The Feasibility and Safety of Obtaining Research Kidney Biopsy Cores in Patients with Diabetes

Hogan, Jonathan J.; Owen, Jonathan; Blady, Shira J.; Almaani, Salem; Avasare, Rupali S.; Bansal, Shweta; Lenz, Oliver; Luciano, Randy L.; Parikh, Samir; Ross, Michael J.; Sharma, Deep; Szerlip, Harold M.; Wadhwani, Shikha; Townsend, Raymond R.; Palmer, Matthew; Suszták, Katalin; Mottl, Amy K.

doi:10.2215/cjn.13061019

Cited by 13 publications

(19 citation statements)

References 5 publications

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“…A recently published study has assessed the safety of obtaining an additional research core from patients with diabetes nephropathy during a clinically indicated biopsy. 28 In this smaller study of 160 patients, Hogan et al 28 reported a 7% biopsy-related complication rate, which is similar to what has been observed in the AMP study. This suggests that the safety of obtaining additional kidney tissue is not limited to LN and reinforces that this methodology has the potential to maximise specimens available for discovery analyses in a wide range of kidney diseases.…”

Section: Discussionsupporting

confidence: 70%

Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network

et al. 2021

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ObjectivesIn lupus nephritis the pathological diagnosis from tissue retrieved during kidney biopsy drives treatment and management. Despite recent approval of new drugs, complete remission rates remain well under aspirational levels, necessitating identification of new therapeutic targets by greater dissection of the pathways to tissue inflammation and injury. This study assessed the safety of kidney biopsies in patients with SLE enrolled in the Accelerating Medicines Partnership, a consortium formed to molecularly deconstruct nephritis.Methods475 patients with SLE across 15 clinical sites in the USA consented to obtain tissue for research purposes during a clinically indicated kidney biopsy. Adverse events (AEs) were documented for 30 days following the procedure and were determined to be related or unrelated by all site investigators. Serious AEs were defined according to the National Institutes of Health reporting guidelines.Results34 patients (7.2%) experienced a procedure-related AE: 30 with haematoma, 2 with jets, 1 with pain and 1 with an arteriovenous fistula. Eighteen (3.8%) experienced a serious AE requiring hospitalisation; four patients (0.8%) required a blood transfusion related to the kidney biopsy. At one site where the number of cores retrieved during the biopsy was recorded, the mean was 3.4 for those who experienced a related AE (n=9) and 3.07 for those who did not experience any AE (n=140). All related AEs resolved.ConclusionsProcurement of research tissue should be considered feasible, accompanied by a complication risk likely no greater than that incurred for standard clinical purposes. In the quest for targeted treatments personalised based on molecular findings, enhanced diagnostics beyond histology will likely be required.

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Section: Discussionsupporting

confidence: 70%

Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network

et al. 2021

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“…Relevant to the underlying question of whether an extra research core of kidney tissue can be safely obtained during native kidney biopsy, the Transformative Research in Diabetic Neproplathy (TRIDENT) study recently reported its initial biopsy experience (17). The TRIDENT is examining the molecular pathology of diabetic kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications

Poggio

McClelland

Blank

et al. 2020

CJASN

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146

101

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Background and objectivesNative 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, & measurementsThis 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.ResultsA 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.ConclusionsAlthough 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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“…Thus, it is important to consider the thickness of the needle used for the puncture and the number of cores that are usually obtained. Several studies that have been focused on post-kidney biopsy complications detailed these relevant aspects [ 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] ( Table 7 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, in a few studies, the KB protocol details are not explained [ 13 , 14 , 36 ]. The thickness of the needles used most frequently was 16G or 18G; usually, the choice of the needle size depends on the professional who performs the kidney biopsy [ 25 , 27 , 28 , 29 , 30 , 33 ]. In other cases, the size of needle that they used is defined by protocol of the center [ 12 , 26 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Safety of Obtaining an Extra Biobank Kidney Biopsy Core

Bermejo

García-Carro

Mast

et al. 2022

JCM

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Background and objectives: Kidney biopsy (KB) is the “gold standard” for the diagnosis of nephropathies and it is a diagnostic tool that presents a low rate of complications. Nowadays, biobank collections of renal tissue of patients with proven renal pathology are essential for research in nephrology. To provide enough tissue for the biobank collection, it is usually needed to obtain an extra kidney core at the time of kidney biopsy. The objective of our study is to evaluate the complications after KB and to analyze whether obtaining an extra core increases the risk of complications. Material and methods: Prospective observational study of KBs performed at Vall d’Hebron Hospital between 2019 and 2020. All patients who accepted to participate to our research biobank of native kidney biopsies were included to the study. Clinical and laboratory data were reviewed and we studied risk factors associated with complications. Results: A total of 221 patients were included, mean age 56.6 (±16.8) years, 130 (58.8%) were men, creatinine was 2.24 (±1.94) mg/dL, proteinuria 1.56 (0.506–3.590) g/24 h, hemoglobin 12.03 (±2.3) g/dL, INR 0.99 (±0.1), and prothrombin time (PT) 11.86 (±1.2) s. A total of 38 patients (17.2%) presented complications associated with the procedure: 13.1% were minor complications, 11.3% (n = 25) required blood transfusion, 1.4% (n = 3) had severe hematomas, 2.3% (n = 5) required embolization, and 0.5% (n = 1) presented arterio-venous fistula. An increased risk for complication was independently associated with obtaining a single kidney core (vs. 2 and 3 cores) (p = 0.021). Conclusions: KB is an invasive and safe procedure with a low percentage of complications. Obtaining an extra kidney core for research does not increase the risk of complications during the intervention, which remains low in concordance with previously published reports.

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The Feasibility and Safety of Obtaining Research Kidney Biopsy Cores in Patients with Diabetes

Cited by 13 publications

References 5 publications

Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network

Safety of procuring research tissue during a clinically indicated kidney biopsy from patients with lupus: data from the Accelerating Medicines Partnership RA/SLE Network

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications

Safety of Obtaining an Extra Biobank Kidney Biopsy Core

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