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Chemouny JM, Bobot M, Sannier A, Maisons V, Jourde-Chiche N, Ferriere E, Joly D, Vigneau C, Rioux-Leclercq N, Barba C, Daniel L, Halimi JM, Vrtovsnik F. Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study. Am J Nephrol 2021; 52:131-140. [PMID: 33780924 DOI: 10.1159/000514259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Kidney biopsies (KBs) are performed in patients with type 2 diabetes (T2D) to diagnose non-diabetic or hypertensive kidney disease (NDHKD) potentially requiring specific management compared to diabetic and or hypertensive nephropathy (absence of NDHKD). Indications for KB are based on the presence of atypical features compared to the typical course of diabetic nephropathy. In this study, we assessed the association of different patterns of atypical features, or KB indications, with NDHKD. METHODS Native KBs performed in patients with T2D were analyzed. Data were collected from the patients' records. KB indications were determined according to the presence of different atypical features considered sequentially: (1) presence of any feature suggesting NDHKD which is not among the following ones, (2) recent onset of nephrotic syndrome, (3) low or rapidly declining estimated glomerular filtration rate (eGFR), (4) rapid increase in proteinuria, (5) short duration of diabetes, (6) presence of hematuria, or (7) normal retinal examination. RESULTS Among the 463 KBs analyzed, NDHKD was diagnosed in 40% of the total population and 54, 40, 24, and 7% of the KBs performed for indications 1-4 respectively. Conversely, no patient who underwent KB for indications 5-7 displayed NDHKD. Logistic regression analyses identified eGFRCKD-EPI >15 mL/min/1.73 m2, urinary protein-to-Cr ratio <0.3 g/mmol, hematuria, HbA1c <7%, and diabetes duration <5 years as predictors of NDHKD, independently from the indication group. CONCLUSION NDHKD is frequent in T2D. Despite the association of hematuria with NDHKD, our results suggest that presence of hematuria and absence of DR are insufficient to indicate KB in the absence of concurrent atypical features. Conversely, rapid progression of proteinuria and rapid deterioration of eGFR are major signals of NDHKD.
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Affiliation(s)
- Jonathan M Chemouny
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, CIC-P 1414 (Centre d'Investigation Clinique), Univ Rennes, Rennes, France
| | - Mickaël Bobot
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Aurélie Sannier
- Laboratoire d'Anatomie et Cytologie Pathologiques, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, Paris, France
| | - Valentin Maisons
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Elsa Ferriere
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Dominique Joly
- Service de Néphrologie, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Cécile Vigneau
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Nathalie Rioux-Leclercq
- CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en santé, Environnement et Travail) - UMR_S 1085, Univ Rennes, Rennes, France
| | - Christophe Barba
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
| | - Laurent Daniel
- Aix-Marseille Univ, INSERM, INRAE, C2VN, Marseille, France
- AP-HM, Laboratoire d'Anatomopathologie, Hôpital de la Timone, Marseille, France
| | - Jean-Michel Halimi
- CHU Tours, Service de Néphrologie et d'Immunologie Clinique, Tours, France
- Université de Tours, INI-CRCT, Tours, France
| | - Francois Vrtovsnik
- Université de Paris, Paris, France
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, AP-HP, DHU Fire, Paris, France
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Parmar MS. Acute Kidney Injury in a Patient following Percutaneous Kidney Biopsy. KIDNEY360 2021; 2:600-601. [PMID: 35369025 PMCID: PMC8786008 DOI: 10.34067/kid.0005252020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 02/04/2023]
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104
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Sousanieh G, Whittier WL, Rodby RA, Peev V, Korbet SM. Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal. Am J Nephrol 2021; 51:982-987. [PMID: 33454708 DOI: 10.1159/000512902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromise adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles. METHODS PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound. Baseline clinical and laboratory data, biopsy data (number of cores, total glomeruli, and total glomeruli per core), and outcome (hematoma on renal US at 1-h, complications, and transfusion) were collected prospectively. PRB with N14g (337) versus N16g (255) and T16g (892) versus T18g (131) needles were compared. A p value of <0.05 was significant. RESULTS PRB with an 18-g needle yielded the lowest number of total glomeruli per biopsy (N14g vs. N16g: 33 ± 13 vs. 29 ± 12, p < 0.01 and T16g vs. T18g: 34 ± 16 vs. 21 ± 11, p < 0.0001), significantly fewer total glomeruli per core (T16g vs. T18g: 12.7 ± 6.4 vs. 9.6 ± 5.0, p < 0.001 and N16g vs. T18g: 14.2 ± 6.3 vs. 9.6 ± 5.0, p < 0.001). A hematoma by renal US 1-h post-PRB was similar for native (14g-35% vs. 16g-29%, p = 0.2), and transplant biopsies (16g-10% vs. 18g-9%, p = 0.9) and the complication rate for native (14g-8.9% vs. 16g-7.1%, p = 0.5), transplant biopsies (16g-4.6% vs. 18g-1.5%, p = 0.2) and transfusion rate for native (14g-7.7% vs. 16g-5.8%, p = 0.4), and transplant biopsies (16g-3.8% vs. 18g-0.8%, p = 0.1) were similar irrespective of needle size. CONCLUSIONS PRB of native and transplant kidneys with the use of a 16-gauge needle provides an optimal sample. However, our experience in transplant biopsies suggests the use of an 18-gauge needle stands to jeopardize the diagnostic accuracy of the PRB while not improving safety.
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Affiliation(s)
- George Sousanieh
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - William L Whittier
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Roger A Rodby
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Vasil Peev
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Stephen M Korbet
- Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA,
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Nielly H, Mathian A, Cazenave M, Izzedine H, Haroche J, Cohen-Aubart F, Hie M, Miyara M, Pineton de Chambrun M, Benameur N, Hausfater P, Pha M, Boutin-Lê Thi Huong D, Rouvier P, Brocheriou I, Cluzel P, Amoura Z. Safety and effectiveness of transjugular renal biopsy for systemic lupus erythematosus and antiphospholipid antibody syndrome patients taking antithrombotics. Nephrol Dial Transplant 2021; 35:1721-1729. [PMID: 31157889 DOI: 10.1093/ndt/gfz085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 03/20/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Renal biopsy is the cornerstone of systemic lupus erythematosus (SLE) nephritis and antiphospholipid syndrome (APS) nephropathy management. However, transcutaneous renal biopsy (TCRB) is hampered by the antithrombotic treatment frequently prescribed for those diseases. Transjugular renal biopsy (TJRB) offers an attractive alternative for patients at increased risk of bleeding. The primary objective of the study was to describe the safety profile and diagnostic performance of TJRB in SLE and APS patients. METHODS All SLE and/or APS patients who underwent a renal biopsy in our department (between January 2004 and October 2016) were retrospectively reviewed. Major complications were death, haemostasis nephrectomy, renal artery embolization, red blood cell transfusion, sepsis and vascular thrombosis; macroscopic haematuria, symptomatic perirenal/retroperitoneal bleeding and renal arteriovenous fistula without artery embolization were considered as minor complications. RESULTS Two hundred and fifty-six TJRBs-119 without antithrombotics (untreated), 69 under aspirin and 68 on anticoagulants and 54 TCRBs without antithrombotics-were analysed. Their major and minor complication rates, respectively, did not differ significantly for the four groups: 0 and 8% for untreated TJRBs, 1 and 6% for aspirin-treated, 6 and 10% for anticoagulant-treated and 2 and 2% for TCRBs. The number of glomeruli sampled and the biopsy contribution to establishing a histological diagnosis was similar for the four groups. CONCLUSIONS TJRBs obtained from SLE and APS patients taking antithrombotics had diagnostic yields and safety profiles similar to those of untreated TCRBs. Thus, TJRB should be considered for SLE and APS patients at risk of bleeding.
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Affiliation(s)
- Hubert Nielly
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Alexis Mathian
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Maud Cazenave
- Sorbonne Université, APHP, GHPS, Nephrology and Renal Transplantation Department, Paris, France
| | - Hassan Izzedine
- Hôpital Privé des Peupliers, Service de Néphrologie, Paris, France
| | - Julien Haroche
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Fleur Cohen-Aubart
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Miguel Hie
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Makoto Miyara
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
- APHP, GHPS, Département d'Immunologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Marc Pineton de Chambrun
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Neila Benameur
- APHP, GHPS, Service de Pharmacie, Hôpital de la Pitié-Salpêtriére, Paris, France
| | - Pierre Hausfater
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Micheline Pha
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Du Boutin-Lê Thi Huong
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - Philippe Rouvier
- Sorbonne Université, APHP, GHPS, Service d'Anatomie et Cytologie Pathologiques, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Isabelle Brocheriou
- Sorbonne Université, APHP, GHPS, Service d'Anatomie et Cytologie Pathologiques, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Sorbonne Université, APHP, GHPS, Département d'Imagerie Cardiovasculaire et de Radiologie Interventionnelle, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Assistance Publique-Hôpitaux de Paris (APHP), Groupe Hospitalier Pitié-Salpêtrière (GHPS), French National Referral Center for Systemic Lupus Erythematosus and Antiphospholipid Antibody Syndrome, Service de Médecine Interne 2, Institut E3M, Paris, France
- Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
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106
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Al-Sadoon EI, Rahim KA, AlAnazi A, Faqeehi H, AlBatati S. Spectrum of pediatricbiopsy-proven renal diseases: A single center experience. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:176-181. [PMID: 32129211 DOI: 10.4103/1319-2442.279938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glomerular diseases are considered to be a significant cause of chronic kidney disease. Kidney biopsy continues to be an essential diagnostic tool. We review the renal biopsies which were done on children below the age of 14 years in the past 10 years (from January 2008 to September 2018) in a single tertiary pediatric hospital in Saudi Arabia to determine the patterns of renal disease among Saudi children as well-correlating clinical presentation with histopathological diagnosis. A total of 203 pediatric kidney biopsies were performed. The mean age was 7.3 ± 3.9 years (3 months to 14 years). There were 105 males and 98 females. The most frequent indication for renal biopsy was nephrotic syndrome in 58.9% of patients, followed by acute glomerulo- nephritis in 20.8%. Other indications included significant proteinuria, persistent microscopic hematuria, acute kidney injury of uncertain etiology, in the remaining 20% of biopsies. Clinical diagnosis was consistent with histopathological diagnosis in 92% of the cases. Minimal change disease was the most common cause of primary glomerular diseases in 37.4%, followed by focal segmental glomerulosclerosis in 20.2%. Lupus nephritis represents the most common cause of the secondary renal disease (8.4%). Complications of kidney biopsy were observed in only 16.3% of patients, of whom 9.9% had perirenal hematomas and 6.4% of the patients developed either microscopic hematuria or macroscopic hematuria.
