RESUMEN
BACKGROUND: The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy. METHODS: The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression. RESULTS: Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08-1.17], liver disease (OR 2.27, 95% CI 1.21-4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07-1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92-0.99) were protective. CONCLUSIONS: This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.
Asunto(s)
Riñón , Humanos , Persona de Mediana Edad , Riñón/patología , Estudios Prospectivos , Estudios Retrospectivos , Creatinina , BiopsiaAsunto(s)
Hipertensión Renal/etiología , Enfermedades Renales/etiología , Esclerodermia Difusa/complicaciones , Antihipertensivos/uso terapéutico , Humanos , Hipertensión Renal/diagnóstico , Hipertensión Renal/inmunología , Hipertensión Renal/terapia , Enfermedades Renales/diagnóstico , Enfermedades Renales/inmunología , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Fotoféresis , Intercambio Plasmático , Diálisis Renal , Esclerodermia Difusa/diagnóstico , Esclerodermia Difusa/inmunología , Esclerodermia Difusa/terapia , Resultado del TratamientoAsunto(s)
Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/terapia , Glomerulonefritis/terapia , Granulomatosis con Poliangitis/terapia , Síndrome Hemolítico-Urémico/terapia , Plasmaféresis , Femenino , Glomerulonefritis/etiología , Humanos , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/terapia , Masculino , Plasmaféresis/efectos adversos , Plasmaféresis/métodos , Esteroides/uso terapéuticoRESUMEN
Wegener Granulomatosis is a systemic Anti-Neutrophil Cytoplasmic Autoantibody-associated Vasculitis, affecting small-to-medium vessels. Clinical presentation with simultaneous involvement of kidney and upper and lower respiratory tract is unusual. We report an instructive case of WG, analyzing clinical course, laboratory, and radiological features, kidney, lung, and larynx histological pictures. Besides renal biopsy, nephrology team performed larynx and lung biopsies because of unusual clinical presentation, computed tomography chest examination, and relevant malignancy risk regarding following immunosuppressant therapy.
