Percutaneous Kidney Biopsy Research Articles

Acute Kidney Disease Increases the Risk of Post-Kidney Biopsy Bleeding Complications

Introduction: Kidney biopsy, providing the insightful information for most kidney diseases, is an invasive diagnostic tool with certain risks ranging from the least severe macroscopic hematuria to the most severe life-threatening bleeding necessitating renal artery embolization. We aimed to compare the postbiopsy bleeding complications between 2 common methods and to further explore the risk factors of bleeding complications in patients using the negative pressure suction puncture (NPS) method. Methods: We retrospectively collected the data from percutaneous native kidney biopsies in 2016. The clinical, laboratory tests, pathological findings, and the occurrence of bleeding complications following kidney biopsy were analyzed. The kidney biopsy was performed in our center by experienced nephrologists with 2 different methods, namely, NPS method and real-time ultrasound-guided needle (RTU) method. We compared rates of complications between 2 methods and evaluated univariate and multivariate association of risk factors with bleeding complications in the NPS group. Results: 626 kidney biopsies were performed between January 2016 and December 2016. There were 83.2% (521/626) participants in the NPS group and 16.8% (105/626) in the RTU group. There were more participants in the RTU group needing >1 needle pass during biopsy than those in the NPS group (61.0 vs. 14.7%, p < 0.001). Acute kidney disease (AKD) occurred before the procedure of kidney biopsy accounted for 13.8% (72/521) in the NPS group and 1.9% (2/105) in the RTU group. The renal pathological findings revealed higher number of glomeruli in the NPS group than in the RTU group (26.8 ± 13.0 vs. 17.2 ± 8.6, p < 0.001). The incidence of bleeding complications in the NPS group was lower than that in the RTU group (9.2 vs. 21.9%, p < 0.01). Logistic multivariate regression showed that AKD was independently associated with bleeding complications after kidney biopsy in the NPS group. Conclusion: Regarding the bleeding risk, there was noninferiority of NPS over RTU. AKD contributes to higher risks of bleeding complications after kidney biopsy.

Desmopressin and bleeding risk after percutaneous kidney biopsy

BackgroundDesmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study was undertaken to evaluate efficacy of desmopressin in reducing bleeding after percutaneous kidney biopsy.MethodsRetrospective cohort study. 269 of 322 patients undergoing percutaneous kidney biopsy between January 1, 2014 and January 31, 2018 were included. Patients had normal bleeding time, platelet count and coagulation profile. Primary outcome was defined as composite of hemoglobin drop ≥1 g/dL, hematoma on post biopsy ultrasound, gross hematuria, erythrocyte transfusion or angiography to stop bleeding. Association of desmopressin with outcomes was assessed using linear (for continuous variables) and logistic (for binary variables) regression models. Propensity score was used to minimize potential confounding.ResultsDesmopressin was administered to 100/269 (37.17%) patients. After propensity score adjustment patients who received desmopressin had increased odds of post biopsy bleeding [OR 3.88 (1.95–7.74), p < 0.001]. Creatinine at time of biopsy influenced bleeding risk; gender, emergent vs elective biopsy, obesity, AKI, diabetes, hypertension or bleeding time did not influence bleeding risk. Administration of desmopressin to patients with serum creatinine ≥1.8 mg/dL decreased bleeding risk [OR 2.11 (95% CI 0.87–5.11), p = 0.09] but increased bleeding risk when serum creatinine was < 1.8 mg/dL (OR 9.72 (95% CI 2.95–31.96), p < 0.001).ConclusionDesmopressin should not be used routinely prior to percutaneous kidney biopsy in patients at low risk for bleeding but should be reserved for patients who are at high risk for bleeding.