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Affiliation(s)
- Ebtisam Ibraheem Al-Sadoon
- Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khawla A Rahim
- Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim AlAnazi
- Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Hassan Faqeehi
- Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sawsan AlBatati
- Department of Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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107
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Bhagavatula SK, Li L, Tearney GJ. Characterization of interventional photoacoustic imaging (iPAI) capabilities in biological tissues. Med Phys 2020; 48:770-780. [PMID: 33264419 DOI: 10.1002/mp.14630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/03/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Interventional photoacoustic imaging (iPAI) could improve ultrasound-guided minimally invasive procedures by enabling high precision needle steering, target detection, and molecular and physiologic tissue assessment. However, iPAI capabilities including visualization field, imaging depth, and spatial resolution are not well understood in biological tissues commonly encountered in clinical practice. Therefore, the potential clinical utility of iPAI remains unclear. We aim to experimentally determine iPAI capabilities in a variety of biological tissues, to assess its potential for clinical translation. METHODS We constructed an iPAI system capable of simultaneous real-time ultrasound (US) and photoacoustic imaging. This system delivers light directly into tissues using optical fiber integrated into a 16-gauge needle and detects photoacoustic signals with an external linear array ultrasound probe. iPAI's geometric visualization field, maximum imaging depth, and spatial resolution were experimentally determined in fat, muscle, kidney, and liver tissues by processing photoacoustic signal intensities of reference targets placed circumferentially around the fiber tip. The maximum detection depths of blood and indocyanine green (ICG), important common endogenous and exogenous contrast agents, respectively, were estimated in each tissue type by comparing their signal intensities with the reference target signal. RESULTS iPAI could be performed in real-time concurrently with US and achieved a nearly spherical visualization field centering around the optical fiber tip in all tissues. Maximum imaging depths from the fiber tip were 54.1 ± 1.3, 50.0 ± 1.5, 32.7 ± 1.1, and 16.9 ± 1.3 mm in fat, muscle, kidney, and liver tissues, respectively. Calculated maximum detection depths for blood were 41.5 ± 3.0, 39.5 ± 2.1, 24.4 ± 4.0, and 8.6 ± 2.0 mm and detection depths for ICG at 0.05 mg/mL concentration were 46.6 ± 2.5, 42.6 ± 1.4, 28.2 ± 3.9, and 12.1 ± 1.5 mm in fat, muscle, kidney, and liver, respectively. Sub-100μ m axial resolution and submillimeter lateral resolution were achieved in all tissues, and resolution did not significantly vary with distance from the fiber tip. CONCLUSIONS Interventional photoacoustic imaging (iPAI) allows real-time visualization of a circumferential volume of tissue around an optical fiber tip, with submillimeter spatial resolution and tissue-dependent imaging depth. Our data strongly support further development of clinical iPAI systems as they could improve needle steering, target detection, and molecular and physiologic tissue assessment during minimally invasive procedures.
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Affiliation(s)
- Sharath K Bhagavatula
- Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Li Li
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Guillermo J Tearney
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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108
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St Jeor JD, Reisenauer CJ, Andrews JC, Fleming CJ, Misra S, Takahashi EA. Transjugular Renal Biopsy Bleeding Risk and Diagnostic Yield: A Systematic Review. J Vasc Interv Radiol 2020; 31:2106-2112. [PMID: 33023806 DOI: 10.1016/j.jvir.2020.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
This study aimed to better define the safety and efficacy of transjugular renal biopsy (TJRB) based on published studies. Seventeen published articles were included (1,321 biopsies). Complications were classified as major if they resulted in blood transfusion or additional invasive procedures. All other bleeding complications were considered minor. Diagnostic tissue was obtained in 1,193 procedures (90.3%). The total incidence of bleeding complications among 15 articles with complete data was 202 of 892 procedures (22.6%): 162 (18.2%) minor and 40 (4.5 %) major. These results show that TJRB is a feasible procedure for obtaining renal tissue for diagnosis and that most complications are self-limiting.
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Affiliation(s)
- Jeffery D St Jeor
- School of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Christopher J Reisenauer
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - James C Andrews
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Chad J Fleming
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Sanjay Misra
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905
| | - Edwin A Takahashi
- Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
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Murakonda VB, Mohapatra A, Geevar T, Vijayan R, Kakde S, Jacob S, Alexander S, David VG, Nair SC, Varughese S, Valson AT. Does Hemodialysis Need to be Initiated to Improve Platelet Function in CKD G5 Patients? A Pilot Prospective, Observational Cohort Study. Indian J Nephrol 2020; 31:43-49. [PMID: 33994687 PMCID: PMC8101674 DOI: 10.4103/ijn.ijn_232_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/17/2019] [Accepted: 05/06/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction: We previously showed that patients with chronic kidney disease (CKD) Stage G4-5 have normal bleeding times. This made us question whether hemodialysis (HD) initiation was really necessary solely to improve platelet function. Methods: In this prospective observational study, two 5 ml citrated blood samples and one 2 ml EDTA blood sample were collected from incident HD patients fulfilling inclusion criteria prior to HD initiation (baseline sample) and after three sessions of short duration, low flow, counter-current HD. In each instance, one sample was used to perform Collagen adenosine diphosphate closure time (CADPCT) using the Platelet function analyzer (PFA 200, normal range 68-142 seconds) and the second for light transmission aggregometry (LTA) with ADP as agonist (normal ≥50%). Results: This study included 20 patients between October 2017 and February 2019. Overall, and in the subgroup with normal baseline CADPCT or LTA, there was no statistically significant improvement after HD. However, of the 30% of patients who had an abnormal baseline CADPCT, 50% attained a normal value after three HD sessions, and the overall reduction in CADPCT in this group was statistically significant (P = 0.02). Of those with a baseline normal CADPCT, 21% developed abnormal prolongation post HD. Conclusion: HD for the sole purpose of improving platelet function is only of benefit in the subgroup of patients with an abnormal CADPCT at baseline, with close to 50% normalizing their platelet function after three sessions of low flow, short duration, counter-current HD.
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Affiliation(s)
- Vinod B Murakonda
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tulasi Geevar
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Vijayan
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shailesh Kakde
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinoi G David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sukesh C Nair
- Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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110
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Affiliation(s)
- Abbal Koirala
- Division of Nephrology, University of Washington, Seattle, Washington
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111
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Kajawo S, Ekrikpo U, Moloi MW, Noubiap JJ, Osman MA, Okpechi-Samuel US, Kengne AP, Bello AK, Okpechi IG. A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries. Kidney Int Rep 2020; 6:78-90. [PMID: 33426387 PMCID: PMC7783578 DOI: 10.1016/j.ekir.2020.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/22/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Kidney biopsy is an important tool for making diagnoses and for assessing the drug treatment requirements and disease prognosis in the management of kidney diseases. There are variations in the rate of complications associated with kidney biopsies across countries, and this depends on various clinical and technical factors. The aim of this study is to report on complications associated with kidney biopsy performed in low- and middle-income countries. Methods Two reviewers searched studies in MEDLINE, Embase, Cochrane Reviews, and African Journals Online. A random effects meta-analysis method was used to pool estimates of complications. Results We identified 39 studies reporting on 19,500 kidney biopsies with overall complications (major + minor) rate of 14.9% (95% confidence interval = 11.4%–18.7%). Fewer complications were reported in biopsies performed with real-time ultrasound scans compared to those pre-marked using ultrasound or blind procedures (12.4% vs. 14.9% vs. 24.5%; P = 0.037), respectively. Complications, albeit lower for procedures performed with automated needles (13.3%), were not significantly different from those performed with nonautomated needles (17.3%; P = 0.588). Major complications included macroscopic hematuria (1.48%), nephrectomy (0.04%), blood loss requiring red cell transfusion (0.24%), angiographic intervention (0.22%), and death (0.01%). Conclusion Complications associated with kidney biopsy in low- and middle-income countries are low, are comparable to those in other settings, and occur more sparingly when real-time ultrasound techniques or automated kidney biopsy needles are used. This suggests the need to expand the use of this procedure to improve diagnosis of kidney pathologies and choice of therapy when indicated.
