number
Minimal change                       0
Membranoproliferative GN             0
Focal segmental sclerosis            0
Benign nephrosclerosis               0
Malign nephrosclerosis               0
Membranous nephropathy               6
Mesangioproliferative GN             8
Endocap proliferative GN             0
Cresentic GN                         0
Diffus prol.Lupusnephritis(IV)       4
Diabetic nephropathy                 0
Amyloidosis                          0




                                                                     -34-
                SLE based on clinical form information and on Diffus prol. Lupus nephritis, 2009


        18


        16


        14


        12


        10


         8


         6


         4


         2


         0
                    ia




                                   h




                                                                                                                0
                                                    h




                                                                                   0




                                                                                               0
                                                                   r




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                                 24




                                                                                                              20




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                                                                                             20
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                                                                               40




                                                                                                                          ph
               at




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                                                g/




                                                                                                          <
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         em




                            <3




                                              >3




                                                                             >1




                                                                                                                        ne
                                                            lf




                                                                                                          e
                                                                                          in




                                                                                                        in
                                                          na




                                                                          BP




                                                                                                                        us
        H




                                                                                        in
                           ria




                                         ia




                                                                                                      in
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                                          r




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                         nu




                                        nu




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                                   ot




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                                                 hr
                 pr




                                 pr




                                                              er
                                                C




                                                                                                              s
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           ith




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          w




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                          m
       ur



                        ro
     at



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  H



                 ic
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         ep
        N




Clinical indication                                                    Number
Hematuria                                                                12
Hematuria with proteinuria <3g/24h                                        2
Nephrotic syndrome with proteinuria >3g/24h                               1
Chronic renal failurer                                                    4
Hypertension BP>140/90                                                    3
Creatinine> 200                                                           5
Creatinine < 200                                                         17
Diffus prol.Lupusnephritis                                                4




                                                                                                                                   -35-
            Those who performed the renal biopsy in Norway 2009


  350



  300



  250



  200



  150



  100



   50



    0
          Nephrologist       Radiologist      Both           Others



Performed the biopsy     Number
Nephrologist               104
Radiologist                293
Both                       134
Others                      1




                                                                      -36-
                                                                                             Those who performed the renal biopsy at different hospitals, 2009

                                                                                                                                                                                     Nephrologist                                                               Radiologist                                                          Both                                                    Others

  90


  80


  70


  60


  50


  40


  30


  20


  10


  0
                                                                                                                                                                                                                                                                                                      Sykehuset Innlandet, Elverum



                                                                                                                                                                                                                                                                                                                                                                        Sykehuset Levanger




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Sørlandet Sykehus, Kristiansand



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 Universitetssykehuset Nord-Norge
                                                                                                                                               Nordlandssykehuset




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Ullevål Universtetssykehus



                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Vestfold Sentralsykehus
                                                                                                                                                                                                                                                                                                                                                                                                                                                     Sørlandet Sykehus, Arendal
                                      Fylkessjukehuset i Haugesund




                                                                                                                                                                                                                                                                                 Sykehuset Buskerud



                                                                                                                                                                                                                                                                                                                                     Sykehuset Innlandet, Lillehammer




                                                                                                                                                                                                                                                                                                                                                                                                                    Sykehuset Østfold, Fredrikstad
       Akershus Universitetssykehus




                                                                                              Haukeland Universitetssykehus

                                                                                                                              Molde sjukehus




                                                                                                                                                                                       Ringerike sykehus

                                                                                                                                                                                                           St.Olavs Hospital
                                                                                                                                                                    Rikshospitalet
                                                                     Førde Sentralsjukehus




                                                                                                                                                                                                                               Stavanger Universitetssjukehus

                                                                                                                                                                                                                                                                Stord sjukehus




                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Ålesund sjukehus
                                                                                                                                                                                                                                                                                                                                                                                               Sykehuset Telemark




