Kidney Week

Abstract: FR-PO924

Kidney Biopsy Quality Improvement Study

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

• Girimaji Satishchandra, Niveditha, The University of Kansas Medical Center, Kansas City, Kansas, United States

Niveditha Girimaji Satishchandra, MD, MBBS

• Johnstone, Duncan B., The University of Kansas Medical Center, Kansas City, Kansas, United States

Duncan B. Johnstone, MD, PhD

• Mustafa, Reem, The University of Kansas Medical Center, Kansas City, Kansas, United States

Reem Mustafa, MD, PhD, MPH, FASN

Background

Kidney biopsy is essential for definitive diagnosis of kidney disease. Recent data indicate an increasing biopsy miss rate and inadequacy. Most retrospective analyses report kidney biopsy major complications in 1-2% of patients, and inadequate tissue for diagnosis in 14%.The study aimed to review the adequacy and complications of kidney biopsy.

Methods

A retrospective single-center quality improvement study of patients who underwent renal biopsies between January-2020 and December-2023. Univariate and binomial logistic regression was used to predict adequacy and complications.

Results

Study included 181 patients,72(39.8%) were male.Mean age and BMI was 52.9±17.3 years and 29.5±7.8 kg/m². Mean baseline serum creatnine and hemoglobin(Hb) was 2.36±1.75 mg/dL and 11.25±2.4 g/dL.28.8% patients had stage 2 or 3 AKI.Mean eGFR in CKD stages <3 was 32.18 ± 15.94 ml/min.5.5% were on active anticoagulation.18 Gauge needle was used in all biopsies. 126(69.6%) biopsies were determined to be adequate(defined >= 10 glomeruli on LM, 1 glomerulus on IF and EM). Sex, age, BMI, length of kidney, and creatinine did not predict the likelihood of adequate sample. Total number of major complications was 11(6.1%) with 4(2.2%) requiring embolization or angiography,5(2.7%) requiring transfusions <7 days, and 2(1.1%) requiring both. Among age, sex, creatinine, platelet, INR, number of passes, total core length, active anticoagulation, AKI, baseline Hb, pre-biopsy SBP and DBP, and radiologist, total core length predicted major complications on univariate analysis(p=0.04)and just missed significance on logistic regression(p=0.06).

Conclusion

One-third of kidney biopsies were inadequate with rare but considerable major complications. No specific predictors linked current biopsy protocols to adequacy. Total core length correlated to major complications. A shallower, wider biopsy with 16G needle would strike a balance between adequacy and minimizing complication. This study is limited by small sample size.