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Affiliation(s)
- Shepherd Kajawo
- Department of Medicine, National University of Science and Technology, Bulawayo, Zimbabwe.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Renal Unit, Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Mothusi Walter Moloi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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112
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Sheth RA, Baerlocher MO, Connolly BL, Dariushnia SR, Shyn PB, Vatsky S, Tam AL, Gupta S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Needle Biopsy in Adult and Pediatric Patients. J Vasc Interv Radiol 2020; 31:1840-1848. [DOI: 10.1016/j.jvir.2020.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022] Open
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113
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Xu J, Wu X, Xu Y, Ren H, Wang W, Chen W, Shen P, Li X, Shi H, Xie J, Chen X, Zhang W, Pan X. Acute Kidney Disease Increases the Risk of Post-Kidney Biopsy Bleeding Complications. Kidney Blood Press Res 2020; 45:873-882. [PMID: 33105145 DOI: 10.1159/000509443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaojing Wu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yaowen Xu
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hong Ren
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weihong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Li
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hao Shi
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaoxia Pan
- Department of Nephrology, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China,
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114
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Poggio ED, McClelland RL, Blank KN, Hansen S, Bansal S, Bomback AS, Canetta PA, Khairallah P, Kiryluk K, Lecker SH, McMahon GM, Palevsky PM, Parikh S, Rosas SE, Tuttle K, Vazquez MA, Vijayan A, Rovin BH. Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications. Clin J Am Soc Nephrol 2020; 15:1595-1602. [PMID: 33060160 PMCID: PMC7646247 DOI: 10.2215/cjn.04710420] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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Affiliation(s)
- Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kristina N Blank
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pascale Khairallah
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Stewart H Lecker
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gearoid M McMahon
- Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul M Palevsky
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samir Parikh
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts.,Nephrology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katherine Tuttle
- Division of Nephrology, Providence Medical Research Center, Sacred Heart Medical Center, Spokane, Washington
| | - Miguel A Vazquez
- Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas
| | - Anitha Vijayan
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri
| | - Brad H Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
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115
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Halimi JM, Gatault P, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Grammatico-Guillon L, Fauchier L. Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study. Clin J Am Soc Nephrol 2020; 15:1587-1594. [PMID: 33060158 PMCID: PMC7646233 DOI: 10.2215/cjn.14721219] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of major bleeding and to build a preprocedure bleeding risk score. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study was a retrospective cohort study in all 52,138 patients who had a percutaneous native kidney biopsy in France in the 2010-2018 period. Measurements included major bleeding (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, or nephrectomy) at day 8 after biopsy and risk of death at day 30. Exposures and outcomes were defined by diagnosis codes. RESULTS Major bleeding occurred in 2765 of 52,138 (5%) patients (blood transfusions: 5%; angiographic intervention: 0.4%; and nephrectomy: 0.1%). Nineteen diagnoses were associated with major bleeding. A bleeding risk score was calculated (Charlson index [2-4: +1; 5 and 6: +2; >6: +3]; frailty index [1.5-4.4: +1; 4.5-9.5: +2; >9.5: +3]; women: +1; dyslipidemia: -1; obesity: -1; anemia: +8; thrombocytopenia: +2; cancer: +2; abnormal kidney function: +4; glomerular disease: -1; vascular kidney disease: -1; diabetic kidney disease: -1; autoimmune disease: +2; vasculitis: +5; hematologic disease: +2; thrombotic microangiopathy: +4; amyloidosis: -2; other kidney diagnosis: -1) + a constant of 5. The risk of bleeding went from 0.4% (lowest score group =0-4 points) to 33% (highest score group ≥35 points). Major bleeding was an independent risk of death (500 of 52,138 deaths: bleeding: 81 of 2765 [3%]; no bleeding: 419 of 49,373 [0.9%]; odds ratio, 1.95; 95% confidence interval, 1.50 to 2.54; P<0.001). CONCLUSIONS The risk of major bleeding after percutaneous native kidney biopsy may be higher than generally thought and is associated with a twofold higher risk of death. It varies widely but can be estimated with a score useful for shared decision making and procedure choice.
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Affiliation(s)
- Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France .,Equipe d'Accueil 4245, University of Tours, Tours, France.,Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, Vandœuvre-lès-Nancy, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Equipe d'Accueil 4245, University of Tours, Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, Vandœuvre-lès-Nancy, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France.,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Equipe d'Accueil 4245, University of Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
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116
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Bobart SA, Fervenza FC. Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: The Con View. KIDNEY360 2020; 1:890-893. [PMID: 35369550 PMCID: PMC8815595 DOI: 10.34067/kid.0003262020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Shane A. Bobart
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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117
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Nance ME, Tarim AO, Nguyen V, Malhotra K, Davis RM, Bhat AP. Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the "core" of the Problem? A Retrospective Case-control Study. J Clin Imaging Sci 2020; 10:54. [PMID: 33024609 PMCID: PMC7533095 DOI: 10.25259/jcis_87_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting. Material and Methods: A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated. Results: A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage. Conclusion: There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.
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Affiliation(s)
- Michael E Nance
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Andrew O Tarim
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Van Nguyen
- Departments of Pathology, University of Missouri, Columbia, Missouri, United States
| | - Kunal Malhotra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, Missouri, United States
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri, Columbia, Missouri, United States
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri, Columbia, Missouri, United States
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118
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Al-Balas A, Almehmi A, Allon M. Value of Immediate Post-Kidney Biopsy Ultrasound in Excluding Late Hemorrhagic Complications. KIDNEY360 2020; 1:797-800. [PMID: 35372962 PMCID: PMC8815738 DOI: 10.34067/kid.0002212020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/22/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hemorrhage is the most serious potential complication of percutaneous kidney biopsy. Patients are typically observed for at least 6-8 hours after a kidney biopsy, with serial measurements of vital signs and hemoglobin to monitor for major hemorrhage. This study assessed whether an immediate postbiopsy ultrasound can reliably exclude delayed major hemorrhage. METHODS We retrospectively evaluated the clinical outcomes in 147 patients undergoing an outpatient native kidney biopsy with an 18-gauge needle at a large medical center during a 2.5-year period (January 2017 to June 2019). All patients underwent a standardized postbiopsy ultrasound to assess for active extravasation of blood. We extracted from the medical records vital signs and hemoglobin values obtained before the biopsy and at 2, 4, and 6 hours after the procedure. We ascertained whether any patients with a negative postbiopsy ultrasound developed a delayed major hemorrhage. RESULTS Each patient underwent two or three biopsy passes. The mean patient age was 48±17 years, 49% were female, 37% were black, 53% had hypertension, and 16% had diabetes. Of the 142 patients without evidence of active extravasation on ultrasound, the BP, heart rate, and hemoglobin remained stable during 6 hours of observation. All were discharged after 6 hours, and none had a late bleeding complication. CONCLUSIONS If the immediate postkidney biopsy ultrasound does not show active bleeding, the patient is extremely unlikely to develop a late major hemorrhagic complication (negative predictive value, 100%). Such patients can be discharged home safely after a 2-hour observation, thereby simplifying their management.
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Affiliation(s)
- Alian Al-Balas
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ammar Almehmi
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
- Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
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119
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Xie W, Xu J, Xie Y, Lin Z, Xu X, Zhang X, Zhang Y. Adequacy and complication rates of percutaneous renal biopsy with 18- vs. 16-gauge needles in native kidneys in Chinese individuals. BMC Nephrol 2020; 21:337. [PMID: 32787784 PMCID: PMC7424979 DOI: 10.1186/s12882-020-01987-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 07/29/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Percutaneous renal biopsy (PRB) is the primary biopsy technique and it was used by 16G needles or 18G needles in China, but there is controversy about the effect and safety of the two different diameters. The study aims to compare the adequacy, complication rate and pathological classification when using 18G vs. 16G needles to perform renal biopsy with ultrasound-guidedance on native kidneys in Chinese individuals. METHODS We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients with the use of 18G or 16G needles from January 2011 to May 2017 and verified whether the needle gauge affected the disease diagnosis. RESULTS A total of 270 kidney biopsies were performed. Among them,72 were performed with 18G needles, and 198 were performed with 16G needles. There was no difference in the number of glomeruli under light microscope using 18G relative to 16G needles (24 ± 11 vs. 25 ± 11, p = 0.265), whereas more glomeruli were found in the 16G group than in the 16G group using immunofluorescence microscopy (3 ± 2 vs. 5 ± 3, p < 0.05). There was no significant difference in the adequate sample rates between the 18G group and the 16G group (90.28% vs. 93.94%, p = 0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs. 7.07%, p = 0.57), gross hematuria (4.17% vs. 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs. 1.52%, p = 0.195), were not significantly different between the 18G and 16G groups. In the 16G group, 2 cases of serious complications occurred: severe gross hematuria requiring blood transfusion and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, although there was no significant difference in serious complications rates between the 18G and 16G groups (0% vs. 1.02%, p = 1). CONCLUSION There was no significant difference in the number of glomeruli, adequate sample rates, or complication rates when using 18G or 16G needles to perform renal biopsy, and the use of an 18G needle with a smaller diameter did not affect the pathological diagnosis or classification of IgA nephropathy and lupus nephritis.
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Affiliation(s)
- Weiji Xie
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Xu
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yi Xie
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Zhijun Lin
- Department of Nephrology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaochang Xu
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Xialan Zhang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou, 515042, Guangdong, China.
| | - Yimin Zhang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.
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120
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Leclerc S, Nadeau-Fredette AC, Elftouh N, Lafrance JP, Pichette V, Laurin LP. Use of Desmopressin Prior to Kidney Biopsy in Patients With High Bleeding Risk. Kidney Int Rep 2020; 5:1180-1187. [PMID: 32775817 PMCID: PMC7403497 DOI: 10.1016/j.ekir.2020.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/24/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION To prevent bleeding after native kidney biopsy (NKB), nephrologists often prescribe desmopressin, especially for patients with reduced estimated glomerular filtration rate (eGFR) at risk of uremia-related platelet dysfunction. However, only 1 randomized study has suggested a beneficial effect for desmopressin in patients with eGFR ≥60 ml/min per 1.73 m2. This retrospective cohort study aimed to evaluate desmopressin effect on postbiopsy bleeding in all patients, regardless of eGFR and other comorbidities. METHODS In this retrospective cohort study, all adult patients who underwent an NKB from April 1, 2013, to April 30, 2018, in a tertiary hospital were identified. The association between desmopressin use and bleeding complications, including hemoglobin fall, transfusion, hematoma, symptomatic hematoma, urgent radiologic study, and hypotension, was analyzed using multivariable logistic regression models. RESULTS A total of 413 native kidney biopsies were studied, 79% of which were performed after receiving desmopressin. Patients receiving desmopressin had worse chronic kidney disease (eGFR 28 vs. 45 ml/min per 1.73 m2; P < 0.001) and were more often hospitalized (48% vs. 32%; P = 0.009). Despite higher bleeding risk, patients using desmopressin had a similar likelihood of symptomatic hematomas (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.13-1.14) and a lower need for urgent radiologic studies (OR, 0.33; 95% CI, 0.11-0.98). CONCLUSION Patients at higher risk of bleeding using desmopressin before kidney biopsy had bleeding complications similar to those not using desmopressin. These results highlight potential important clinical and financial benefits of desmopressin use before kidney biopsy.
