Les jeunes néphrologues publient #SFNDT2018: Une biopsie osseuse de 4 mm de diamètre est-elle aussi performante qu’une BO de 7.5 mm de diamètre pour le diagnostic de l’ostéodystrophie rénale

Le CJN s’attache à mettre en avant les travaux scientifiques de ses membres et de la jeune génération néphrologique. Durant la #SFNDT2018 les internes sont à l’honneur. Nous relayons ici le poster publié par Etienne Novel, interne de Néphrologie à Lyon, et son équipe. Félicitation à eux pour ce beau travail!

Vous pourrez retrouver cette communication dans l’espace poster dès Jeudi sous la référence PN99J

Une biopsie osseuse (BO) de 4 mm de diamètre est-elle aussi performante qu’une BO de 7.5 mm de diamètre pour le diagnostic de l’ostéodystrophie rénale (ODR) ?

Introduction

Histomorphometric analysis of an anterior transiliac bone biopsy is the gold standard for the diagnosis of renal osteodystrophy (ROD). This procedure is usually performed with an 8mm-diameter trephine. However, this procedure is progressively forgone due to its invasiveness and cost as well as to the increasing lack of experts able to carry it out. Our objective was to validate ROD diagnosis on halved bone samples, mimicking those obtained with a 4mm Jamshidi needle, a procedure of increasing popularity that has not been endorsed yet.

Méthodes

Fifty two bone biopsies performed in CKD patients with Meunier-Bordier trephines were included. Quantitative histomorphometric analysis of the complete bone samples was performed including assessment of bone mass (Bone volume, BV/TV,%), turnover (Bone Formation Rate, BFR, μm3/μm2/d, mineralizing surface, MS/BS, and Mineral Apposition Rate, MAR, μm/d), resorption (TRAP positive osteoclastic surface, OcS/BS, %), mineralization (osteoid surface, OS/BS %, osteoid thickness OTh, μm and Mineralization Lag Time, MLT, days) . Each histological section was then divided lengthwise in two 4mm-wide hemi-biopsies. Histomorphometric analysis was repeated this time on one randomly chosen hemi-biopsy for each sample, blind form initial results. Diagnoses were classified as Osteitis Fibrosa (OF), Adynamic bone disease (ABD), Mixed uremic bone disease (MUO), Osteomalacia (OM) or other. Correlation of each parameter between the whole biopsy and the corresponding hemi-biopsy was studied using Pearson’s test. Concordance between the ROD diagnosis obtained from the whole biopsy and the two hemi biopsies was analyzed.

Résultats

Fifty two biopsies were analyzed including 39 OF, 2 ABD, 3 MUO, 3 OM and 5 Other. Correlations between whole 8mm-wide biopsies and the corresponding hemi- biopsies was for BV/TV, r=0.97, p<0.001), OS/BS, r=0.98, p<0.001), Oc.S/BS, r=0.98, p<0.001, and BFR/BS, r=0.93, p<0.001). Final diagnosis was concordant between the whole biopsy and the hemi-biopsies in 97% of cases.

Conclusion

Four mm wide bone biopsies allow for an accurate assessment ROD in CKD patients. The replacement of Meunier/Bordier trephines with disposable Jamshidi- type needles could improve the procedure’s feasibility at the patient’s bedside, as well as decrease both its invasiveness and cost.