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Kidney Week

Abstract: PO1677

Percutaneous Renal Biopsy in Frail and High-Risk Patients

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Roccatello, Dario, 1Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy, Turin, Italy, Italy
  • Sciascia, Savino, 1Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy, Turin, Italy, Italy
  • Fenoglio, Roberta, 1Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy, Turin, Italy, Italy
Background

Many patients (pts) with End Stage Kidney Disease (ESKD) do not undergo percutaneous kidney biopsy (KB) and do lack a definite diagnosis. Whether KB is beneficial in the extreme patients’ categories, remains controversial. Aim: To analyse the benefit/risk balance in terms of therapeutic options and general outcome of KB procedure in these borderline categories.

Methods

Files for all biopsies performed in our Centre between 2013 and 2019 (# 903 inpatients’ native kidney) were retrospectively analysed with special focus on histological diagnosis, biopsy complications, and post-biopsy patient’s outcome. Two groups of high risk patients were identified 1. >75 years old patients, and 2. patients requiring dialysis at the first clinical evaluation. A rigorous protocol of screening of the bleeding risks was adopted.

Results

Of the 903 biopsies, 217 cases had group 1, and 92 group 2 criteria. Group 1: mean age 80 years, main histological diagnoses: ANCA associated vasculitis (AAV); membranous nephropathy (MN), diabetic nephropathy, IgA glomerulonephritis (IgAGN), cast nephropathy, renal amyloidosis, focal segmental glomerulosclerosis (FSGS). Group 2: mean age 60 years, most frequent histological diagnosis: AAV; cast nephropathy, nephroangiosclerosis, IgAGN, diabetic nephropathy, renal amyloidosis; FSGS. Five major complications (2,3%), including AV fistula with spontaneous resolution in 4 pts and 1 case of severe bleeding requiring arterial embolization, and 14 minor complications (6,5%), including post biopsy haematomas <2cm in 12 pts and haematuria in 2 pts were observed in group 1. Only 1 major complication (AV fistula) and 4 minor complications, including post biopsy <2cm haematomas in group 2 were identified in group 2. Histological diagnosis conditioned or changed treatment strategy in 71% of elderly pts (group 1), and 63% of pts in dialysis (group 2). Dialysis discontinuation was achieved in 30 out of 92 pts (36,6%) with a sparing of over 1 million euro/year.

Conclusion

Given its high diagnostic value (especially in patients who are willing to be transplanted), the prognostic significance, and the potential impact on the treatment policy, indications to percutaneous KB in elderly and dialysis pts should be probably revised.