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Affiliation(s)
- Simon Leclerc
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Naoual Elftouh
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Philippe Lafrance
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Pichette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, University of Montreal, Montreal, Quebec, Canada
| | - Louis-Philippe Laurin
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Research Center, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
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121
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McMahon GM, Amodu A, Sise ME, Mothi SS, Palsson R, Waikar SS. Physician Attitudes on Kidney Biopsies for Research: A Survey Study. Kidney Med 2020; 2:82-84. [PMID: 32734230 PMCID: PMC7380349 DOI: 10.1016/j.xkme.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gearoid M McMahon
- Renal Division, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Afolarin Amodu
- Renal Division, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA
| | - Meghan E Sise
- Harvard Medical School, Boston, MA.,Renal Division, Massachusetts General Hospital, Boston, MA
| | - Suraj Sarvode Mothi
- Renal Division, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Ragnar Palsson
- Renal Division, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Sushrut S Waikar
- Renal Division, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA.,Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA
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122
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Ren J, Yin X, Chen Y, Chen Y, Su H, Wang K, Zhang L, Zhu J, Zhang C. Alginate hydrogel-coated syringe needles for rapid haemostasis of vessel and viscera puncture. Biomaterials 2020; 249:120019. [DOI: 10.1016/j.biomaterials.2020.120019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 01/03/2023]
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123
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Iyama T, Takata T, Yamada K, Mae Y, Taniguchi S, Ida A, Ogawa M, Yamamoto M, Hamada S, Fukuda S, Kanda T, Sugihara T, Isomoto H, Urano Y. A novel method for assessing the renal biopsy specimens using an activatable fluorescent probe. Sci Rep 2020; 10:12094. [PMID: 32694710 PMCID: PMC7374171 DOI: 10.1038/s41598-020-69077-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/07/2020] [Indexed: 01/21/2023] Open
Abstract
Gamma-glutamyl hydroxymethyl rhodamine green (gGlu-HMRG) is an activatable fluorescent probe that can be activated by γ-glutamyltranspeptidase (GGT). The expression of GGT in the kidney, which is one of the major organs exhibiting enhanced GGT expression, is exclusively localised to the cortex. Here, we aimed to investigate the feasibility of gGlu-HMRG as a probe for the on-site assessment of renal biopsy specimens. gGlu-HMRG fluorescent probe was applied to the renal proximal tubular epithelial cells and cortical collecting duct cells in vitro, mouse kidneys ex vivo, and human biopsy specimens. In addition, the fluorescence intensities in the cortex and the medulla were comparatively evaluated in the biopsy specimens. The fluorescence signal was rapidly detected in the renal proximal tubular epithelial cells, whereas that in the cortical collecting duct cells was not detected. The fluorescence signal was detected in the mouse kidneys ex vivo without markedly affecting the tissue morphology. In the human biopsy specimens, the fluorescence signal in the cortex was significantly distinct from that in the medulla (p < 0.05). Thus, this fluorescent probe can be used to distinctly identify the renal cortex in the biopsy specimens.
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Affiliation(s)
- Takuji Iyama
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Tomoaki Takata
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan.
| | - Kentaro Yamada
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Yukari Mae
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Sosuke Taniguchi
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Ayami Ida
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Masaya Ogawa
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Marie Yamamoto
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Shintaro Hamada
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Satoko Fukuda
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Tsutomu Kanda
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Takaaki Sugihara
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Tottori University Faculty of Medicine, 36-1, Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Yasuteru Urano
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Hogan JJ, Owen JG, Blady SJ, Almaani S, Avasare RS, Bansal S, Lenz O, Luciano RL, Parikh SV, Ross MJ, Sharma D, Szerlip H, Wadhwani S, Townsend RR, Palmer MB, Susztak K, Mottl AK. The Feasibility and Safety of Obtaining Research Kidney Biopsy Cores in Patients with Diabetes: An Interim Analysis of the TRIDENT Study. Clin J Am Soc Nephrol 2020; 15:1024-1026. [PMID: 32341009 PMCID: PMC7341767 DOI: 10.2215/cjn.13061019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jonathan J. Hogan
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan G. Owen
- Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Shira J. Blady
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Salem Almaani
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rupali S. Avasare
- Division of Nephrology, Oregon Health & Science University, Portland, Oregon
| | - Shweta Bansal
- Division of Nephrology, University of Texas Health at San Antonio, San Antonio, Texas
| | - Oliver Lenz
- Division of Nephrology and Hypertension, Department of Medicine, University of Miami Leonard Miller School of Medicine, Miami, Florida
| | - Randy L. Luciano
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Samir V. Parikh
- Division of Nephrology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Michael J. Ross
- Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Deep Sharma
- Division of Nephrology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Harold Szerlip
- Division of Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Shikha Wadhwani
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raymond R. Townsend
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew B. Palmer
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katalin Susztak
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy K. Mottl
- University of North Carolina Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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125
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Gagnon MH, Lin MF, Lancia S, Salter A, Yano M. A Color Flow Tract in Ultrasound-Guided Random Renal Core Biopsy Predicts Complications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1335-1342. [PMID: 31995242 DOI: 10.1002/jum.15227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine patient and procedural risk factors for major complications in ultrasound (US)-guided random renal core biopsy. METHODS Random renal biopsies performed by radiologists in the US department at a single institution between 2014 and 2018 were retrospectively reviewed. The patient's age, sex, race, and estimated glomerular filtration rate (eGFR) were recorded. The biopsy approach, needle gauge, length of cores, number of throws, and presence of a color flow tract were recorded. Outcome data included minor and major complications. Associations between variables were tested with χ2 analyses and univariable/multivariable logistic regression models. RESULTS A total of 231 biopsies (167 native and 64 allografts) were reviewed. There was no significant difference in the sex, age, race, or eGFR between native and allograft groups. The overall rate for any complication was 18.2%, with a 4.3% rate of major complications, which was significantly greater in native compared to allograft biopsies (6% versus 0%; P = .045). A risk analysis in native biopsies only showed that major complications were significantly associated with a low eGFR such that patients with stage 4 or 5 kidney disease had higher odds of complications (odds ratio [95% confidence interval]: stage 4, 9.405 [1.995-44.338]; P = .0393; stage 5, 10.749 [2.218-52.080]; P = .0203) than patients with normal function (eGFR >60 mL/min). The presence of a color flow tract portended a 10.7 times greater risk of having any complication (95% confidence interval, 4.595-24.994; P < .001). Other procedural factors were not significantly associated with complications. CONCLUSIONS There is an increased risk of major complications in US-guided random native kidney biopsy in patients with a low eGFR (<30 mL/min) and a patent color flow tract in the immediate postbiopsy setting.
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Affiliation(s)
| | | | - Samantha Lancia
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Amber Salter
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
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126
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Affiliation(s)
| | - W Charles O'Neill
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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127
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Gal-Oz A, Papushado A, Kirgner I, Meirsdorf S, Schwartz D, Schwartz IF, Zubkov A, Grupper A. Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy. Ren Fail 2020; 42:10-18. [PMID: 31842662 PMCID: PMC6968702 DOI: 10.1080/0886022x.2019.1700805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Introduction The risk of bleeding has led to screening of the primary hemostasis before renal biopsy. A bleeding time test (BT) is considered standard practice, but reliance on this test is controversial and its benefits remain questionable. A possible alternative is thromboelastography (TEG). However, data regarding TEG in patients with renal dysfunction is limited. Objectives To determine TEG abnormalities and their consequences in patients who underwent a native kidney biopsy. Methods A retrospective study of 417 consecutive percutaneous native renal biopsies performed in our Center. If serum creatinine >1.5 mg/dL, the patient underwent either a BT test (period A, January 2015–31 December 2016) or TEG (period B, January 2017–August 2018). In patients with prolonged BT, or an abnormal low maximal amplitude (MA) parameter of TEG, or suspected clinical uremic thrombopathy, the use of desmopressin acetate (DDAVP) was considered. Results Most biopsies (90.6%) were done by the same dedicated radiologist. Fifty-one patients had a BT test, which was normal in all tested patients. Seventy-one patients underwent TEG, and it was abnormal in 34 of them, most patients had combined abnormalities. The only parameter related to abnormal TEG was older age (Odds Ratio 1.21 [95% CI 1.09–2.38] p = 0.04 for abnormal Kinetics; OR 1.37 (1.05–1.96) p = 0.037 for abnormal MA). Twenty-six patients (6.23%) had bleeding complications. Risk of bleeding was significantly related to age (1.4 [1.11–7.48] p = 0.04), systolic blood pressure (1.85 [1.258–9.65] p = 0.02), and serum creatinine (1.21 [1.06–3.134] p = 0.048). Conclusions TEG abnormalities in patients with renal dysfunction are variable and fail to predict bleeding during kidney biopsy. The decision to administer DDAVP as a preventive measure during these procedures should be based on clinical judgment only.
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Affiliation(s)
- Amir Gal-Oz
- ICU Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amitay Papushado
- Department of Internal Medicine "B", Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilya Kirgner
- Hematology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Meirsdorf
- Radiology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Idit Francesca Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asia Zubkov
- Pathology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Grupper
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Vargas J, Le P, Shahedi M, Gahan J, Johnson B, Dormer JD, Shahub S, Pfefferle M, Judson BO, Alshara Y, Li Q, Fei B. A complex dual-modality kidney phantom for renal biopsy studies. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11319. [PMID: 32476707 DOI: 10.1117/12.2549892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We developed a reliable and repeatable process to create hyper-realistic, kidney phantoms with tunable image visibility under ultrasound (US) and CT imaging modalities. A methodology was defined to create phantoms that could be produced for renal biopsy evaluation. The final complex kidney phantom was devised containing critical structures of a kidney: kidney cortex, medulla, and ureter. Simultaneously, some lesions were integrated into the phantom to mimic the presence of tumors during biopsy. The phantoms were created and scanned by ultrasound and CT scanners to verify the visibility of the complex internal structures and to observe the interactions between material properties. The result was a successful advancement in knowledge of materials with ideal acoustic and impedance properties to replicate human organs for the field of image-guided interventions.
