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Asai Y, Iwakura T, Ishigaki S, Isobe S, Fujikura T, Ohashi N, Kato A, Yasuda H. Diagnostic Pitfalls of the Bleeding Origin after a Percutaneous Renal Biopsy. Intern Med 2025; 64:881-885. [PMID: 39111890 PMCID: PMC11986308 DOI: 10.2169/internalmedicine.3888-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/12/2024] [Indexed: 03/18/2025] Open
Abstract
A percutaneous renal biopsy (PRB) is a standard procedure for diagnosing renal disease, but can cause bleeding complications. Bleeding after a PRB can be classified as early- or late-onset, depending on the timing of the onset of the bleeding symptoms (<24 h or ≥24 h). We herein report two patients who experienced bleeding complications: one experienced early-onset bleeding from the 12th subcostal artery, and the other experienced late-onset bleeding from an arteriovenous fistula between a branch of the renal artery and renal vein. In both cases, the origin of the bleeding vessel was misjudged during the first examination. We discuss the diagnostic pitfalls of the origin of bleeding after a PRB and propose measures to avoid falling such pitfalls.
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Affiliation(s)
- Yu Asai
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
| | - Takamasa Iwakura
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
| | - Sayaka Ishigaki
- Blood Purification Unit, Hamamatsu University School of Medicine, Japan
| | - Shinsuke Isobe
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
| | - Naro Ohashi
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University School of Medicine, Japan
| | - Hideo Yasuda
- First Department of Medicine, Division of Nephrology, Hamamatsu University School of Medicine, Japan
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Toal MP, Hill CJ, Quinn MP, McQuarrie EP, O’Neill CE, Maxwell AP. An International Study of Variation in Attitudes to Kidney Biopsy Practice. Clin J Am Soc Nephrol 2025; 20:377-386. [PMID: 39705236 PMCID: PMC11906007 DOI: 10.2215/cjn.0000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 12/13/2024] [Indexed: 12/22/2024]
Abstract
Key Points Attitudes on kidney biopsy practice vary significantly across the world. Male clinicians, younger clinicians, and individuals who perform biopsies more frequently had an increased propensity to recommend a kidney biopsy. Kidney biopsy was most often recommended in the setting of higher proteinuria levels and preserved kidney function. Background A kidney biopsy is an essential investigation for diagnosis but is invasive and associated with complications. Delaying or missing the opportunity to diagnose kidney disease could result in adverse patient outcomes. The aim of this study was to examine attitudes to kidney biopsy across the world. Methods An online questionnaire for nephrologists was designed on the basis of the existing literature with input from patients. Anonymized data were collected on individual and institutional demographics, indications and contraindications for biopsy, and attitudes and barriers to access. A propensity-to-biopsy score was generated from responses, which allowed clinicians to compare their practice with international colleagues. A higher score was associated with an increased likelihood of recommending biopsy. The questionnaire was disseminated through international nephrology societies, including the National Kidney Foundation, and by social media. Results Participants responding to the questionnaire included 1181 clinicians from 83 countries, making it the largest international study in this area to date. The propensity-to-biopsy scores were significantly different between the 13 countries with over 20 clinicians participating (P < 0.001) and was highest in Mexico and lowest in the Philippines. Kidney biopsy was most often recommended in patients with higher proteinuria levels and most often avoided in patients with small kidneys. An adjusted linear regression model demonstrated that a significantly higher propensity-to-biopsy score was found in male clinicians, younger clinicians, frequent performers of kidney biopsy, increased job seniority, and larger institution size (P = 0.05). Conclusions Kidney biopsy practice is varied internationally and is subject to human and systemic factors. Further research is required to understand the variances behind clinical decision making.