Hospital                                                                                                                                                                                                                                                        Nephrologist Radiologist                                                                                                                                                                                                                                                         Both                                                                            Others
Akershus Universitetssykehus                                                                                                                                                                                                                                         0           19                                                                                                                                                                                                                                                               1                                                                                0
Fylkessjukehuset i Haugesund                                                                                                                                                                                                                                         0           9                                                                                                                                                                                                                                                                0                                                                                0
Førde Sentralsjukehus                                                                                                                                                                                                                                                0           0                                                                                                                                                                                                                                                                9                                                                                0
Haukeland Universitetssykehus                                                                                                                                                                                                                                       61           7                                                                                                                                                                                                                                                                0                                                                                0
Molde sjukehus                                                                                                                                                                                                                                                       0           1                                                                                                                                                                                                                                                                0                                                                                0
Nordlandssykehuset                                                                                                                                                                                                                                                   0           0                                                                                                                                                                                                                                                                8                                                                                0
Rikshospitalet                                                                                                                                                                                                                                                       0           34                                                                                                                                                                                                                                                               30                                                                               1
Ringerike sykehus                                                                                                                                                                                                                                                    1            3                                                                                                                                                                                                                                                               11                                                                               0
St.Olavs Hospital                                                                                                                                                                                                                                                    0           23                                                                                                                                                                                                                                                               0                                                                                0
Stavanger Universitetssjukehus                                                                                                                                                                                                                                      35           0                                                                                                                                                                                                                                                                1                                                                                0
Stord sjukehus                                                                                                                                                                                                                                                       0           7                                                                                                                                                                                                                                                                0                                                                                0
Sykehuset Buskerud                                                                                                                                                                                                                                                   0           16                                                                                                                                                                                                                                                               12                                                                               0
Sykehuset Innlandet, Elverum                                                                                                                                                                                                                                         0           9                                                                                                                                                                                                                                                                0                                                                                0
Sykehuset Innlandet, Lillehammer                                                                                                                                                                                                                                     0           12                                                                                                                                                                                                                                                               0                                                                                0
Sykehuset Levanger                                                                                                                                                                                                                                                   0           4                                                                                                                                                                                                                                                                20                                                                               0
Sykehuset Telemark                                                                                                                                                                                                                                                   0           0                                                                                                                                                                                                                                                                10                                                                               0
Sykehuset Østfold, Fredrikstad                                                                                                                                                                                                                                       1           8                                                                                                                                                                                                                                                                22                                                                               0
Sørlandet Sykehus, Arendal                                                                                                                                                                                                                                           0           3                                                                                                                                                                                                                                                                3                                                                                0
Sørlandet Sykehus, Kristiansand                                                                                                                                                                                                                                      0           30                                                                                                                                                                                                                                                               2                                                                                0
Ullevål Universtetssykehus                                                                                                                                                                                                                                           5           79                                                                                                                                                                                                                                                               0                                                                                0
Universitetssykehuset Nord-Norge                                                                                                                                                                                                                                     0           5                                                                                                                                                                                                                                                                1                                                                                0
Vestfold Sentralsykehus                                                                                                                                                                                                                                              1           19                                                                                                                                                                                                                                                               5                                                                                0
Ålesund sjukehus                                                                                                                                                                                                                                                     0           5                                                                                                                                                                                                                                                                0                                                                                0

                                                                                             Toltal                                                                                                                                                                                     104                                                                                                                         293                                                                                                                             135                                                                            1


                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          -37-
                              Complications to renal biopsies, 2009


   16




   14




   12




   10




    8




    6




    4




    2




    0
            Macroscopical hematuria        Need for blood tranfusion   Surgical intervention




Macroscopical hematuria               14
Need for blood tranfusion              5
Surgical intervention                  0




                                                                                               -38-
                            Complication to renal biopsies (%), 2009

   4




   3




   2




   1




   0
           Macroscopical hematuria         Need for blood tranfusion   Surgical intervention




Macroscopical hematuria              2,9
Need for blood tranfusion             1
Surgical intervention                 0




                                                                                               -39-
                 Complications to renal biopsies and who performed it, 2009


   12




   10




    8

                                                               Macroscopical hematuria
                                                               Blood transfusion
    6
                                                               Surgical intervention


    4




    2




    0
                             st




                                         th
             t




                                                    s
           is




                                                    er
                           gi




                                      Bo
          og




                                                  th
                        lo
        ol




                                                 O
                     io
      hr




                   ad
    ep




                  R
   N




Complications                     Nephrologist   Radiologist   Both       Others
Macroscopical hematuria                1             10         3           0
Blood transfusion                      0              2         3           0
Surgical intervention                  0              0         0           0




                                                                                         -40-
            Complications to renal biopsy performed by nephrologist, 2009



  2




                                                                 Macroscopical haematuria
  1                                                              Blood transfusion
                                                                 Surgical intervention




  0
                      Stavanger Universitetssjukehus




                                       Macroscopical      Blood            Surgical
Hospital                                haematuria     transfusion       intervention

Stavanger Universitetssjukehus                 1           0                     0

              Total                            1           0                     0




                                                                                            -41-
                                Complications to renal biopsy performed by radiologist, 2009


                        4




                                                                                           Macroscopical hematuria
                        3


                                                                                           Blood transfusion



                                                                                           Surgical intervention
                        2




                        1




                        0
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                                                            s
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                                                 Macroscopical         Blood           Surgical
Hospital                                          hematuria         transfusion      intervention
Akershus Universitetssykehus                          3                  0                 0
Fylkessjukehuset i Haugesund                          0                  1                 0
Stord sjukehus                                        1                  0                 0
Sykehuset Buskerud                                    0                  1                 0
Sørlandet Sykehus, Kristiansand                       1                  0                 0
Ullevål Universtetssykehus                            2                  0                 0
Vestfold Sentralsykehus                               3                  0                 0


                        Total                           10                2                0




                                                                                                                     - 42 -

				
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