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Affiliation(s)
- Jose Vargas
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Phuc Le
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Maysam Shahedi
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Jeffrey Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Brett Johnson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - James D Dormer
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Sarah Shahub
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | | | - Blake O Judson
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Yasmeen Alshara
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Qinmei Li
- Department of Bioengineering, The Univ. of Texas at Dallas, TX
| | - Baowei Fei
- Department of Bioengineering, The Univ. of Texas at Dallas, TX.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX.,Dept. of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Schorr M, Roshanov PS, Weir MA, House AA. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Can J Kidney Health Dis 2020; 7:2054358120923527. [PMID: 32547772 PMCID: PMC7251654 DOI: 10.1177/2054358120923527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background and Objectives: The risk and timing of bleeding events following ultrasound-guided
percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: We performed a retrospective study of 617 consecutive adult patients who
underwent kidney biopsy between 2012 and 2017 at a tertiary academic
hospital in London, Canada. We assessed frequency and timing of minor (not
requiring intervention) and major (requiring blood transfusion, surgery, or
embolization) bleeds and developed a personalized risk calculator for
these. Results: Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]:
10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI:
8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI:
1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%)
and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three
of 79 events were identified immediately on post-procedure ultrasound (92.4%
of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor
event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients
(0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not
recognized immediately; both required blood transfusions only. There were no
deaths or nephrectomies. A risk calculator using age, body mass index,
platelet count, hemoglobin concentration, size of the target kidney, and
whether the kidney is native, or an allograft predicted minor (C-statistic,
0.70) and major bleeding (C-statistic, 0.83). Conclusions: This retrospective study of 617 patients who had percutaneous
ultrasound-guided renal biopsies supports the safety of short post-biopsy
monitoring for most patients. A risk calculator can further personalize
estimates of complication risk (http://perioperativerisk.com/kbrc).
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Affiliation(s)
- Melissa Schorr
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
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130
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Risk of incident bleeding after acute kidney injury: A retrospective cohort study. J Crit Care 2020; 59:23-31. [PMID: 32485439 DOI: 10.1016/j.jcrc.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/07/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE End-stage kidney disease (ESKD) causes bleeding diathesis; however, whether these findings are extrapolable to acute kidney injury (AKI) remains uncertain. We assessed whether AKI is associated with an increased risk of bleeding. METHODS Single-center retrospective cohort study, excluding readmissions, admissions <24 h, ESKD or kidney transplants. The primary outcome was the development of incident bleeding analyzed by multivariate time-dependent Cox models. RESULTS In 1001 patients, bleeding occurred in 48% of AKI and 57% of non-AKI patients (p = .007). To identify predictors of incident bleeding, we excluded patients who bled before ICU (n = 488). In bleeding-free patients (n = 513), we observed a trend toward higher risks of bleeding in AKI (22% vs. 16%, p = .06), and a higher risk of bleeding in AKI-requiring dialysis (38% vs. 17%, p = .01). Cirrhosis, AKI-requiring dialysis, anticoagulation, and coronary artery disease were associated with bleeding (HR 3.67, 95%CI:1.33-10.25; HR 2.82, 95%CI:1.26-6.32; HR 2.34, 95%CI:1.45-3.80; and HR 1.84, 95%CI:1.06-3.20, respectively), while SOFA score and sepsis had a protective association (HR 0.92 95%CI:0.84-0.99 and HR 0.55, 95%CI:0.34-0.91, respectively). Incident bleeding was not associated with mortality. CONCLUSIONS AKI-requiring dialysis was associated with incident bleeding, independent of anticoagulant administration. Studies are needed to better understand how AKI affects coagulation and clinical outcomes.
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Çildağ MB, Gök M, Abdullayev O. Pre-procedural shear wave elastography on prediction of hemorrhage after percutaneous real-time ultrasound-guided renal biopsy. Radiol Med 2020; 125:784-789. [PMID: 32200456 DOI: 10.1007/s11547-020-01176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/16/2020] [Indexed: 03/30/2024]
Abstract
PURPOSE To evaluate the relationship between renal elasticity which was determined with shear wave elastography (SWE) and hemorrhage in patients who undergone percutaneous renal parenchyma biopsy (PRB). MATERIALS AND METHODS In total, 60 patients who were performed ultrasound-guided PRB after the B-mode ultrasonography and SWE assessment were recruited in this study. All patients' serum creatinine, blood urea nitrogen and coagulation tests before PRB were obtained from medical records. The patients were divided into two groups who did and did not develop hemorrhage after PRB. We investigated whether there was any statistically significant difference between the two groups in terms of laboratory findings, B-mode ultrasonographic measurements and SWE measurements. RESULTS Of the 60 patients, 23 (38.3%) had post-procedure hemorrhage and 37 (61.7%) had not. Mean hemorrhage size was 17.04 mm (7-50 mm). The mean value of renal cortical shear wave velocity of all patients was 1.91 m/s (0.96-3.57 m/sn). Patients with post-procedure hemorrhage had significantly lower mean shear wave velocity compared with patients with no hemorrhage (p < 0.05). ROC curve analysis suggested that the optimum SWV cutoff point for hemorrhage presence was 1.21 m/sn, with 39.1% sensitivity and 97.3% specificity. There was no other statistically significant demographic, ultrasonographic or laboratory value differences between two groups. CONCLUSION Although shear wave velocities have low sensitivity for hemorrhage after renal biopsy, high specificity and statistically significant difference in hemorrhage and non-hemorrhage group suggest that patients who have lower renal cortical shear wave velocity have a tendency to hemorrhage after PRB.
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Affiliation(s)
- Mehmet Burak Çildağ
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey.
| | - Mustafa Gök
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey
| | - Oguz Abdullayev
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey
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A nationwide survey on clinical practice patterns and bleeding complications of percutaneous native kidney biopsy in Japan. Clin Exp Nephrol 2020; 24:389-401. [PMID: 32189101 PMCID: PMC7174253 DOI: 10.1007/s10157-020-01869-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/01/2020] [Indexed: 12/29/2022]
Abstract
Background Practice patterns and bleeding complications of percutaneous native kidney biopsy (PNKB) have not recently been investigated and the Japanese Society of Nephrology performed a nationwide questionnaire survey in 2018. Methods The survey consisted of nine sections about PNKB: (1) general indications; (2) indications for high-risk patients; (3) informed consent; (4) pre-biopsy evaluation; (5) procedures; (6) sedation; (7) post-biopsy hemostasis, bed rest, and examinations; (8) bleeding complications; and (9) specimen processing. A supplementary survey examined bleeding requiring transcatheter arterial embolization (TAE). Results Overall, 220 directors of facilities (nephrology facility [NF], 168; pediatric nephrology facility [PF], 52) completed the survey. Indications, procedures, and monitoring protocols varied across facilities. Median lengths of hospital stay were 5 days in NFs and 6 days in PFs. Gauge 14, 16, 18 needles were used in 5%, 56%, 33% in NFs and 0%, 63%, 64% in PFs. Mean limits of needle passes were 5 in NFs and 4 in PFs. The bed rest period was 16–24 h in 60% of NFs and 65% of PFs. Based on 17,342 PNKBs, incidence rates of macroscopic hematuria, erythrocyte transfusion, and TAE were 3.1% (NF, 2.8%; PF, 6.2%), 0.7% (NF, 0.8%; PF, 0%), and 0.2% (NF, 0.2%; PF, 0.06%), respectively. Forty-six percent of facilities processed specimens all for light microscopy, immunofluorescence, and electron microscopy, and 21% processed for light microscopy only. Timing of bleeding requiring TAE varied among PNKB cases. Conclusion Wide variations in practice patterns of PNKB existed among facilities, while PNKBs were performed as safely as previously reported. Electronic supplementary material The online version of this article (10.1007/s10157-020-01869-w) contains supplementary material, which is available to authorized users.
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133
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Palsson R, Short SAP, Kibbelaar ZA, Amodu A, Stillman IE, Rennke HG, McMahon GM, Waikar SS. Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort. Kidney Int Rep 2020; 5:511-518. [PMID: 32274455 PMCID: PMC7136322 DOI: 10.1016/j.ekir.2020.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background The major risk of kidney biopsy is severe bleeding. Numerous risk factors for bleeding after biopsy have been reported, but findings have been inconsistent. Methods We retrospectively reviewed medical records of adult patients enrolled in a native kidney biopsy cohort study to identify major bleeding events (red blood cell [RBC] transfusions, invasive procedures, kidney loss, or death). We used logistic and linear regression models to identify characteristics associated with postbiopsy RBC transfusions and decline in hemoglobin within a week after the procedure. Results Major bleeding events occurred in 28 of 644 (4.3%) patients (28 required an RBC transfusion, 4 underwent angiographic intervention, and 1 had open surgery to control bleeding). No patient lost a kidney or died because of the biopsy. Postbiopsy RBC transfusion risk was driven by the baseline hemoglobin level (odds ratio [OR] 13.6; 95% confidence interval [CI] 5.4–34.1 for hemoglobin <10 vs. ≥10 g/dl). After adjusting for hemoglobin, no other patient characteristics were independently associated with RBC transfusions. Female sex (β = 0.18; 95% CI: 0.04–0.32), estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (β = 0.32; 95% CI: 0.14–0.49), and baseline hemoglobin (β = 0.09; 95% CI: 0.05–0.13, per g/dl increase) were independently associated with a larger drop in hemoglobin. Histopathologic lesions were not independently associated with major bleeding after biopsy. Conclusion Biopsies were generally well tolerated. Baseline hemoglobin was the dominant risk factor for RBC transfusions, but female sex and eGFR <30 ml/min per 1.73 m2 were also associated with a larger decline in hemoglobin after the procedure.