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Affiliation(s)
- Michael P. Toal
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Christopher J. Hill
- Regional Centre for Nephrology and Transplantation, Belfast City Hospital, Belfast, Northern Ireland
| | - Michael P. Quinn
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Emily P. McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Ciaran E. O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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Toal MP, Fergie R, Quinn MP, Hill CJ, O'Neill C, Maxwell AP. Systematic review of the application of the Kidney Failure Risk Equation and Oxford classification in estimating prognosis in IgA Nephropathy. Syst Rev 2025; 14:16. [PMID: 39819700 PMCID: PMC11737263 DOI: 10.1186/s13643-024-02739-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 12/17/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world and is an important cause of chronic kidney disease (CKD) and kidney failure. Outcomes are heterogeneous, and accurate risk stratification is important to identify the highest risk individuals for treatment and to help prevent disease progression. The Oxford classification (OC) is an internationally adopted standard for renal biopsy reporting in IgAN, which measures the degree of histological abnormalities and predicts prognosis. The kidney failure risk equation (KFRE) was developed to predict kidney failure in all causes of CKD and has been shown to be highly accurate across diverse etiologies. This review aimed to compare the KFRE with formulae incorporating the OC in accurately determining the risk of kidney failure in IgAN. METHODS A systematic review was conducted in accordance with the Cochrane library guidelines and PRISMA statement for reporting of systematic reviews. Studies comparing the accuracy of the KFRE with the OC in predicting disease progression and kidney failure in IgAN were evaluated. The search strategy and analysis were performed independently by two reviewers. Studies that were eligible for inclusion compared the KFRE with any tool incorporating the OC in a cohort of individuals with IgAN. Eligible outcomes were reduction of estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD), and prognostic tools were required to assess the accuracy of these formulae by discrimination and/or calibration. RESULTS After searching several databases, only one study was eligible for inclusion in the review. This study of 2300 Chinese individuals with IgAN had a median follow-up of 2.5 years. Two-hundred eighty-eight individuals had a composite outcome of 50% decline in eGFR or ESRD, and 214 individuals developed ESRD. Both the KFRE and the IgAN Risk Prediction (IRP) tool (incorporating the OC) were highly accurate at predicting ESRD with a C-statistic of 0.90 and 0.91, respectively. Subgroup analysis demonstrated improved performance of IRP over KFRE in discrimination for individuals with preserved eGFR (> 60 ml/min/1.73 m2) at baseline. The risk of bias was high due to insufficient follow-up and handling of missing data, so overall confidence in findings is very low. CONCLUSION There is currently insufficient evidence to compare the accuracy of the KFRE and OC in determining outcomes in IgAN. Further research is required in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022364569.
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Affiliation(s)
- M P Toal
- Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland.
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Lisburn Road, BT9 7BA, Belfast, Northern Ireland.
| | - R Fergie
- Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Lisburn Road, BT9 7BA, Belfast, Northern Ireland
| | - M P Quinn
- Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland
| | - C J Hill
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Lisburn Road, BT9 7BA, Belfast, Northern Ireland
| | - C O'Neill
- Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland
| | - A P Maxwell
- Centre for Public Health, Queen's University of Belfast, Belfast, BT12 6AB, Northern Ireland
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Lim CY, Khay SL. Bleeding complications after percutaneous kidney biopsies - nationwide experience from Brunei Darussalam. World J Nephrol 2023; 12:147-158. [PMID: 38230299 PMCID: PMC10789084 DOI: 10.5527/wjn.v12.i5.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions. Various studies have identified several risk factors associated with bleeding complications following the procedure, but these findings have shown inconsistency and variation. AIM To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam. We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context. METHODS We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020. The outcomes of interest were post-biopsy bleeding and the need for blood transfusions. Demographics, clinical, laboratory and procedural-related data were collected. Logistic regression analysis was used to identify predictors of outcomes. RESULTS A total of 255 kidney biopsies were included, with 11% being performed on transplanted kidneys. The majority of biopsies were done under ultrasound guidance (83.1%), with the rest under computer tomography guidance (16.9%). The most common indications for biopsy were chronic kidney disease of undefined cause (36.1%), nephrotic syndrome (24.3%) and acute kidney injury (11%). Rate of bleeding complication was 6.3% - 2% frank hematuria and 4.3% perinephric hematoma. Blood transfusion was required in 2.8% of patients. No patient lost a kidney or died because of the biopsy. Multivariate logistic regression identified baseline hemoglobin [odds ratio (OR): 4.11; 95% confidence interval (95%CI): 1.12-15.1; P = 0.03 for hemoglobin ≤ 11 g/dL vs. > 11 g/dL) and the presence of microscopic hematuria (OR: 5.24; 95%CI: 1.43-19.1; P = 0.01) as independent risk factors for post-biopsy bleeding. Furthermore, low baseline platelet count was identified as the dominant risk factor for requiring post-biopsy transfusions. Specifically, each 10 109/L decrease in baseline platelet count was associated with an 12% increase risk of needing transfusion (OR: 0.88; 95%CI: 0.79-0.98; P = 0.02). CONCLUSION Kidney biopsies were generally well-tolerated. The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.
