The goal of this study was to estimate the diagnostic and prognostic accuracy of renal biopsies in focal segmental glomerulosclerosis (FSGS), accounting for the focal nature of affected glomeruli. Computational simulations were performed on a total of 138,600 virtual kidneys, across a range of FSGS involvement. Simulations were designed to address the diagnostic accuracy of renal biopsies, and the biopsy characteristics required to reflect accurately the true degree of involvement of FSGS in the entire kidney or just the juxtamedullary (JM) region. The diagnostic accuracy of renal biopsies for the detection of at least one FSGS glomerulus exceeded 80% when 10-20% of the kidney was affected by FSGS. Hundreds to thousands of biopsy glomeruli were required to characterize reliably the true extent of FSGS when fewer than 75% of the kidney's glomeruli were affected. Renal biopsies with an average of 20 glomeruli did not accurately reflect the extent of FSGS in kidneys until at least 80% of all glomeruli in the kidney were affected. Targeting JM glomeruli did not result in significant improvements in the prognostic performance characteristics of renal biopsies. These findings suggest that conventional renal biopsies might be inadequate for characterizing the extent of FSGS.

中文翻译：

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局灶节段性肾小球硬化症肾活检准确性的计算模拟。


本研究的目的是评估局灶性节段性肾小球硬化症 (FSGS) 肾活检的诊断和预后准确性，考虑受影响肾小球的局灶性质。对 FSGS 涉及的总共 138,600 个虚拟肾脏进行了计算模拟。模拟旨在解决肾活检的诊断准确性，以及准确反映 FSGS 在整个肾脏或仅近髓 (JM) 区域的真实受累程度所需的活检特征。当 10-20% 的肾脏受到 FSGS 影响时，肾活检检测至少一个 FSGS 肾小球的诊断准确性超过 80%。当不到 75% 的肾脏肾小球受到影响时，需要数百至数千个肾小球活检才能可靠地表征 FSGS 的真实范围。平均 20 个肾小球的肾活检并不能准确反映肾脏中 FSGS 的程度，直到肾脏中至少 80% 的肾小球受到影响。靶向 JM 肾小球并没有显着改善肾活检的预后性能特征。这些发现表明，传统的肾活检可能不足以表征 FSGS 的程度。