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Kidney Week

Abstract: SA-PO572

Kidney Biopsy in Initial Presentation of Markedly Reduced Kidney Function: Is It Safe? Will It Make a Difference?

Session Information

Category: Glomerular Diseases

  • 1201 Glomerular Diseases: Fibrosis and Extracellular Matrix

Authors

  • Eltayeb, Fatima Babiker ahmed, Hamad Medical Corporation, Doha, Qatar
  • Thappy, Dr. Shaefiq Babu, Hamad Medical Corporation, Doha, Qatar
  • Abuhelaiqa, Essa, Hamad Medical Corporation, Doha, Qatar
  • Fituri, Omar, Hamad Medical Corporation, Doha, Qatar
  • Al-Malki, Hassan A., Hamad Medical Corporation, Doha, Qatar
  • Alkadi, Mohamad M., Hamad Medical Corporation, Doha, Qatar
Background

One of the dilemmas faced by nephrologist is a patient presenting for the first time with elevated creatinine and unknown baseline renal function. It is usually unclear whether this represents an acute or chronic kidney disease, especially when the size of kidneys is normal and immunologic workup is negative. The aim of this study is to retrospectively determine the risks and benefits of obtaining a kidney biopsy in patients presenting with elevated creatinine and negative immunologic workup.

Methods

We included patients who presented with serum creatinine higher than 4.5 mg/dL and underwent kidney biopsy between April 1st, 2017 and April 1st, 2019. Patients who had known baseline creatinine or positive serologic studies were excluded from the study.

Results

52 patients were included in the study and their baseline characteristics are summarized in Figure 1. 54% of patients were initiated on chronic hemodialysis during hospitalization. All kidney biopsies were ultrasound-guided and were done with blood pressure <140/80. 29% of kidney biopsies were considered suboptimal or inadequate to make a diagnosis. Only two biopsies (4%) showed treatable acute pathology (1 multiple myeloma and 1 proliferative GN). All the remaining biopsies had at least moderate IFTA and 86% had diffuse global glomerulosclerosis. IgA nephropathy was the most common etiology (n=11; 21%) followed by hypertension (n=5) and diabetic nephropathy (n=4). 13 patients (25%) developed hematoma post procedure: 6 patients (46%) required no intervention, 6 patients (46%) required blood transfusion, and 1 patient (8%) required embolization to control bleeding. Figure 1 compares kidney size and incidence of hematoma.

Conclusion

Initial presentation of markedly reduced renal function with insignificant history and negative work up are at high risk for native kidney biopsy complications and have low yield to diagnose a reversable disease even if kidney size is normal. Benefits and risks of kidney biopsy should be carefully discussed with patients.