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Affiliation(s)
- Chiao Yuen Lim
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
| | - Sai Laung Khay
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
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Schnuelle P. Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique, and Safety. J Clin Med 2023; 12:6424. [PMID: 37835066 PMCID: PMC10573674 DOI: 10.3390/jcm12196424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Renal biopsies are the gold standard for diagnosis, staging, and prognosis of underlying parenchymal kidney disease. This article provides an overview of the current indications and highlights ways to reduce bleeding complications in order to achieve optimal diagnostic yield with minimal risk to the patient. Novel indications have emerged from the increasing use of new molecularly targeted oncologic therapies in recent years, which often induce immune-mediated renal disease. On the other hand, the detection of specific antibodies against target antigens on podocytes in the sera of patients with new-onset nephrotic syndrome has now relativized the indication for biopsy in membranous nephropathy. The use of semi-automatic spring-loaded biopsy devices and real-time ultrasound considerably declined the complication rate and is the current standard. Percutaneous renal biopsies are overall a safe procedure if contraindications are considered. A coagulation disorder needs to be excluded beforehand, and an elevated blood pressure must be reduced to the normotensive range with medications. A laparoscopic approach or a radiology interventional procedure through the internal jugular vein may be considered for obtaining a kidney tissue sample if there is an urgent indication and a bleeding tendency cannot be adequately corrected. Major bleeding after a percutaneous renal biopsy can usually be managed with selective arterial embolization of the injured renal vessel. The use of a 16-gauge needle is the most reasonable compromise between diagnostic benefit and risk of complication. In the routine diagnostic, the biopsy specimen is examined with light microscopy, immunohistochemistry, and electron microscopy. Combination with modern molecular pathology techniques will contribute to more precise insights into the development and progression of kidney disease, which will likely refine future treatments in nephrology.
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Affiliation(s)
- Peter Schnuelle
- Center for Renal Diseases Weinheim, Academic Teaching Practice of the University Medical Center Mannheim, University of Heidelberg, D-69469 Weinheim, Germany
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Oda Y, Nishi H, Nangaku M. Regional Variation in the Use of Percutaneous Kidney Biopsy in Japan. Nephron Clin Pract 2023; 148:357-366. [PMID: 37793361 PMCID: PMC11151969 DOI: 10.1159/000534449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION The regional variation in the use of percutaneous kidney biopsy in Japan remains unknown. There are several large datasets of kidney biopsies in Japan, but an exhaustive survey of kidney biopsies is lacking. METHODS We analyzed insurance claims for percutaneous kidney biopsies registered in the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which is the closest to a complete dataset of kidney biopsies performed in Japan. In combination with other nationwide survey results, the number of inpatient percutaneous kidney biopsies per population in each prefecture was calculated. Factors associated with the frequency of percutaneous kidney biopsies were also explored. RESULTS The database contained 22,419 health insurance claims for percutaneous kidney biopsy in the fiscal year 2020. The frequency of inpatient percutaneous kidney biopsies could be up to 4.8 times as frequent in one prefecture than in another, even after adjusting for age and sex. The frequency of inpatient percutaneous kidney biopsies showed a positive correlation with the number of annual kidney transplants and patients on peritoneal dialysis per population and a weak negative correlation with the prevalence of reduced kidney function in the population aged 40-74 years. CONCLUSION We found a large regional variation in the frequency of inpatient percutaneous kidney biopsies. Kidney transplants and peritoneal dialysis might be offered more frequently in regions with a higher frequency of kidney biopsy. This is the first dataset that shows more than 20,000 kidney biopsies were performed per year in Japan, as of 2020.
