Abstract: FR-PO923
Paradox of Precision: More Parameters, Fewer Complications in Kidney Biopsy Outcomes
Session Information
- Glomerular Diseases: Potpourri
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- E Lima Souza, Joao Mateus, Universidade Federal de Pernambuco, Recife, Brazil
- Dourado, Marclebio M.C., Universidade Federal de Pernambuco, Recife, Brazil
- Nogueira de Azevedo, Maria Zayne, Universidade Federal de Pernambuco, Recife, Brazil
- Gueiros, Ana Paula, Universidade Federal de Pernambuco, Recife, Brazil
- Paiva, Thiago Vinícius Paulo, Universidade Federal de Pernambuco, Recife, Brazil
- Sá, Breno Matheus dos Santos, Universidade Federal de Pernambuco, Recife, Brazil
- Freitas, Tiago Moura, Universidade Federal de Pernambuco, Recife, Brazil
Background
Kidney biopsy is definitive for diagnosis of various glomerular diseases. Although minimal, this procedure is not done without risks. There is still no consensus regarding on best pre-biopsy protocol
Methods
Retrospective analysis of all post-renal biopsy complications in a single center after a change to a more restrictive protocol, starting in November 2018 until December 2022. All biopsied patients met the pre-established parameters showed in table 01. If any parameter was out of range, a specific intervention was performed (transfusion, antihypertensive, dialysis). Complication rate was also analyzed within after the procedure: fall in hemoglobin levels,blood transfusion,need for hemodynamic intervention,refractory pain,nephrectomy,and death.
Results
A total of 370 patients were included in the study, the majority being female [243 patients (65.6%)], and 88.9% of the biopsies performed on native kidneys. The age range varied from 4 to 76 years, with the majority between 14 and 53 years (81.6%). Regarding pre-biopsy parameters, the average hemoglobin was 11.3g/dL; platelets, 251,000/mm3; INR 1.09; systolic pressure 126mmHg and diastolic 79mmHg. In terms of glomerular filtration rate (GFR) and BUN, about 23.6% of patients had a GFR below 30mL/min, with BUN > 65, requiring pre-biopsy dialysis.
Following this protocol, major complications occurred in only 4.86% of patients (10 patients with macroscopic hematuria, 6 patients requiring blood transfusion, 2 with intense pain). There were no instances requiring hemodynamic intervention, nephrectomy, or resulting in mortality. There was no association of complications with age, biopsy indication, or final diagnosis.
Conclusion
A comprehensive renal biopsy protocol with well-defined parameters proved to be effective and feasible, with minimal complication rates.
| Parameters | Value | Necessary intervention if required |
| hemoglobin (g/dL) | > 9,0 | Transfusion |
| platelets (mm3) | > 100.000 | Transfusion |
| International Normalized Ratio (INR) | < 1,4 | Transfusion |
| Systolic blood pressure (mmHg) | < 140 | antihypertensive medication 1 hour prior |
| Diastolic blood pressure (mmHg) | < 90 | antihypertensive medication 1 hour prior |
| Blood urea nitrogen (BUN) | < 65 | Dialysis |