Acute kidney injury in hospitalized patients who underwent percutaneous kidney biopsy for histological diagnosis of their renal disease

BackgroundPerforming a kidney biopsy is necessary to accurately diagnose diseases such as glomerulonephritis and tubulointerstitial nephritis, among other such conditions. These conditions predispose patients to chronic kidney disease, as well as acute kidney injury (AKI). Notably, most epidemiological studies describing AKI have not investigated this patient population.MethodsIncluded patients admitted to the nephrology ward of a tertiary hospital who underwent percutaneous kidney biopsy. AKI was diagnosed based on the Kidney Disease: Improving Global Outcomes criteria.ResultsOf the 223 patients investigated, 140 (62.8%) showed AKI. Of these, 91 (65%), 19 (13.6%), and 30 (21.4%) presented with AKI classified as stages 1, 2, and 3, respectively. The primary indication for performing biopsy was nephrotic syndrome or nephrotic proteinuria (73 [52.1%] in the AKI vs. 51 [61.4%] in the non-AKI group, p = 0.048). Focal segmental glomerulosclerosis was the most prevalent primary disease (24 [17.1%] in the AKI vs. 15 [18.0%] in the non-AKI group, p = 0.150). Multivariate analysis of risk factors associated with AKI showed hemoglobin levels (odds ratio [OR] 0.805, 95% confidence interval [CI] 0.681–0.951, p = 0.011), serum high-density lipoprotein cholesterol levels (HDL-c, OR 0.970, 95% CI 0.949–0.992, p = 0.008), and baseline serum creatinine levels (OR 2.703, 95% CI 1.471–4.968, p = 0.001) were significantly associated with AKI.ConclusionsWe observed a high prevalence of AKI in hospitalized patients who underwent kidney biopsy to investigate their renal disease, particularly glomerulonephritis. Higher levels of hemoglobin and serum HDL-c were associated with a lower risk of AKI.

How long should patients be observed after percutaneous kidney biopsies?

How long should patients be observed after percutaneous kidney biopsies?

Percutaneous Kidney Biopsy and the Utilization of Blood Transfusion and Renal Angiography Among Hospitalized Adults

IntroductionData on percutaneous kidney biopsy (KBx) incidence and frequencies of hemorrhagic complications among inpatients are limited.MethodsUsing nationally representative US hospitalization discharge data, we report temporal trends in inpatient KBx rates from 2007 to 2014 and estimate frequencies of, and risk factors for, utilization of packed red blood cell (pRBC) transfusion and renal angiography.ResultsFrom 2007 to 2014, rates of native KBx among adult inpatients increased from 8.2 to 10.0 per 100,000, while transplant KBx rates declined from 3.6 to 3.1 per 100,000. We studied 35,183 and 14,266 discharge records with native and transplant KBx. We found that 5.7% (95% confidence interval [CI]: 5.3%–6.0%) of inpatients undergoing native KBx and 4.9% (4.2%–5.5%) of those undergoing transplant KBx received a pRBC transfusion within 2 days of biopsy. Similarly, 0.6% (0.5%–0.7%) of inpatients undergoing native KBx and 0.4% (0.2%–0.5%) undergoing transplant KBx received a renal angiogram within 2 days of KBx. For inpatient native KBx, female sex, older age, higher chronic kidney disease stage, acute renal failure, lupus, vasculitis, cirrhosis, multiple myeloma/paraproteinemia, and anemia of chronic disease were independently associated with increased odds of pRBC transfusion; cirrhosis and end-stage renal disease (ESRD) were associated with increased odds, and nephrotic syndrome was associated with decreased odds, of renal angiography.ConclusionsIn this large population-based study of inpatient KBx practices, we demonstrate increasing rates of inpatient native KBx among US adults and provide accurate estimates of the frequencies of, and risk factors for, pRBC transfusion and renal angiography following inpatient KBx.

MON-031 OLDER INDIVIDUALS UNDERGOING NATIVE KIDNEY BIOPSIES: TREND OVER 10 YEARS IN AN URBAN SOUTHEAST ASIAN CENTER

Kidney biopsy remains the definitive diagnostic tool for glomerulonephritis, a frequent cause for end-stage renal disease. There is a recent trend towards older age among those biopsied in developed countries but older age may increase risk of post-biopsy complications. Hence there is a need to ascertain the patient profile in our local practice and increase awareness among physicians. This study aims to examine changes in patient characteristics for individuals who underwent percutaneous native kidney biopsy in our Southeast Asian city-state over the past 10 years and characterise indications for native kidney biopsies among elderly.

