Kidney Week

Abstract: SA-PO191

Safety of Kidney Biopsy Performed by Nephrology Trainees vs Interventional Radiology

Session Information

• Educational Research
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

• 800 Educational Research

Authors

• Bapat, Manasi, Icahn School of Medicine, Mount Sinai Hospital, NY, New York, New York, United States

Manasi Bapat,

• Martin, Timothy Charles, Albany Medical Center, Rensselaer, New York, United States

Timothy Charles Martin,

• Kattamanchi, Siddhartha, Mount Sinai Medical Center, New Rochelle, New York, United States

Siddhartha Kattamanchi,

• Tokita, Joji E., Mount Sinai School of Medicine, New York, New York, United States

Joji E. Tokita,

• Sharma, Shuchita, Icahn School of Medicine, Mount Sinai Hospital, NY, New York, New York, United States

Shuchita Sharma,

• Nadkarni, Girish N., Ichan School of Medicine, New York, New York, United States

Girish N. Nadkarni,

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca,

• Mehta, Swati, Albany Medical Center, Rensselaer, New York, United States

Swati Mehta,

• Chan, Lili, Icahn School of Medicine, Mount Sinai Hospital, NY, New York, New York, United States

Lili Chan,

Background

Kidney biopsy is the gold standard in the diagnosis and management of kidney diseases, yet most nephrology fellows are not getting adequate training in kidney biopsies. Our aim was to review kidney biopsies performed by nephrology trainees under the supervision of nephrologist with outcomes compared to interventional radiology (IR).

Methods

This is a retrospective cohort study of 251 patients who underwent a native kidney biopsy at Mount Sinai Hospital (MSH) and Albany Medical Center (AMC) from 2016 - 2017. Biopsies done at MSH were performed by nephrology fellows under nephrology supervision while those done at AMC were done by IR.

Results

There were 251 patients who underwent kidney biopsy; mean age was 51 ± 16 years, 52% were male, and 60% were done by nephrology fellows. The most frequent indication for biopsy was non-nephrotic range proteinuria, 83 (33.2%). ddAVP was given in15 of biopsies performed by nephrology trainees and 1 of biopsies performed by IR; there was no difference in BUN between the MSH or AMC cohorts (40±24 mg/dL vs 37±27 mg/dL respectively, P=0.24). Diagnostic yield (≥11 glomeruli) did not differ by operator, trainee 89% vs. IR 94%, p=0.14. There was no difference in hematoma or track formation by proceduralist (IR 6% vs. trainee 10%, p=0.1) or for ED visits for outpatient biopsies (IR 4% vs trainee 4%). Transfusions were higher in those performed by IR (11% vs. 1%, P<0.001). Mean change in hemoglobin while not statistically different was clinically meaningful (trainee 0.2±0.7 g/dL vs. IR 1.6±10.7, P=0.1) After adjustment for patient and biopsy characteristics, prebiopsy hemoglobin but not proceduralist type was a significantly associated with higher odds of 1gm drop in hemoglobin, (adjusted odds ratio 1.4, 95% CI 1.1 – 1.7).

Conclusion

Nephrology trainees can safely perform kidney biopsies with similar diagnostic yield and complication rates.

Funding

• NIDDK Support