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Affiliation(s)
- Ragnar Palsson
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Division of Nephrology, National University Hospital of Iceland, Reykjavik, Iceland
| | - Samuel A P Short
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Zoe A Kibbelaar
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
| | - Afolarin Amodu
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
| | - Isaac E Stillman
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gearoid M McMahon
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sushrut S Waikar
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Renal Section, Boston University Medical Center, Boston, Massachusetts, USA
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134
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Qualls D, Seethapathy H, Bates H, Tajmir S, Heidari P, Endres P, Reynolds K, Lawrence D, Sise M. Positron emission tomography as an adjuvant diagnostic test in the evaluation of checkpoint inhibitor-associated acute interstitial nephritis. J Immunother Cancer 2019; 7:356. [PMID: 31864416 PMCID: PMC6925427 DOI: 10.1186/s40425-019-0820-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background Acute interstitial nephritis is an immune-related adverse event that can occur in patients receiving immune checkpoint inhibitor therapy. Differentiating checkpoint inhibitor-associated acute interstitial nephritis from other causes of acute kidney injury in patients with cancer is challenging and can lead to diagnostic delays and/or unwarranted immunosuppression. In this case report, we assess the use of 18F-flourodeoxyglucose positron-emission tomography imaging as an alternative diagnostic modality in the evaluation of potential acute interstitial nephritis. Case presentation A 55-year-old woman with metastatic vulvar melanoma underwent treatment with two cycles of ipilimumab plus nivolumab, followed by seven cycles of nivolumab combined with radiation therapy. During her treatment, she developed non-oliguric acute kidney injury to a creatinine of 4.5 mg/dL from a baseline of 0.5 mg/dL. A clinical diagnosis of acute interstitial nephritis was made, and steroids were initiated, with rapid improvement of her acute kidney injury. Retrospectively, four positron-emission tomography scans obtained for cancer staging purposes were reviewed. We found a markedly increased 18F-flourodeoxyglucose uptake in the renal cortex at the time acute interstitial nephritis was diagnosed compared to baseline. In three cases of acute kidney injury due to alternative causes there was no increase in 18F-flourodeoxyglucose uptake from baseline. Conclusions To our knowledge, this is the first report describing increased 18F-flourodeoxyglucose uptake in the renal cortex in a patient with checkpoint inhibitor-associated acute interstitial nephritis. Our findings suggest that 18F-flourodeoxyglucose positron-emission tomography may be a valuable test for diagnosing immune-mediated nephritis, particularly in patients where timely kidney biopsy is not feasible.
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Affiliation(s)
- David Qualls
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street Suite 302, Boston, MA, 02114, USA
| | | | - Shahein Tajmir
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Endres
- Division of Nephrology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street Suite 302, Boston, MA, 02114, USA
| | - Kerry Reynolds
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Donald Lawrence
- Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Meghan Sise
- Division of Nephrology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street Suite 302, Boston, MA, 02114, USA.
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Pombas B, Rodríguez E, Sánchez J, Radosevic A, Gimeno J, Busto M, Barrios C, Sans L, Pascual J, Soler MJ. Risk Factors Associated with Major Complications after Ultrasound-Guided Percutaneous Renal Biopsy of Native Kidneys. Kidney Blood Press Res 2019; 45:122-130. [PMID: 31822004 DOI: 10.1159/000504544] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Percutaneous renal biopsy (PRB) of native kidneys is an important tool for diagnosis and management of renal disease. In this study, we analyzed the success, safety, and risk complications of PRB in our center. METHODS A retrospective review of ultrasound-guided PRB done at our institution from January 1998 to December 2017 was performed. Clinical and laboratory data were collected for 661 PRBs. Statistical analysis was performed using the Mann-Whitney U test for continuous variable and chi-square test for categorical variables. Multivariate analysis using logistic regression was performed to assess factors associated with increased risk of complications after PRB. RESULTS The median age was 56 (42-68) years old, the majority were male (64%) and white (82%). Ten glomeruli were present in 63.5% of PRBs. Overall, the rate of complications was 16.6%, where 15.1% of them were minor complications and 1.5% were major complications. Perinephritic hematoma accounted for the minor complication that occurred most frequently, whereas the need of a blood transfusion was the prevalent for major complications. By multivariate analysis, increased activated partial thromboplastin time (aPTT; OR 1.11, 95% CI 1.035-1.180) and prebiopsy lower hemoglobin (Hgb; OR 1.61, 95% CI 1.086-2.304) were identified as independent risk factors for major complications. In addition, older patients (OR 1.057, 95% CI 1.001-1.117) were identified as an independent risk factor for blood transfusion requirement. CONCLUSION The current risk of complications after native PRB is low. Major complications are most common in case of increased aPTT and decreased Hgb baseline level.
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Affiliation(s)
- Beatriz Pombas
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan Sánchez
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Aleksandar Radosevic
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Javier Gimeno
- Department of Pathology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marcos Busto
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Clara Barrios
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laia Sans
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - María José Soler
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain, .,Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain,
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136
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Athavale A, Kulkarni H, Arslan CD, Hart P. Desmopressin and bleeding risk after percutaneous kidney biopsy. BMC Nephrol 2019; 20:413. [PMID: 31730448 PMCID: PMC6858772 DOI: 10.1186/s12882-019-1595-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Desmopressin 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. Methods Retrospective 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. Results Desmopressin 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). Conclusion Desmopressin 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.
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Affiliation(s)
- Ambarish Athavale
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA.
| | | | - Cagil D Arslan
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA
| | - Peter Hart
- Division of Nephrology, Cook County Health, 1950 W. Polk Street, 5th Floor, Chicago, IL, 60605, USA
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137
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MacGinley R, Champion De Crespigny PJ, Gutman T, Lopez-Vargas P, Manera K, Menahem S, Saunders J, See E, Voss D, Wong J. KHA-CARI Guideline recommendations for renal biopsy. Nephrology (Carlton) 2019; 24:1205-1213. [PMID: 31490584 DOI: 10.1111/nep.13662] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/13/2019] [Accepted: 08/17/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Rob MacGinley
- Department of Renal and General Medicine, Eastern Health Clinical School, Monash University Melbourne, Melbourne, Victoria, Australia
| | - Paul J Champion De Crespigny
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Talia Gutman
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Pamela Lopez-Vargas
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Karine Manera
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Solomon Menahem
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - John Saunders
- Renal Unit, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Emily See
- Department of Nephrology, Monash Health, Melbourne, Victoria, Australia
| | - David Voss
- Counties Manukau Health, Auckland, New Zealand
| | - Jeffrey Wong
- Department of Nephrology, Liverpool Hospital, Liverpool, New South Wales, Australia
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138
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Peters B, Nasic S, Segelmark M. Clinical parameters predicting complications in native kidney biopsies. Clin Kidney J 2019; 13:654-659. [PMID: 32905412 PMCID: PMC7467621 DOI: 10.1093/ckj/sfz132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Renal biopsies are essential in nephrology but they are invasive and complications can occur. The aim of this study was to explore clinical parameters that can be used as predictors for biopsy complications. Methods Clinical parameters such as demographics, biopsy indications, serology, comorbidities and clinical chemistry were retrieved from a regional biopsy registry between 2006 and 2015 and from a nationwide registry between 2015 and 2017. Clinical data before biopsy were compared with data on major biopsy complications. Fisher’s exact and χ2 tests were used and odds ratios (ORs) with 95% confidence intervals (CIs) were presented. Univariate and multiple binary logistic regression analyses were performed with complications as outcome. A two-sided P-value <0.05 was considered significant. Results In total, 2835 consecutive native kidney biopsies were analysed (39% women and 61% men, median age 57 years). No death and nephrectomy due to biopsy complications were registered. The frequency of major biopsy complications was 5.65%. In the multiple logistic regression, the risk for complications increased in women [OR 1.51 (95% CI 1.08–2.11)] and decreased with age: 45–64 years age group [OR 0.66 (95% CI 0.44–0.99)] and >74 years age group [OR 0.51 (95% CI 0.27–0.96)]. Among comorbidities, patients with diabetes mellitus type 2 [OR 2.07 (95% CI 1.15–3.72)] and non-ischaemic heart disease [OR 3.20 (95% CI 1.64–6.25)] had a higher risk for major biopsy complications. Conclusions Female gender, younger age (≤44 years), diabetes mellitus type 2 and non-ischaemic heart disease were found as risk factors for major biopsy complications.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Salmir Nasic
- Research and Development Centre (FoU) at Skaraborg Hospital, Skövde, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences, Nephrology, Lund University, Lund, Sweden
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139
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Role of MR texture analysis in histological subtyping and grading of renal cell carcinoma: a preliminary study. Abdom Radiol (NY) 2019; 44:3336-3349. [PMID: 31300850 DOI: 10.1007/s00261-019-02122-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The study evaluated the usefulness of magnetic resonance imaging (MRI) texture parameters in differentiating clear cell renal carcinoma (CC-RCC) from non-clear cell carcinoma (NC-RCC) and in the histological grading of CC-RCC. MATERIALS AND METHODS After institutional ethical approval, this retrospective study analyzed 33 patients with 34 RCC masses (29 CC-RCC and five NC-RCC; 19 low-grade and 10 high-grade CC-RCC), who underwent MRI between January 2011 and December 2012 on a 1.5-T scanner (Avanto, Siemens, Erlangen, Germany). The MRI protocol included T2-weighted imaging (T2WI), diffusion-weighted imaging [DWI; at b 0, 500 and 1000 s/mm2 with apparent diffusion coefficient (ADC) maps] and T1-weighted pre and postcontrast [corticomedullary (CM) and nephrographic (NG) phase] acquisition. MR texture analysis (MRTA) was performed using the TexRAD research software (Feedback Medical Ltd., Cambridge, UK) by a single reader who placed free-hand polygonal region of interest (ROI) on the slice showing the maximum viable tumor. Filtration histogram-based texture analysis was used to generate six first-order statistical parameters [mean intensity, standard deviation (SD), mean of positive pixels (MPP), entropy, skewness and kurtosis] at five spatial scaling factors (SSF) as well as on the unfiltered image. Mann-Whitney test was used to compare the texture parameters of CC-RCC versus NC-RCC, and high-grade versus low-grade CC-RCC. P value < 0.05 was considered significant. A 3-step feature selection was used to obtain the best texture metrics for each MRI sequence and included the receiver-operating characteristic (ROC) curve analysis and Pearson's correlation test. RESULTS The best performing texture parameters in differentiating CC-RCC from NC-RCC for each sequence included (area under the curve in parentheses): entropy at SSF 4 (0.807) on T2WI, SD at SSF 4 (0.814) on DWI b500, SD at SSF 6 (0.879) on DWI b1000, mean at SSF 0 (0.848) on ADC, skewness at SSF 2 (0.854) on T1WI and skewness at SSF 3 (0.908) on CM phase. In differentiating high from low-grade CC-RCC, the best parameters were: entropy at SSF 6 (0.823) on DWI b1000, mean at SSF 3 (0.889) on CM phase and MPP at SSF 5 (0.870) on NG phase. CONCLUSION Several MR texture parameters showed excellent diagnostic performance (AUC > 0.8) in differentiating CC-RCC from NC-RCC, and high-grade from low-grade CC-RCC. MRTA could serve as a useful non-invasive tool for this purpose.