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Affiliation(s)
- Yasuhiro Oda
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan,
| | - Hiroshi Nishi
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Nishino T, Hirano S, Takemura S, Tomori S, Ono S, Takahashi K, Mimaki M. Glomeruli Count and Arterial Injury in Real-Time Ultrasound-Guided Needle Kidney Biopsy Specimens: Adequacy of Three Approaches for Pig Kidneys. Am J Nephrol 2023; 54:528-535. [PMID: 37579726 DOI: 10.1159/000533593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Real-time ultrasound-guided percutaneous kidney biopsy is essential for diagnosis and treatment planning; nonetheless, the optimal puncture approach has yet to be established. In vivo, performing different approaches on the same patient at once is not possible. This study aimed to determine the impact of different approaches on the number of obtained glomeruli and their potential to cause arterial injury using pig kidneys, which are similar to humans. METHODS A total of 120 pig kidneys (60 right-sided kidneys and 60 left-sided kidneys) for research were obtained from a slaughterhouse. The specimens were collected from the lower pole on the sagittal plane of the kidney using three different approaches on the same kidney: caudocranial approach, caudal to cranial; craniocaudal approach, cranial to caudal; and vertical approach, through the surface cortex. Five blinded pediatric nephrologists assessed the number of glomeruli and arterial injuries. RESULTS Overall, 360 specimens were collected from the kidneys through biopsy using a 16-gauge needle (mean vertical kidney length, 11.2 ± 0.7 cm; mean depth, 3.47 ± 0.23 cm). No significant difference in the incidence of arterial injury was observed between the three approaches (caudocranial vs. craniocaudal vs. vertical approaches: 78% vs. 87% vs. 87%, p = 0.14). In contrast, the vertical approach retrieved significantly more glomeruli than the caudocranial and craniocaudal approaches (caudocranial approach: 7.5 ± 2.8, craniocaudal approach: 7.8 ± 2.7, and vertical approach: 8.9 ± 3.3, p < 0.001). CONCLUSIONS Considering its efficacy and safety profile, the vertical approach may be preferred, as more glomeruli can be obtained without increasing the incidence of arterial injury. Although the results cannot be directly extrapolated to humans due to the differences between species, they still offer important insights into the characteristics of each approach.
