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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局灶性节段性肾小球硬化的肾脏活检准确性的计算模拟。

这项研究的目的是估计肾活检在局灶性节段性肾小球硬化症（FSGS）中的诊断和预后准确性，考虑到受影响的肾小球的局灶性。在一系列FSGS涉及的范围内，总共对138,600个虚拟肾脏进行了计算模拟。设计模拟以解决肾脏活检的诊断准确性，以及准确反映FSGS累及整个肾脏或仅颈髓（JM）区域的真实程度所需的活检特征。当10-20％的肾脏受FSGS影响时，肾脏活检对至少一种FSGS肾小球的诊断准确性超过80％。当肾的少于75％时，需要数百至数千个活检肾小球来可靠地表征FSGS的真实范围 肾小球受到影响。肾脏活检平均有20个肾小球，直到肾脏中至少80％的所有肾小球受到影响后，才能准确反映肾脏中FSGS的程度。靶向JM肾小球并未显着改善肾活检的预后性能特征。这些发现表明，常规的肾活检可能不足以表征FSGS的程度。