부산대학교 도서관

Aim: Kidney biopsy (KBx) is the gold standard for evaluation of kidney disease, but is associated with a higher risk of complications in patients with reduced glomerular filtration rate (GFR). We studied the safety and utility of KBx in patients with eGFR <30 ml/min/1.73 m2. Methods: Consecutive adult patients with eGFR <30 ml/min/1.73 m2, who were planned for a KBx and consented to participate were prospectively enrolled. Patients with solitary/transplant kidney or acute kidney injury were excluded. Haemoglobin was checked on the day of KBx and repeated 18–24 h later along with a screening ultrasound. Post‐KBx complications were noted and their risk‐factors analysed. The utility of the KBx was graded as effecting significant, some, or no change to subsequent management. Results: Of the 126 patients included, 75% were male, 27.7% were diabetic, and the median eGFR was 13.5 ml/min/1.73m2. Major complications occurred in 5.6%. Peri‐renal haematomas were detected in 37.3%, and haematomas ≥2 cm were significantly more frequent in those with eGFR <15 ml/min/1.73 m2 (29.2% vs. 13%, p =.032). Dialysis was a risk factor, while pre KBx blood transfusion, diabetes and higher serum albumin were protective against any complication. KBx was more likely to make a significant difference in management in those with eGFR 15–29 ml/min/1.73m2 (44.1% vs. 11.1%, p <.001). Increasing age, lower serum creatinine and albumin were independently associated with KBx utility. Conclusion: KBx is relatively safe in severe kidney disease but its risk to benefit balance needs to be carefully considered when eGFR is <15 ml/min/1.73m2. SUMMARY AT A GLANCE: The utility and safety of kidney biopsies in patients with significantly reduced kidney function is a common clinical conundrum. This paper reports a single centre case series of kidney biopsies in patients with an eGFR < 30 ml/min/1.73 m2, where clinical suspicion of an alternative diagnosis is high. The authors demonstrate that in a high volume centre, biopsies in advanced kidney disease are relatively safe and can alter management decisions. [ABSTRACT FROM AUTHOR]