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Affiliation(s)
- Tomohiko Nishino
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Sakurako Hirano
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shin Takemura
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Tomori
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Sayaka Ono
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
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Variability in personal protective equipment in cross-sectional interventional abdominal radiology practices. Abdom Radiol (NY) 2022; 47:1167-1176. [PMID: 35013750 PMCID: PMC8744567 DOI: 10.1007/s00261-021-03406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/19/2022]
Abstract
Purpose To determine institutional practice requirements for personal protective equipment (PPE) in cross-sectional interventional radiology (CSIR) procedures among a variety of radiology practices in the USA and Canada. Methods Members of the Society of Abdominal Radiology (SAR) CSIR Emerging Technology Commission (ETC) were sent an eight-question survey about what PPE they were required to use during common CSIR procedures: paracentesis, thoracentesis, thyroid fine needle aspiration (FNA), superficial lymph node biopsy, deep lymph node biopsy, solid organ biopsy, and ablation. Types of PPE evaluated were sterile gloves, surgical masks, gowns, surgical hats, eye shields, foot covers, and scrubs. Results 26/38 surveys were completed by respondents at 20/22 (91%) institutions. The most common PPE was sterile gloves, required by 20/20 (100%) institutions for every procedure. The second most common PPE was masks, required by 14/20 (70%) institutions for superficial and deep procedures and 12/12 (100%) institutions for ablation. Scrubs, sterile gowns, eye shields, and surgical hats were required at nearly all institutions for ablation, whereas approximately half of institutions required their use for deep lymph node and solid organ biopsy. Compared with other types of PPE, required mask and eye shield use showed the greatest increase during the SARS-CoV-2 pandemic. Conclusion PPE use during common cross-sectional procedures is widely variable. Given the environmental and financial impact and lack of consensus practice, further studies examining the appropriate level of PPE are needed. Graphical abstract ![]()
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Association Between Diabetes and Major Bleeding Complications of Renal Biopsy. Kidney Int Rep 2022; 7:232-240. [PMID: 35155862 PMCID: PMC8821035 DOI: 10.1016/j.ekir.2021.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Nephrologists have recently recognized the heterogeneity of kidney diseases among patients with diabetes and begun to actively perform percutaneous renal biopsies (PRBs). Nevertheless, the association between diabetes and major bleeding complications of PRB remains unclear. Methods In this retrospective cohort study using the Diagnosis Procedure Combination database in Japan, we identified patients who underwent an elective PRB from July 2010 to March 2018. The primary outcome was the occurrence of major bleeding complications, defined as red blood cell transfusion within 7 days after PRB or invasive hemostasis after PRB. Multivariable regression analysis was performed to analyze the association between diabetes and major bleeding complications with adjustment for patient and hospital characteristics. Results We identified 76,302 patients, including 8245 with diabetes. The proportion of PRBs performed for patients with diabetes continuously increased over time. Major bleeding complications occurred in 678 patients (0.9%), including 622 (0.8%) with red blood cell (RBC) transfusion and 109 (0.1%) with invasive hemostasis. Diabetes was significantly associated with major bleeding complications (relative risk [RR] = 2.41; 95% CI 2.00–2.90). Among patients with diabetes, multiagent or insulin treatment had significant association with major bleeding complications (RR = 1.57; 95% CI 1.18–2.10), compared with single-agent diabetes treatment. Conclusion Diabetes is significantly associated with major bleeding complications of PRBs. Moreover, severity of diabetes has association with increases in major bleeding complications. Thus, nephrologists should carefully judge whether the anticipated benefits outweigh the relatively high risk of major bleeding complications when considering PRB for patients with diabetes.
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Zhang XM, Gao Y, Yang MX, Zheng XD, Zhang R, Wu YY, Zeng M, Yang Q, Yu ZY, Liu J, Zha BB, Yang B. Exploration of Noninvasive Detection of Advanced Glycation End Products in the Lens to Screen for Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2022; 13:892070. [PMID: 35846309 PMCID: PMC9278348 DOI: 10.3389/fendo.2022.892070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Diabetic kidney disease (DKD) is a complication of diabetes, which is the most common cause of end-stage renal disease (dialysis). DKD has a high mortality rate, and only early detection can nip this disease in the bud. Advanced glycation end products (AGEs)are generally believed to be involved in the occurrence of DKD. Studies have shown that the lens AGEs fluorescence for noninvasive detection has high consistency with the gold standard OGTT, has high sensitivity and specificity, and could be used as a practical tool for the early screening of type 2 diabetes mellitus (T2DM).Therefore, we speculated that the noninvasive lens AGEs fluorescence detection method can be used to predict the occurrence of DKD. This study detected levels of AGEs in multiple cellular and tissues and analyzed the relationships between AGEs and lens, eyeballs, peripheral blood mononuclear cell (PBMC), serum, and kidney. Additionally, we examined the possible role of lens AGEs fluorescence in DKD screening. Our preexperimental study found that lens AGE levels in patients with T2DM were positively correlated with PBM and serum AGE levels. Lens AGE levels in patients with T2DM were negatively correlated with eGFR and positively correlated with urinary ACR. The animal and cell experiments showed that the AGE levels in the eyeballs of DM mice were also positively correlated with those in the serum and kidney. To increase the reliability of the experiment, we increased the sample size. In our results, lens AGEs levels were positively correlated with the occurrence of DKD, and the incidence of DKD in the high lens AGEs group was 2.739 times that in the low lens AGEs group. The receiver operating characteristic (ROC) curves showed that patients with T2DM with a lens AGEs value ≥ 0.306 were likely to have DKD. The area under the ROC curve of the noninvasive technique for identifying DKD was 0.757 (95% Cl: 0.677-0.838, p<0.001), and the sensitivity and specificity were 70.0% and 78.7%, respectively. These results suggest that noninvasive lens AGEs detection technology has certain clinical value in diagnosing whether patients with T2DM have DKD.
