We can often see that some kidney patients have good results and go into remission quickly, while others have ups and downs, some can be stable for many years, while others enter uremia and need dialysis treatment within a few years. Why does it seem that the symptoms of kidney disease patients look similar, no more than edema, hypertension, proteinuria, hematuria, but some have good results and some have bad results? Due to the wide variety of kidney diseases, complex etiology and pathogenesis, the macroscopic clinical manifestations of many kidney diseases are often inconsistent with the microscopic histological changes of the kidney. For example, the clinical manifestation of nephrotic syndrome, the pathology can present as microscopic lesions, mild lesions, mild thylakoid hyperplasia, membranous nephropathy, membranoproliferative nephritis, focal segmental sclerosis, and other changes, and the treatment plan and the outcome of the development of the disease vary greatly. In addition, the histopathological changes of renal disease are inconsistent in different periods of development. For example, the same IgA nephropathy can manifest pathologically in almost all stages of development from near normal renal tissue to sclerosis of most glomeruli. Therefore, understanding the histomorphologic alterations of the kidney is very important in determining the condition, treating the disease and estimating the prognosis. Kidney disease has a strong insidious nature, known as the “silent killer”, we have treated such a patient, who was originally seen for upper limb numbness, but found protein and occult blood in the urine, and then performed a kidney puncture to diagnose IgA nephropathy focal segmental sclerosis, the patient was effectively treated, it is conceivable that if there is no detection of It is conceivable that if hematuria and proteinuria are not found and there is no pathological diagnosis, the patient will not be treated, and when it is found later, his condition will be very serious, and he will even lose the time for treatment and have to maintain dialysis. Renal puncture examination is called “percutaneous renal puncture biopsy”, which is an important means to obtain kidney tissue specimens in vivo for pathological examination. Contemporary renal histopathological examination includes light microscopy, electron microscopy and immunofluorescence (or immunohistochemistry) examination. The combination of these multiple examination data has significantly improved the accuracy of disease diagnosis. Renal puncture biopsy is very meaningful in determining the diagnosis of glomerular diseases, formulating treatment plans and judging prognosis, and it has become an important test frequently performed in nephrology. It can be said that the development of renal pathology examination is a leap in the development of nephrology. At present, the results of renal pathology examination have become the golden indicator for the diagnosis of kidney diseases. Some patients think: I already have kidney disease, I have to put another needle in the kidney, won’t it cause more damage? In fact, although kidney biopsy is an invasive operation, the damage caused is very small, a kidney has 1 million glomeruli, biopsy specimens generally dozens of glomeruli, the impact on the kidney is minimal, the injection of anesthetic during the puncture, patients will not feel pain, puncture patients can generally lie in bed for a day to get out of bed. Patients usually have mild hematuria and slight back pain after the operation, and they can recover soon. Therefore, never be resistant to kidney biopsy, but look at it correctly. In order to clarify the diagnosis, guide the treatment or judge the prognosis, and when there is no contraindication to puncture, renal puncture can be performed for various primary, secondary and hereditary renal parenchymal diseases (especially diffuse lesions) in internal medicine. Specifically, renal puncture biopsy is helpful in the diagnosis of glomerular disease as follows: 1. To determine whether one has nephritis? Microscopic hematuria is common. Whether it is Alport syndrome or IgA nephropathy with poor prognosis or thin basement membrane nephropathy with good prognosis can only be distinguished by pathological examination; renal amyloidosis, hepatitis B-associated nephritis, etc. must be diagnosed by kidney biopsy. 2.Determine which kind of nephritis is suffered from? Glomerulonephritis can be divided into two categories: primary and secondary, each of which contains many nephritis of different nature, such as primary glomerulonephritis includes at least 9 pathological types, and different pathological types differ greatly in the rate of disease progression, treatment options, efficacy response and prognosis, so it is important to do kidney puncture biopsy to distinguish them accurately; we have admitted a young female patient with only mild We have treated a young female patient with only mild proteinuria and hematuria, ANA 1:80, who was originally thought to be fine with rheumatism in an outside hospital, but the diagnosis of lupus nephritis type V was confirmed only after a renal biopsy was performed, and her condition was relieved by treatment. 3. To determine the severity of the lesion and whether it is reversible? Sometimes the clinical and pathological manifestations of the disease are not parallel, and the clinical manifestations are very light but the pathology is already very heavy. Only by doing kidney puncture pathological examination can we accurately understand the severity of the lesion and whether the lesion is an active lesion (such as cell proliferation or infiltration, which is reversible) or already irreversible (such as fibrosis and sclerosis). Only after the above diagnostic issues are clarified can we accurately formulate a treatment plan and determine the prognosis of the disease. A middle-aged female patient was admitted to the hospital with poor appetite, anemia and weakness. There was no previous history of renal disease or medication. Urine routine: urine glucose 3+, urine protein 2+, normal blood glucose, blood creatinine 360 μmmol/L. Diagnosis of renal failure, cause to be investigated. We did ultrasound and found that the kidney was not too small, so we decisively gave the patient a renal puncture, and the result was: acute interstitial nephritis. Through the treatment in January, the patient’s blood creatinine was normal and he was discharged from the hospital. There was also a rural elderly female patient who suddenly developed renal failure, blood creatinine 680μmmol/L, no obvious anemia, normal kidney size, clinical suspicion of renal failure due to small vessel inflammation, but did not know whether the patient’s condition could still be reversed, repeatedly explained the need for kidney biopsy after the patient finally agreed to kidney biopsy, clearly for crescentic nephritis, acute renal failure, after treatment, blood creatinine returned to normal. If the diagnosis of chronic renal failure is taken for granted, the patient will have to go to hemodialysis and kidney transplantation. At present, there are not many hospitals that can conduct renal pathology examination nationwide, and due to the strong empirical nature, the diagnostic level of renal pathology varies greatly. Now we send the kidney pathology specimens to the nephrology laboratory of Peking Union Medical College Hospital for examination, and the reliability of the pathology examination is guaranteed, and the treatment plan is determined by the guidance of the nephrology experts of Peking Union Medical College Hospital, so that patients can get the The best treatment is available at the doorstep of patients without the need to travel.