Abstract
BackgroundFew data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients.MethodsMulticenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed.Results104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months.ConclusionsKB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.
Highlights
As life expectancy increases, the proportion of elderly patients with renal diseases raises [1, 2]: the medical care of elderly patients is changing in developed countries [3]
Kidney biopsy (KB) is an invasive diagnostic procedure aimed at identifying kidney diseases and guiding treatment to prevent progression to chronic kidney disease and end-stage kidney disease (ESKD)
Between January 2010 and December 2018, a total of 114 very elderly patients underwent a native kidney biopsy (KB) analyzed at the Laboratory of Pathology of AP-HM, which represents 2% of all native KB analyzed during the same period
Summary
The proportion of elderly patients with renal diseases raises [1, 2]: the medical care of elderly patients is changing in developed countries [3]. The life expectancy in France in 2019 was 85.6 years for women and 79.7 years for men. There is consensus of opinion that an age over 60–65 years is not a contraindication to kidney biopsy (KB) [5, 6] but the level of evidence for patients over 80–85 years of age remains low. There is a general reluctance [7] to perform KB in very elderly patients due to the risk of complications. To evaluate the risk/benefit balance of KB in very elderly patients, we analyzed the indications, adverse events and therapeutic impact of KB in a cohort of consecutive patients over 85 years of age. Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients
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