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Kidney biopsy in very elderly patients: indications, therapeutic impact and complications

Abstract : Background: Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients. Methods: Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. Results: 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. Conclusions: KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.
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https://www.hal.inserm.fr/inserm-03474201
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Submitted on : Friday, December 10, 2021 - 10:09:19 AM
Last modification on : Tuesday, June 28, 2022 - 5:31:25 PM
Long-term archiving on: : Friday, March 11, 2022 - 6:37:27 PM

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Mathilde Fedi, Mickaël Bobot, Julia Torrents, Pierre Gobert, Éric Magnant, et al.. Kidney biopsy in very elderly patients: indications, therapeutic impact and complications. BMC Nephrology, BioMed Central, 2021, 22 (1), pp.362. ⟨10.1186/s12882-021-02559-9⟩. ⟨inserm-03474201⟩

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