Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

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Abstract

Background: Although the number of patients reaching end-stage kidney disease without a biopsy-proven diagnosis is increasing, the utility of renal biopsy is still an object of debate. We analyzed epidemiological data and the main indications for renal biopsy with a systematic, evidence-based review at current literature. Summary: There is a high discrepancy observed in biopsy rates and in the epidemiology of glomerular diseases worldwide, related to the different time frame of the analyzed reports, lack of data collection, the different reference source population and the heterogeneity of indications. The evidence-based analysis of indications showed that renal biopsy should be crucial in adults with nephrotic syndrome or urinary abnormalities as coexistent hematuria and proteinuria and in corticosteroid resistant-children with severe proteinuria. The knowledge of renal histology can change the clinical management in patients with acute kidney injury significantly, after the exclusion of pre-renal or obstructive causes of kidney damage. Scarce evidence indicates that renal biopsy can be useful in patients with advanced chronic kidney disease and its use should always be considered after weighing the benefits and potential risks. Renal biopsy should be crucial in patients with renal involvement due to systemic disease. In patients with diabetes with atypical features, renal biopsy may be fundamental to diagnose an unexpected parenchymal disease mislabeled as diabetic nephropathy. Finally, in elderly patients, the indications and the risks are not different from those in the general population. Key Message: Renal biopsy still remains a concrete approach for managing a substantial percentage of renal diseases.

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Most cited references 61

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Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

Ann E. Gordon, Ethan Balk, L. Chen … (2012)

Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. Meta-analysis of randomized controlled trials and prospective or retrospective observational studies. Adults undergoing native kidney biopsy in an inpatient or outpatient setting. MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more. Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance. Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes. 34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant. Publication bias, few randomized controlled trials, and missing data. Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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The aging kidney revisited: a systematic review.

Davide Bolignano, Francesco Mattace-Raso, Eric J. G. Sijbrands … (2014)

As for the whole human body, the kidney undergoes age-related changes which translate in an inexorable and progressive decline in renal function. Renal aging is a multifactorial process where gender, race and genetic background and several key-mediators such as chronic inflammation, oxidative stress, the renin-angiotensin-aldosterone (RAAS) system, impairment in kidney repair capacities and background cardiovascular disease play a significant role. Features of the aging kidney include macroscopic and microscopic changes and important functional adaptations, none of which is pathognomonic of aging. The assessment of renal function in the framework of aging is problematic and the question whether renal aging should be considered as a physiological or pathological process remains a much debated issue. Although promising dietary and pharmacological approaches have been tested to retard aging processes or renal function decline in the elderly, proper lifestyle modifications, as those applicable to the general population, currently represent the most plausible approach to maintain kidney health.

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Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience.

Jae Chang, Dong Ki Kim, Hyun Kim … (2009)

The prevalence of glomerular diseases differs according to geographic area, race, age and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of renal diseases during the past 20 years in a large patient population in Korea. Patients aged 16 years or older who underwent a renal biopsy at Severance Hospital in the Yonsei University Health System from 1987 to 2006 were enrolled. All medical records were reviewed retrospectively. In total, 1818 patients (M:F = 1.02:1) were reviewed. Glomerulonephritis (GN) comprised 85.9% of the total biopsied cases. The most common primary GN was IgA nephropathy (IgAN) (28.3%), which was followed by minimal change disease (MCD) (15.5%), membranous nephropathy (MN) (12.3%), focal segmental glomerulosclerosis (FSGS) (5.6%) and membranoproliferative GN (MPGN) (4.0%). The most common secondary GN was lupus nephritis (8.7%). The most common idiopathic nephrotic syndrome was MCD (38.5%), which was followed by MN and IgAN. Among 128 (7.4%) patients who were HBsAg-positive, MN (30.5%) and MPGN (21.1%) were the most common GN. When the incidence rates between 1987-91 and 2002-06 were compared, IgAN increased from 25.6 to 34.5%, while MCD (from 23.2 to 7.0%) and MPGN (from 6.7 to 1.7%) decreased significantly (P < 0.01). IgAN was the most common primary GN, and MCD was the most common cause of nephrotic syndrome. In the 5-year quartile comparison, the relative frequency of IgAN increased, while the relative frequency of MCD and MPGN decreased significantly during the past 20 years.

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Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Abbreviated Title: Am J Nephrol

Publisher: S. Karger AG (Basel, Switzerland karger@ 123456karger.com http://www.karger.com )

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date (Print): March 2016

Publication date (Electronic): 05 February 2016

Volume: 43

Issue: 1

Pages: 1-19

Affiliations

^aDepartment of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, and ^bCNR-Institute of Clinical Physiology, Reggio Calabria, Italy; ^cEuropean Renal Best Practice, University Hospital Ghent, Ghent, Belgium; ^dDepartment of Nephrology, 1st School of Medicine, Charles University, Prague, Czech Republic

Article

Publisher ID: AJN2016043001001 Other ID: Am J Nephrol 2016;43:1-19

DOI: 10.1159/000444026

PubMed ID: 26844777

SO-VID: 5257f897-2068-47fa-ae58-5b92e3850ab7

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Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

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Karger: Nephrology

Most cited references 61

Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

The aging kidney revisited: a systematic review.

Changing prevalence of glomerular diseases in Korean adults: a review of 20 years of experience.

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