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140
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Rao NS, Chandra A. Intranasal desmopressin reduces renal biopsy-related bleeding and serum sodium levels in patients with reduced renal function. Clin Kidney J 2019; 13:1063-1067. [PMID: 33391750 PMCID: PMC7769509 DOI: 10.1093/ckj/sfz114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background The use of desmopressin in preventing renal biopsy-related bleeding is not established and its effects on serum sodium levels are not well studied. The study aimed to compare the bleeding complication rates between the groups with and without desmopressin use prebiopsy and to observe the effect of desmopressin on postbiopsy serum sodium levels. Methods In this single-center, prospective and retrospective interventional study, from June 2018 onwards, patients with serum creatinine >132.6 μmol/L but not on dialysis and undergoing ultrasound-assisted needle-guided renal biopsy received 150 μg of desmopressin (D-amino D-arginine vasopressin (DDAVP)) (Group II). Data from patients from June 2017 to May 2018 were included in Group I in whom desmopressin was not used. Bleeding complications were monitored by clinical and ultrasound surveillance. Serum sodium levels were checked prior to and 24 h following desmopressin in Group II. Results A total of 194 patients were included in the study: 105 in Group I and 89 in Group II. Group II had lower overall minor bleeding complications and perinephric hematomas than Group I (15.7% versus 31.4%, 14% versus 27% and 7.8% versus 19% in Group II and Group I, respectively, with P < 0.05). Not using desmopressin and female sex were significant predictors for overall risk of bleeding on multivariate logistic regression. Serum sodium levels fell in 94% of patients in Group II. Lower prebiopsy serum sodium, higher estimated glomerular function rate and higher spot urine sodium values were associated with a greater decrease in serum sodium after desmopressin. Conclusion Intranasal desmopressin reduces bleeding complications during renal biopsies performed in patients with reduced renal function not requiring dialysis, albeit with a risk of developing hyponatremia.
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Affiliation(s)
- Namrata S Rao
- Department of Nephrology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Abhilash Chandra
- Department of Nephrology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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141
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Diagnostic role of renal biopsy in PLA 2R1-antibody-positive patients with nephrotic syndrome. Mod Pathol 2019; 32:1320-1328. [PMID: 30962506 DOI: 10.1038/s41379-019-0267-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022]
Abstract
Renal biopsy is the gold standard for diagnosis of membranous nephropathy. Circulating PLA2R1 antibody found in 75% of patients with membranous nephropathy is very specific for the diagnosis of this disease. Therefore, the question arises whether PLA2R1-antibody-positive patients still need a diagnostic renal biopsy. In this study we investigated whether additional relevant information is obtained by performing renal biopsy in nephrotic patients, who are PLA2R1-antibody positive. A detailed analysis of renal biopsies, including immunohistochemistry and electron microscopy, was performed in 263 patients with biopsy-proven membranous nephropathy, of whom 194 patients were PLA2R1-antibody positive, to detect diagnostic features additional to membranous nephropathy. Twelve (6%) of the 194 PLA2R1-antibody-positive patients had a second relevant diagnosis in addition to membranous nephropathy: five (3%) patients had interstitial nephritis, in five (3%) other patients a diabetic nephropathy was diagnosed and two (1%) patients had IgA nephropathy. Patients with a second diagnosis in addition to membranous nephropathy had a significantly higher serum creatinine (p < 0.01) and lower eGFR (p = 0.04) compared to patients in whom only the diagnosis of membranous nephropathy was made. In 7 (10%) of 69 PLA2R1-antibody-negative patients, renal biopsies showed an additional diagnosis to membranous nephropathy: one (1%) case of IgA nephropathy, cholesterol emboli, IgG4-related disease, necrotising glomerulonephritis, thrombotic microangiopathy, interstitial nephritis and diabetic nephropathy each. The advantage of detecting an additional diagnosis to membranous nephropathy in 6% of PLA2R1-antibody-positive patients by renal biopsy has to be balanced to the potential risks and costs of the biopsy procedure. Renal biopsy is particularly relevant in patients presenting with impaired renal function and abnormalities in urinalysis going beyond proteinuria. Immunohistochemical staining for PLA2R1 was the only histomorphologic analysis allowing a reliable differentiation of PLA2R1-antibody-positive from PLA2R1-antibody-negative membranous nephropathy.
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142
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Wendt R, Schliecker J, Beige J. Inflammatory leucocyte infiltrates are associated with recovery in biopsy-proven acute interstitial nephritis: a 20-year registry-based case series. Clin Kidney J 2019; 12:814-820. [PMID: 31808445 PMCID: PMC6885674 DOI: 10.1093/ckj/sfz097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Indexed: 12/15/2022] Open
Abstract
Background Acute interstitial nephritis (AIN) is a renal injury causing renal function deterioration and requiring renal replacement therapy (RRT) in a substantial number of cases. Therapy is based on withdrawal of suspicious causative drugs or the underlying diseases and/or steroid application if renal function is not restored after cessation of the underlying condition. Hard clinical evidence for augmenting steroid therapy is not available. Methods We reviewed the course and diagnosis for >20 years among all 1126 biopsied samples of our tertiary renal centre. Results 49 (4.4%) were diagnosed with primary AIN, corresponding to an annual incidence of 1/100 000 population; 17 out of 49 biopsy-proven AIN patients required short-term or long-term (n = 5) RRT. According to a combined outcome criterion of coming off dialysis and/or reaching serum creatinine <200 µmol/L, 19 patients reached recovery whereas 20 did not. Among 39 patients with a comprehensive clinical and histopathological data set, presence of cortical scars, AIN histological activity (acute leucocyte infiltrates) and proteinuria were baseline parameters discriminating significantly between groups with or without recovery. No associations with the presence of specific drugs were found. Therapeutic use of steroids was associated with a lower probability of recovery (P = 0.008), presumably due to inclusion bias. Conclusions Following our basic finding of the importance of histopathological parameters of acuity associated with recovery, we argue for the inauguration of grading measures to characterize this issue quantitatively and make it usable for future controlled investigations. Finally, we provide a suggestion for a therapeutic algorithm in the management of AIN.
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Affiliation(s)
- Ralph Wendt
- Division of Nephrology and Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St Georg, Leipzig, Germany
| | - Jennifer Schliecker
- Division of Nephrology and Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St Georg, Leipzig, Germany
| | - Joachim Beige
- Division of Nephrology and Kuratorium for Dialysis and Transplantation (KfH) Renal Unit, Hospital St Georg, Leipzig, Germany.,Department of Internal Medicine II, Division of Nephrology and Rheumatology, Martin-Luther-University Halle/Wittenberg, Halle (Saale), Germany
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143
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Percutaneous Kidney Biopsy and the Utilization of Blood Transfusion and Renal Angiography Among Hospitalized Adults. Kidney Int Rep 2019; 4:1435-1445. [PMID: 31701053 PMCID: PMC6829181 DOI: 10.1016/j.ekir.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Data on percutaneous kidney biopsy (KBx) incidence and frequencies of hemorrhagic complications among inpatients are limited. Methods Using 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. Results From 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. Conclusions In 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.
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144
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Shima N, Hayami N, Mizuno H, Kawada M, Sekine A, Sumida K, Hiramatsu R, Yamanouchi M, Hasegawa E, Suwabe T, Hoshino J, Sawa N, Takaichi K, Ohashi K, Fujii T, Minota S, Ubara Y. Arteriovenous fistula-related renal bleeding 5 days after percutaneous renal biopsy. CEN Case Rep 2019; 8:280-284. [PMID: 31214889 PMCID: PMC6820813 DOI: 10.1007/s13730-019-00408-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/07/2019] [Indexed: 11/25/2022] Open
Abstract
A 32-year-old Japanese woman was admitted to our hospital for evaluation of microscopic hematuria with a positive family history. Percutaneous renal biopsy was performed under real-time ultrasound guidance using a 16-gauge automated needle and three specimens were obtained. She had no risk factors for hemorrhage. However, macroscopic hematuria developed from 5 days after biopsy and persisted for 4 days. Her Hb decreased markedly from 15.0 to 8.1 g/dL. Enhanced computed tomography revealed urinary tract hematoma, while the early arterial phase showed inflow of contrast medium into the left renal vein from a pseudoaneurysm on a branch left renal artery. Renal transcatheter arterial embolization was performed using platinum microcoils and the arteriovenous fistula was occluded. The patient did not require blood transfusion. Severe renal bleeding that causes urinary tract hematoma usually occurs within 24 h after renal biopsy, but the possibility of late-onset renal bleeding should be kept in mind.
