Abstract: PUB453
Percutaneous Kidney Biopsy in Patients with Metastatic Solid Malignancy and AKI on Systemic Anticancer Therapy
Session Information
Category: Onconephrology
- 1700 Onconephrology
Authors
- Milanez, Tomaz, Onkoloski Institut Ljubljana, Ljubljana, Ljubljana, Slovenia
- Srinivasan, Vinay, Cooper University Health Care, Camden, New Jersey, United States
- Ocvirk, Janja, Onkoloski Institut Ljubljana, Ljubljana, Ljubljana, Slovenia
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
Percutaneous renal biopsy (PRB) is the gold standard for assessing renal parenchymal disease and renal toxicity of systemic anticancer therapy (SAT). In pateints with solitary kidney (SK), PRBs are often deferred due to the perceived risk for major bleeding complications that may result in permanent loss of renal function. In this study we assessed the safety of PB and findings in patients receiving SAT including those with SK.
Methods
We retrospectively analyzed pathological findings of PRBs and the incidence of major complications of PRBs performed on native kidneys for the evaluation of AKI in patients with metastatic solid malignancy who received SAT and who underwent PRB between 2018 and 2023 at the Institute of Oncology Ljubljana, the University Medical Centre Ljubljana, and at Cooper University Hospital in Camden, NJ. All PRBs were performed under ultrasound guidance by a nephrologist.
Results
A total of 19 PRBs were performed in 18 patients and of these 11 PRBs where performed in patients with a SK. At the time of acute kdiney injury (AKI) 15 patients were being treated with immune check point inhibitors (ICIs) and 4 with a tyrosine kinase inhibitor (TKI). Five patients who developed AKI stage 3 during ICI therapy experienced at least one Grade 3 concomitant immune-related adverse event. Pathologic analysis revealed TMA in 5 patients exposed to TKIs, and acute interstitial nephritis in two, Acute tubular injury (ATI) in 5, and severe necrotizing granulomatous vasculitis in one patient exposed to ICIs. In a patient with severe ATI, the pathologic analysis also revealed IgA nephropathy. Based on pathological findings, SAT was changed in twelve patients after PRBs. One patient with TMA had progressive loss of renal function after discontinuation of TKI, while the other 3 had stable or improved renal function. After PRB, one patient experienced a large perinephric hematoma. In another patient, who had a SK, a follow-up ultrasound revealed an A-V fistula and 7 days after PRB. Both patients fully recovered.
Conclusion
Our results indicate that PRB in patients with AKI and receiving SAT are safe and informative even in patients with SK. Importantly, the observed pathological findings can have a significant impact in the cancer treatment plan for these patients. Major PRB complications were manageable even in patients with a SK.
Funding
- NIDDK Support