SUN-202 DESMOPRESSIN PROPHYLAXIS IS ASSOCIATED WITH SEVERE HYPONATREMIA AFTER PERCUTANEOUS KIDNEY BIOPSY IN OLDER ADULTS WITH RENAL IMPAIRMENT

Elderly patients who undergo renal biopsy are at increased risk of bleeding. Prophylactic desmopressin may reduce uremic bleed but it can cause or exacerbate hyponatremia, a condition common among older individuals. As there is little data on utility, efficacy and safety of desmopressin prophylaxis in older adults, we aimed to evaluate post-biopsy outcomes and the impact of desmopressin prophylaxis in older adults with renal impairment undergoing percutaneous kidney biopsies.

Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia.

Desmopressin is used to reduce bleeding complications for kidney biopsies with azotemia but little is known about desmopressin-induced hyponatremia in these individuals. We aimed to evaluate the impact of desmopressin prophylaxis on severe hyponatremia and bleeding after kidney biopsies in individuals with renal impairment. This is a single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 150µmol/L and had ultrasound-guided percutaneous native or transplant kidney biopsies between June 2011 and July 2015. Data were retrieved from electronic medical records. Primary outcomes were the use of desmopressin prophylaxis and severe hyponatremia (serum sodium ≤ 125mmol/L) within 7days post-biopsy. Secondary outcome was post-biopsy bleeding. 240 native kidney and 196 allograft biopsies were performed. Median age was 51 (IQR 42.3, 60)years and eGFR was 21.9 (12.9, 30.1) ml/min/1.73m2. Although patients prescribed desmopressin prophylaxis (n = 226) had higher serum creatinine [279 (201, 392) vs. 187 (160, 241), p < 0.001], bleeding (15.0% vs. 13.3%, p = 0.60) was not significantly different with and without desmopressin. Severe hyponatremia occurred in 30 biopsies (6.9%) with nadir serum sodium level of 122 (119, 124) mmol/L at 3 (2, 5)days after biopsy, more frequently among those with desmopressin prophylaxis (10.7% vs. 3.0%, p = 0.002). Multi-variate analysis found that pre-biopsy serum sodium level [adjusted OR 0.80 (95% CI 0.72, 0.90), p < 0.001] and desmopressin prophylaxis [adjusted OR 4.02 (95% CI 1.58, 10.21), p = 0.003] were independently associated with severe hyponatremia after kidney biopsy. Pre-biopsy desmopressin was associated with severe hyponatremia in individuals with renal impairment; hence, susceptible patients given desmopressin should be closely monitored.

371 Retrospective Review of Percutaneous Kidney Biopsies from a Rural Center Predominately Caucasian Cohort

371 Retrospective Review of Percutaneous Kidney Biopsies from a Rural Center Predominately Caucasian Cohort

Renal Parenchymal Thickness as a Predictor of Post Percutaneous Kidney Biopsy Complication

Objective: To investigate the relationship of renal parenchymal thickness and the risk of developing post-procedure hematoma. Methods: Ultrasound-guided percutaneous renal biopsy was performed in 122 patients who underwent percutaneous kidney biopsy between January 2013 and ­December 2013 at Tai-he hospital. Post-biopsy renal ultrasound was performed within 12 h after the biopsy to assess the presence of hematoma in biopsied kidney. Logistic regression analysis was used to determine the effect of parenchymal thickness on formation of hematoma adjusted for other nonstructural patient-related factors such as age, sex, systolic and diastolic blood pressure, serum creatinine, and urea. Results: The incidence of complication was 19.4%, all of which were hematoma less than 5 cm. None of the patients went on to have severe complications that required clinical, surgical, or radiological intervention. Out of the collected clinical and anatomical parameters, renal parenchymal thickness of the biopsied kidney was found to be the only factor with strong association with complication risks. Conclusion: This is the first study investigating the impact of structural perimeters on complication risks of percutaneous renal biopsy. Renal parenchymal thickness is a significant predictor of presence of hematoma evident on post-biopsy ultrasound evaluation, which would be used in the early prevent the complications of percutaneous renal biopsy.