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Affiliation(s)
- Xue-Meng Zhang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- General Practice Clinic, Pujiang Community Health Service Center in Minhang District, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Yuan Gao
- General Practice Clinic, Pujiang Community Health Service Center in Minhang District, Shanghai, China
| | - Meng-Xue Yang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
- *Correspondence: Meng-Xue Yang,
| | - Xiao-Di Zheng
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Rui Zhang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Yue-Yue Wu
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Miao Zeng
- Department of Infectious Diseases, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Qian Yang
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Zhi-Yan Yu
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Jun Liu
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Bing-Bing Zha
- Department of Endocrinology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Center of Community-Based Health Research, Fudan University, Shanghai, China
| | - Bo Yang
- Department of Endocrinology, Affiliated hospital of Zunyi Medical University, Zunyi, China
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Abstract
Rationale & Objective Although kidney biopsy is a useful tool, nephrologists' approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy. Study Design Qualitative study using semistructured interviews. Setting & Participants Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation. Analytical Approach A modified grounded theory was used to identify dominant themes reflecting the nephrologists' decision-making styles about kidney biopsy. Results Twenty nephrologists were interviewed: 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks and benefits of the procedure for an individual patient. Five overarching themes were identified: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about the invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. Limitations Generalizability was limited because the nephrologists sampled may not have been broadly representative. Conclusions Multiple factors influence nephrologists' decision to pursue kidney biopsy, with substantial variability among nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized.
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Burke JP, Pham T, May S, Okano S, Ratanjee SK, Thet Z, Wong JKW, Venuthurupalli S, Ranganathan D. Kidney biopsy practice amongst Australasian nephrologists. BMC Nephrol 2021; 22:291. [PMID: 34445981 PMCID: PMC8390249 DOI: 10.1186/s12882-021-02505-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous kidney biopsy is the gold standard investigation for the diagnosis of kidney diseases. The associated risks of the procedure depend on the skill and experience of the proceduralist as well as the characteristics of the patient. The Kidney Health Australia - Caring for Australasians with Renal Impairment (KHA-CARI) guidelines on kidney biopsies, published in 2019, are the only published national kidney biopsy guidelines. As such, this study surveys current kidney biopsy practices in Australasia and examines how they align with the Australian guidelines, as well as international biopsy practice. METHODS A cross-sectional, multiple-choice questionnaire was developed examining precautions prior to kidney biopsy; rationalisation of medications prior to kidney biopsy; technical aspects of kidney biopsy; complications of kidney biopsy; and indications for kidney biopsy. This was distributed to all members of the Australian and New Zealand Society of Nephrology (ANZSN). RESULTS The response rate for this survey is approximately 21.4 % (182/850). Respondents found agreement (> 75.0 %) in only six out of the twelve questions (50.0 %) which assessed their practice against the KHA-CARI guidelines. CONCLUSIONS This is the first study of its kind where kidney biopsy practices are examined against a clinical guideline. Furthermore, responses showed that practices were incongruent with guidelines and that there was a lack of consensus on many issues.