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Affiliation(s)
- Natsuki Shima
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Noriko Hayami
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Hiroki Mizuno
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Rikako Hiramatsu
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Masayuki Yamanouchi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan.,Department of Pathology, Yokohama City University Hospital Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Seiji Minota
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital Kajigaya, 1-3-1, Takatsu, Kawasaki, Kanagawa, 212-0015, Japan. .,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
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145
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Sise ME, Seethapathy H, Reynolds KL. Diagnosis and Management of Immune Checkpoint Inhibitor-Associated Renal Toxicity: Illustrative Case and Review. Oncologist 2019; 24:735-742. [PMID: 30902916 PMCID: PMC6656503 DOI: 10.1634/theoncologist.2018-0764] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/08/2019] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) are monoclonal antibodies directed at negative regulatory components on T cells, such as cytotoxic T lymphocyte-associated antigen 4, programmed cell death-1 (PD-1), and its ligand, programmed cell death ligand-1. ICIs initate antitumor immunity; however, these agents are associated with immune-related adverse events (irAEs) that may affect a variety of organs. Renal irAEs most commonly present with asymptomatic acute kidney injury (AKI), which is often detected by routine laboratory testing. The severity of AKI associated with irAEs ranges from mild (grade 1-2) to severe (grade 3-4). It is often challenging to diagnose because this group of patients often have multiple reasons to have AKI (dehydration, sepsis, or nephrotoxic medication exposure). We present an illustrative case of a 60-year-old man with metastatic melanoma who presented with AKI during treatment with nivolumab and review the literature to address frequently asked questions concerning the diagnosis and management of renal irAEs in patients with advanced cancer. Importantly, most patients will recover completely, and some may tolerate a rechallenge of ICI therapy, with prompt and effective treatment. KEY POINTS: Renal immune-related adverse events (irAEs) are less frequently reported than other irAEs; however, it is possible that available data underestimate their true incidence because of missed diagnoses and under-reporting. Although severe renal irAEs are more easily detected, smaller rises in creatinine may not be appreciated or may be attributed to other causes, because the differential diagnosis of acute kidney injury (AKI) in patients with cancer is broad.Baseline creatinine should be established prior to beginning immune checkpoint inhibitorss (ICIs), and it should be monitored with every cycle. If a patient develops AKI, the ICI should be held while the evaluation is pursued. A thorough workup of suspected renal irAEs must exclude other potential causes of AKI such as infection, dehydration, urinary tract obstruction, and nephrotoxin exposure.Acute kidney injury after ICI therapy does not appear to be more common in patients with baseline estimated glomerular filtration rate <60 mL per min per 1.73 m. One particular concern, however, is that those with baseline renal disease have less "renal reserve," and repeated AKI events may push a patient closer to end-stage renal disease. Thus, clinicians must exert caution when rechallenging patients with pre-existing renal disease with ICI therapy in the event of a prior AKI from ICI-related allergic interstitial nephritis.
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Affiliation(s)
- Meghan E Sise
- Division of Nephrology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harish Seethapathy
- Division of Nephrology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Division of Oncology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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146
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Risk factors associated with significant bleeding events after ultrasound-guided percutaneous native renal biopsies: a review of 2204 cases. Abdom Radiol (NY) 2019; 44:2316-2322. [PMID: 30830293 DOI: 10.1007/s00261-019-01962-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To review the incidence of significant bleeding complications after ultrasound-guided percutaneous core native renal biopsies at a single center using a standardized technique. MATERIALS AND METHODS A retrospective review of ultrasound (US)-guided percutaneous native renal core biopsies done at our institution from September 2005 to December 2015 was performed. Demographic and clinical data were collected at the time of biopsy, with additional clinical information recorded 24 h and 3 months after the biopsy. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) created by the National Institutes of Health. RESULTS 2204 US-guided native renal core biopsies were performed during the study period, with 37 hemorrhages (1.64%) that were CTCAE grade 3 or higher. The rate of inadequate sampling as reported by pathology was extremely low (1.1%). Factors demonstrating a significant association with bleeding risk included estimated glomerular filtration rate (eGFR), specifically when the eGFR was less than 60 (p = 0.025), platelet count (p = 0.002), including a statistically significant decreased risk of bleeding with a platelet count greater than 100 (109/L) (p = <0.001), and performing four or more needle passes (p = 0.012). While female gender was also associated with an increased bleeding risk (p = 0.05), there was a significant association between females with a BMI ≥ 25 and a decreased bleeding risk (0.034). No statistically significant association between post-biopsy hemorrhage and aspirin use within 10 days prior to biopsy or a prior diagnosis of amyloidosis was demonstrated. CONCLUSION US-guided native renal biopsy is a safe procedure with a low rate of significant bleeding complications and a high tissue adequacy rate using an 18-gage spring-loaded biopsy device. Factors associated with increased bleeding risk include female gender, lower platelet counts, decreased eGFR and performing four or more needle passes, which has not been reported previously. Interestingly, females with a BMI ≥ to 25 demonstrated a decreased bleeding risk, and aspirin (81 mg or 325 mg) within 10 days of the procedure did not demonstrate a significant effect. While not shown in this current study, the relationship of very recent aspirin therapy with bleeding is yet to be defined. Similarly, the statistically significant decreased risk of bleeding complications in overweight or obese females requires further investigation.
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147
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Pritzker KPH, Nieminen HJ. Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care. Arch Pathol Lab Med 2019; 143:1399-1415. [PMID: 31100015 DOI: 10.5858/arpa.2018-0463-ra] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. OBJECTIVE.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. DATA SOURCES.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. CONCLUSIONS.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.
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Affiliation(s)
- Kenneth P H Pritzker
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
| | - Heikki J Nieminen
- From the Departments of Laboratory Medicine and Pathobiology, and Surgery, University of Toronto, Toronto, Ontario, Canada (Dr Pritzker); and the Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland (Dr Nieminen)
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148
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Bakdash K, Schramm KM, Annam A, Brown M, Kondo K, Lindquist JD. Complications of Percutaneous Renal Biopsy. Semin Intervent Radiol 2019; 36:97-103. [PMID: 31123379 DOI: 10.1055/s-0039-1688422] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Percutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.
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Affiliation(s)
- Kenaz Bakdash
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kristofer M Schramm
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Aparna Annam
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Matthew Brown
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kimi Kondo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Jonathan D Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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149
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Pongsittisak W, Wutilertcharoenwong N, Ngamvichchukorn T, Kurathong S, Chavanisakun C, Teepprasan T, Prommool S, Srisawat N. The efficacy of blind versus real-time ultrasound-guided percutaneous renal biopsy in developing country. SAGE Open Med 2019; 7:2050312119849770. [PMID: 31205694 PMCID: PMC6537046 DOI: 10.1177/2050312119849770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction: Renal biopsy is a useful diagnostic procedure. In developing countries, two techniques of renal biopsy, blind percutaneous renal biopsy and real-time ultrasound-guided percutaneous renal biopsy, have been performed. The majority of studies compared these using different types and sizes of biopsy needle. The aim of this study was to compare both techniques in resource constraint country. Method: We reviewed renal biopsy database, between 1 January 2014 to 30 June 2017. The primary outcome was the total number of glomeruli. The other outcomes were tissue adequacy and bleeding complications. We also analyzed multivariable logistic regression to find factors associated with tissue adequacy and bleeding complications. Result: Of the 204 renal biopsies, 100 were blind percutaneous renal biopsy and 104 real-time ultrasound-guided percutaneous renal biopsy. The number of native renal biopsies was 169 (82.8%). Baseline characteristics of two groups were comparable. The mean number of total glomeruli from real-time ultrasound-guided percutaneous renal biopsy was significantly more than blind percutaneous renal biopsy (20.8 ± 12.1 vs 16.0 ± 13.0, p = 0.001). The real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissues than blind percutaneous renal biopsy (45.2% vs 16%, p < 0.001) and was the only factor associated with adequate tissue. Moreover, 16 renal biopsies from blind percutaneous renal biopsy obtained inadequate tissue. The overall bleeding complications were not statistically different. We found being female, lower eGFR and lower hematocrit were associated with bleeding complications. Conclusion: In comparison with blind percutaneous renal biopsy, real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissue and number of glomeruli. While the complications of both were comparable. We encourage to practice and perform real-time ultrasound-guided percutaneous renal biopsy in resource constraint countries.
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Affiliation(s)
- Wanjak Pongsittisak
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Naphat Wutilertcharoenwong
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanun Ngamvichchukorn
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sathit Kurathong
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chutima Chavanisakun
- Department of Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tavichai Teepprasan
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Surazee Prommool
- Division of Nephrology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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150
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Belghasem ME, A'amar O, Roth D, Walker J, Arinze N, Richards SM, Francis JM, Salant DJ, Chitalia VC, Bigio IJ. Towards minimally-invasive, quantitative assessment of chronic kidney disease using optical spectroscopy. Sci Rep 2019; 9:7168. [PMID: 31073168 PMCID: PMC6509114 DOI: 10.1038/s41598-019-43684-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/25/2019] [Indexed: 01/01/2023] Open
Abstract
The universal pathologic features implicated in the progression of chronic kidney disease (CKD) are interstitial fibrosis and tubular atrophy (IFTA). Current methods of estimating IFTA are slow, labor-intensive and fraught with variability and sampling error, and are not quantitative. As such, there is pressing clinical need for a less-invasive and faster method that can quantitatively assess the degree of IFTA. We propose a minimally-invasive optical method to assess the macro-architecture of kidney tissue, as an objective, quantitative assessment of IFTA, as an indicator of the degree of kidney disease. The method of elastic-scattering spectroscopy (ESS) measures backscattered light over the spectral range 320-900 nm and is highly sensitive to micromorphological changes in tissues. Using two discrete mouse models of CKD, we observed spectral trends of increased scattering intensity in the near-UV to short-visible region (350-450 nm), relative to longer wavelengths, for fibrotic kidneys compared to normal kidney, with a quasi-linear correlation between the ESS changes and the histopathology-determined degree of IFTA. These results suggest the potential of ESS as an objective, quantitative and faster assessment of IFTA for the management of CKD patients and in the allocation of organs for kidney transplantation.
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Affiliation(s)
- Mostafa E Belghasem
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ousama A'amar
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Daniel Roth
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Joshua Walker
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nkiruka Arinze
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Sean M Richards
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jean M Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David J Salant
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Vipul C Chitalia
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Veterans Administration Boston Healthcare system, Boston, MA, USA
| | - Irving J Bigio
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.
- Department of Electrical & Computer Engineering, Boston University, Boston, MA, USA.
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