Dasatinib-induced nephrotic syndrome in a patient with chronic myelogenous leukemia: a case report

BackgroundDasatinib is a second-generation tyrosine kinase inhibitor that is indicated for the treatment of patients with chronic myeloid leukemia. Here, we report the case of a man with nephrotic syndrome that was caused by dasatinib.Case presentationA 40-year-old man with chronic myeloid leukemia was referred to our hospital because of proteinuria 1 month after dasatinib therapy was introduced. A percutaneous kidney biopsy was performed, diffuse glomerular endothelial injury and effacement of the foot process were noted, and the patient was diagnosed with dasatinib-induced nephrotic syndrome. Additionally, in an electron microscopy study, randomly arranged fibrils were observed in the mesangial and subendothelial regions. Switching from dasatinib to nilotinib led to a decrease in the proteinuria level, from 12 to 0.6 g/g creatinine, within 2 weeks. The patient was discharged from our department on the 25th day after hospitalization, without any drug aftereffects.ConclusionsDrug-related nephrotic syndrome should be considered when nephrotic syndrome develops during treatment with dasatinib.

Abstract No. 549 Sample adequacy and safety outcomes of small-bore needles for ultrasound-guided percutaneous biopsy of the native kidney

Abstract No. 549 Sample adequacy and safety outcomes of small-bore needles for ultrasound-guided percutaneous biopsy of the native kidney

Renal Dysfunction in Patients With Direct Infiltration by B-Cell Lymphoma

BackgroundB-cell lymphoproliferative disorders with renal involvement are relatively frequent, but remain poorly described. A kidney biopsy is usually required to detect the renal lesions that are often missed using other diagnostic tools.MethodsWe retrospectively identified 34 patients with renal lymphoma diagnosed by percutaneous kidney biopsy (PKB) at Rennes University Hospital and its affiliated hospital centers between January 1, 2004, and May 1, 2016. Clinical, biological, radiological, and histological characteristics were collected at biopsy time.ResultsThe included patients had Waldenström macroglobulinemia (n = 12; 35.3%), chronic lymphocytic leukemia/lymphocytic lymphoma (n = 10; 29.5%), high-grade B-cell lymphoma (n = 6; 17.6%), and low-grade B-cell lymphoma (n = 6; 17.6%). The median follow-up was 29 months. Renal involvement led to renal function impairment in 29 patients (85.3%), among whom 20 had acute kidney injury (70%), and to nephrotic syndrome in 4 patients (11.8%). Only 13 patients (38.2%) presented morphological kidney anomalies among whom 5 showed bilateral infiltration. Histologically, interstitial infiltrate (97.1%) was the most common kidney lesion, and 9 patients (26.5%) had specific lymphomatous intraglomerular lesions. After hematological treatment (n = 29), a renal response was observed only in 8 patients (27.6%).ConclusionRenal involvement in the context of B-cell lymphoproliferative disorders is not uncommon. PKB is the best method to confirm this diagnosis. It should be performed early to rapidly initiate the hematological treatment to preserve kidney function.

Cryofibrinogen-associated glomerulonephritis diagnosed by mass spectrometry and immunoelectron microscopy

A 60-year-old male presented with accelerated hypertension, renal insufficiency, proteinuria, and hematuria. Percutaneous kidney biopsy revealed membranoproliferative glomerulonephritis (MPGN) without any immunoglobulin and complement deposition. On performing electron microscopy, deposits with a tubular, organized structure and approximately 60 nm in diameter were detected in the glomerular subendothelial spaces and mesangial areas. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) demonstrated the significantly increased deposition of fibrinogen and fibronectin in glomeruli. Immunohistochemistry and immunoelectron microscopy demonstrated that the deposits were composed of fibrinogen. Here we report a case of cryofibrinogen -associated GN in which LC-MS/MS and immunoelectron microscopy were useful for diagnosis. When MPGN with organized deposits without the deposition of immunoglobulins and complements is diagnosed, we considered the cryofibrinogen-associated GN in one of the differential diagnosis, and even skin symptoms cannot be detected.

