Safety and diagnostic yield of renal biopsy in the intensive care unit

• Published in: Intensive care medicine 2012-11, Vol.38 (11), p.1826-1833
• Main Authors: Augusto, Jean-François, Lassalle, Vincent, Fillatre, Pierre, Perrotin, Dominique, Meziani, Ferhat, Schenck-Dhif, Maleka, Bollaert, Pierre Edouard, du Cheyron, Damien, Beduneau, Gaetan, Vinsonneau, Christophe, Guitton, Christophe, Lerolle, Nicolas
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biochemistry, Molecular Biology; Biological and medical sciences; Biopsy; Cellular Biology; Clinical death. Palliative care. Organ gift and preservation; Creatinine; Critical Care Medicine; Data analysis; Emergency Medicine; Female; France; Health aspects; Hospital patients; Humans; Information management; Intensive; Intensive care; Intensive care medicine; Intensive Care Units; Kidney - pathology; Kidney Tubular Necrosis, Acute - pathology; Kidney Tubular Necrosis, Acute - therapy; Kidneys; Life Sciences; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Necrosis; Nephrology; Original; Pain Medicine; Patient Safety; Pediatrics; Physiology; Pneumology/Respiratory System; Renal replacement therapy; Retrospective Studies; Safety and security measures; Systemic diseases; Transplantation; Treatment Outcome; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-012-2634-9

Purpose Renal biopsy (RB) is occasionally performed in critically ill patients. The safety and impact of RB in this setting have not been reported. Methods A 10-year (2000–2009) retrospective multicentre study was conducted in ten French intensive care units (ICU) on patients who underwent RB during their management. Medical files were retrieved for data analysis. Results Seventy-seven patients underwent an RB of which 68 (88 %) were on a native kidney and 9 (12 %) on a transplanted kidney. Percutaneous ultrasound-guided RB was used in most cases (87 %). Fifty-seven per cent of the patients were on mechanical ventilation at the time of RB. RB-related complications occurred in 17 (22 %) patients, two were graded as severe (requirement for kidney embolization, eventually successful). In 35 (51 %) non-transplanted patients, RB established a specific diagnosis other than acute tubular necrosis (ATN), which was diagnosed in only 18 % of patients. In the remaining patients, only non-specific lesions were observed. Therapeutic modifications followed RB in 14 (21 %) non-transplanted patients. Presence of signs of systemic disease involving the renal tract, occurrence of renal failure before hospital admission, and absence of any factor usually associated with ATN significantly predicted the presence of a specific diagnosis at RB other than ATN. Conclusions In this cohort, the contribution of RB to diagnosis and treatment was undeniable, but at the expense of frequent adverse events although most of them were not considered severe.