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Affiliation(s)
- J P Burke
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - T Pham
- Kidney Health Service, Rockhampton Base Hospital, Rockhampton, QLD, Australia
| | - S May
- Kidney Health Service, Tamworth Hospital, Tamworth, NSW, Australia
| | - S Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - S K Ratanjee
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Z Thet
- Kidney Health Service, Rockhampton Base Hospital, Rockhampton, QLD, Australia.,School of Medicine, Griffith University, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - J K W Wong
- Renal Unit, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Venuthurupalli
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.,Kidney Health Service, Ipswich Hospital, Ipswich, QLD, Australia
| | - D Ranganathan
- Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. .,School of Medicine, Griffith University, Brisbane, QLD, Australia.
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Torigoe K, Muta K, Tsuji K, Yamashita A, Abe S, Ota Y, Mukae H, Nishino T. Safety of Renal Biopsy by Physicians with Short Nephrology Experience. Healthcare (Basel) 2021; 9:healthcare9040474. [PMID: 33923650 PMCID: PMC8072574 DOI: 10.3390/healthcare9040474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/18/2022] Open
Abstract
Percutaneous renal biopsy is an essential tool for diagnosing various renal diseases; however, little is known about whether renal biopsy performed by physicians with short nephrology experience is safe in Japan. This study included 238 patients who underwent percutaneous renal biopsy between April 2017 and September 2020. We retrospectively analyzed the frequency of post-renal biopsy complications (hemoglobin decrease of ≥10%, hypotension, blood transfusion, renal artery embolization, nephrectomy and death) and compared their incidence among physicians with varied experience in nephrology. After renal biopsy, a hemoglobin decrease of ≥10%, hypotension and transfusion occurred in 13.1%, 3.8% and 0.8% of patients, respectively. There were no cases of post-biopsy renal artery embolism, nephrectomy, or death. The composite complication rate was 16.0%. The incidence of post-biopsy complications was similar between physicians with ≥3 years and <3 years of clinical nephrology experience (12.5% vs. 16.8%, p = 0.64). Furthermore, the post-biopsy composite complication rates were similar between physicians with ≥6 months and <6 months of clinical nephrology experience (16.3% vs. 15.6%, p > 0.99). Under attending nephrologist supervision, a physician with short clinical nephrology experience can safely perform renal biopsy.
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Affiliation(s)
- Kenta Torigoe
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
- Correspondence: ; Tel.: +81-95-819-7282
| | - Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
| | - Ayuko Yamashita
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
| | - Shinichi Abe
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan;
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki 852-8501, Japan; (K.T.); (K.T.); (A.Y.); (S.A.); (Y.O.); (T.N.)
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15
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Poggio ED, McClelland RL, Blank KN, Hansen S, Bansal S, Bomback AS, Canetta PA, Khairallah P, Kiryluk K, Lecker SH, McMahon GM, Palevsky PM, Parikh S, Rosas SE, Tuttle K, Vazquez MA, Vijayan A, Rovin BH. Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications. Clin J Am Soc Nephrol 2020; 15:1595-1602. [PMID: 33060160 PMCID: PMC7646247 DOI: 10.2215/cjn.04710420] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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Affiliation(s)
- Emilio D Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Robyn L McClelland
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kristina N Blank
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Shweta Bansal
- Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Andrew S Bomback
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pietro A Canetta
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Pascale Khairallah
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Krzysztof Kiryluk
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York
| | - Stewart H Lecker
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Gearoid M McMahon
- Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paul M Palevsky
- Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samir Parikh
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts.,Nephrology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katherine Tuttle
- Division of Nephrology, Providence Medical Research Center, Sacred Heart Medical Center, Spokane, Washington
| | - Miguel A Vazquez
- Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas
| | - Anitha Vijayan
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri
| | - Brad H Rovin
- Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio
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