Impaired glucose metabolism – A potential risk factor for idiopathic nodular glomerulosclerosis: A single center study

Nodular glomerulosclerosis is a characteristic histological finding of diabetic nephropathy (DN) with thickened glomerular basement membrane and hyalinized arterioles. Idiopathic nodular glomerulosclerosis (ING), a distinct clinicopathologic entity, is the term used to denote classic DN confirmed by light microscopy, immuno-fluorescence, and electron microscopy but in the absence of diabetes mellitus (DM). ING has been linked to heavy tobacco smoking, chronic hypertension, and obesity. We report the result of a retrospective study identifying seventeen subjects from Thomas Jefferson University (1999–2014) with biopsy-proven nodular glomerulosclerosis but no pre-existing history of DM. The main indications for percutaneous kidney biopsy (PKB) were either reduced renal function or the presence of proteinuria. The subjects’ mean (±SD) age was 60.2 (14.4) years, their highest documented random glucose level was 104.4 (23.5) mg/dL, serum creatinine measured 2.35 (1.03) mg/dL, and body mass index calculated 29.4 (6.2) kg/m2. None of the patients fulfilled criteria for diabetes at the time of PKB. However, review of medical records revealed history of intermittently elevated blood glucose or borderline-high HgbA1c levels. The role of impaired glucose metabolism or insulin resistance, as a possible etiology for ING is potentially underestimated and needs additional studies.

Training Nephrology Fellows in Temporary Hemodialysis Catheters and Kidney Biopsies Is Not Needed and Should Not Be Required.

This opinion piece argues against the training of all nephrology fellows in the United States in our profession’s two major procedures: dialysis catheter insertion and percutaneous kidney biopsies. Many of us choose nephrology as a career because of a role model’s influence, the intriguing

Training Nephrology Fellows in Temporary Hemodialysis Catheter Placement and Kidney Biopsies is Needed and Should be Required.

Proficiency in performing percutaneous kidney biopsies and placing temporary vascular access for hemodialysis (nontunneled catheters) has been a requirement of nephrology fellowship training in the United States since at least the 1980s. A lot has changed since then, but in my opinion, the need to

Histological predictors of renal outcome in lupus nephritis: the importance of tubulointerstitial lesions and scoring of glomerular lesions.

Introduction Lupus nephritis (LN) affects nearly 60% of patients with systemic lupus erythematosus and up to 30% of them will progress to end-stage renal disease (ESRD), despite receiving aggressive immunosuppressive therapy. The prognostic value of ISN/RPS classification is controversial. Therefore, we aimed to identify clinical and pathological predictors of outcome in LN patients independent of this classification. Material and methods Thirty-seven patients with LN who underwent percutaneous kidney biopsy between 1997 and 2016 were included in this study. Twenty clinical and twenty histological variables were tested for their association with a composite end-point of doubling of serum creatinine, ESRD and death. Univariate and multivariate Cox proportional hazard regression analysis were performed to identify independent predictors of outcome. Results During a median follow-up period of 48 months (IQR: 17.5-120 months), 21.6% of patients reached the composite end-point. The overall survival rate of our cohort was 89% at one year, 86% at five years, 74% at 10 years and 64% at 20 years. Patients with Class IV LN showed the worst prognosis with 44% survival at 10 years, while those who additionally showed crescents and global sclerosis on kidney biopsy had an even lower survival of 21% and 0% at 10 years, respectively. After multivariate adjustment, we identified estimated glomerular filtration rate at baseline (HR, 0.91 per ml/min /1.73 m2; 95% CI, 0.84 to 0.99), 24-hour proteinuria at baseline (HR, 2.04 per g/d; 95% CI, 1.19 to 3.5), crescents (HR, 1.068 per %; 95% CI, 1.003 to 1.091), global sclerosis (HR, 1.036 per %; 95% CI, 0.984 to 1.091), presence of adhesions (HR, 9.2; 95% CI, 1.38 to 61.2) and tubulitis (HR, 13.1; 95% CI; 1.3 to 131) as independent predictors of outcome in our cohort of LN. Conclusions Our study identified glomerular (crescents, global sclerosis, adhesions) and tubulointerstitial (tubulitis) lesions, in addition to clinical variables (renal function, 24-hour proteinuria), as important predictors of renal outcome, independent of the ISN/RPS classification. We suggest that the ISN/RPS classification could be improved by a quantitative assessment of glomeruli with active and chronic lesions and by a greater emphasis given to tubulointerstitial lesions.

