Evaluation of Percutaneous Kidney Biopsy in Advanced Renal Failure

Abstract

As more information is gained on the long-term survival in chronic dialysis and transplant patients, it is unacceptable to be satisfied with a clinical impression of the etiology of the end stage renal failure in each case. It becomes important to know the histological diagnosis in patients who present with terminal renal failure. In the past there was little to offer such individuals in terms of therapeutics, and their prognosis was uniformly poor. Thus, biopsy for other than academic reasons was difficult to justify. This is no longer true and presented here is a series of 28 such patients in whom percutaneous renal biopsy was performed. The complications and diagnostic yield are reported. It is further demonstrated that the added knowledge of histological diagnosis can be of benefit to the individual patient.

Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

“…Renal tissue obtained by biopsy cannot give a great quantity of information if chronic damage (tubulointerstitial fibrosis, glomerulosclerosis, arteriosclerosis) prevails [8] and there is usually an inverse relationship between the degree of renal function and the need for therapeutic changes [94] . Sparse evidence indicates that the histological diagnosis made in CKD patients can differ from the expected, clinically made diagnosis in a significant percentage of cases [95][96][97] . In patients with NS and non-advanced CKD, renal biopsy is still a useful tool for managing immunosuppressive therapy, as well as for the knowledge of a specific renal diagnosis for transplant candidates [99] .…”

“…These subjects may have a higher risk of bleeding and have lower chances of diagnostic success, particularly when the kidneys are smaller and more scarred [94] . Nevertheless, renal biopsy in CKD patients is relatively a safe procedure as reported in several studies [94][95][96][97][98][99] and may represent a valid tool for clinical management. Renal tissue obtained by biopsy cannot give a great quantity of information if chronic damage (tubulointerstitial fibrosis, glomerulosclerosis, arteriosclerosis) prevails [8] and there is usually an inverse relationship between the degree of renal function and the need for therapeutic changes [94] .…”

Utility of percutaneous renal biopsy in chronic kidney disease

“…The utility of PRB in revealing unsuspected renal histology in highly advanced CKD patients has been evaluated previously 3,4,7 . Curtis et al .…”

“…Curtis et al . carried out PRB on 28 dialysis patients and obtained tissue in 25 3 . Of these, histological analysis revealed clinically unsuspected disease in 48%.…”

“…10 The utility of PRB in revealing unsuspected renal histology in highly advanced CKD patients has been evaluated previously. 3 4 Sobh et al obtained tissue by biopsy and nephrectomy from 120 dialysis patient. 7 Insufficient tissue was obtained in 15%, and endstage kidney was revealed in 25%.…”