Indications and results of renal biopsy in children: a 36-year experience.

This study was conducted to investigate retrospectively the indications for renal biopsy (RB) in native kidneys and to analyze pathological findings in a single tertiary pediatric hospital in Southern Italy for the last 36years. All patients who underwent RB at our hospital from 1979 to 2014 were included. All renal tissue specimens were studied under light and immunofluorescent microscopy, while electron microscopy was performed only for specific clinical indications. The study group included 213 patients (female43.2%) who underwent 225 percutaneous native kidney biopsies. Median age was 10.4years (range 0.6-24years). The most frequent indication for RB was nephrotic syndrome (44.4%), followed by proteinuria (27.6%), asymptomatic hematuria (17.3%) and acute kidney injury (9.8%). Gross hematuria appeared after biopsy in less than 5% of the patients, but none of them needed blood transfusion. Adequate renal tissue sample was obtained in 95.5% of the renal biopsies. Primary glomerulonephritis (GN) was the most common finding (61.4%), followed by secondary GN (21.4%), tubulointerstitial diseases (3.7%) and hereditary nephropathy (2.8%), while in 10.7% of the cases, normal renal tissues were found. According to histopathological diagnosis, the most common causes of primary GN were IgA nephropathy (20.9%), followed by minimal change disease (18.1%) and focal segmental glomerulosclerosis (11.6%). The epidemiology of glomerular disease in our single-center cohort is similar to that shown in other national and international reports. Moreover, our study shows that percutaneous ultrasound-guided RB is a safe, reliable and effective technique in children.

3:27 PM Abstract No. 114 Nationwide trends in pediatric percutaneous kidney and liver biopsies: is there a value proposition for interventional radiologists who can safely perform these procedures as outpatients?

To investigate trends, costs, relative safety, and potential savings of inpatient versus outpatient percutaneous kidney and liver biopsies in the pediatric population. Data on admission type and cost (using billed charges as a cost-surrogate) from all percutaneous kidney and liver biopsies performed from 2008-2015 was collected using the Pediatric Health Information System (PHIS), a comparative database of patient encounters from 44 US Children’s Hospitals. Regression analysis was performed to evaluate the annual trend in the biopsy patients admitted as inpatients vs outpatients. Costs were compared using the Tukey-Kramer Method (significance: p < 0.05). To assess safety of outpatient biopsies performed by interventional radiology (IR), data was collected on all percutaneous kidney and liver biopsies performed at a single, large tertiary care children’s hospital (“Hospital A”) from 2014-2017, using complications requiring escalation in care (SIR Classifications B-F) as a surrogate for safety. 7,835 kidney and 9,984 liver biopsies were performed by all specialties at all PHIS hospitals. Regression analysis showed a significant annual decline in percentage of kidney (-0.6%, p = 0.008) and liver (-3.0%, p = 0.01) biopsies. Notably, > 15% and >10% of kidney and liver biopsies were still performed as inpatients as of 2015, respectively. Costs were significantly (p < 0.0001) higher for inpatient biopsies (mean: $65,872 + $201,572 for kidney, mean: $173,331+ $505,177 for liver) vs outpatients (mean: $13,410 + $7,385 kidney, mean: $10,338+ $7,273 liver). 223 kidney biopsies and 441 liver biopsies were performed on outpatients from 2014-17 by IR at Hospital A. Percutaneous kidney biopsy complication rate = 1.3% (1 SIR class C, 2 SIR class D). Percutaneous liver biopsy complication rate = 0.2% (1 SIR Class C). A substantial percentage of pediatric patients are still admitted as inpatients for postprocedure monitoring following percutaneous kidney and liver biopsies. Our study shows that these procedures can be done safely by IRs as outpatients, offering substantial potential cost savings for healthcare systems.