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Research Article
Noémie Jourde-Chiche
Aix-Marseille Univ, C2VN, INSERM, INRAE, AP-HM Conception Hospital, Department of Nephrology
Corresponding Author
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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 mmol/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. Median renal survival was higher in patients without AKI (p=0.007) or treated with corticosteroids (p=0.046). Dialysis-free survival censored for death was higher in patients without AKI (p=0.019), or treated (p=0.022), especially with corticosteroids (p=0.006).
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.
Keywords
Kidney biopsy, elderly patient, advanced age, acute kidney injury, nephrotic syndrome, glomerulonephritis, pathology, adverse events, treatment, survival
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No competing interests reported.
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A new preprint design is coming!
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This preprint is under consideration at BMC Nephrology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Noémie Jourde-Chiche
Aix-Marseille Univ, C2VN, INSERM, INRAE, AP-HM Conception Hospital, Department of Nephrology
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 09 Apr, 2021
No community comments so far
Editorial decision: Major revision
On 17 May, 2021
Reviews received
Received 14 May, 2021
Reviews received
Received 06 May, 2021
Reviewers agreed
On 13 Apr, 2021
Reviewers agreed
On 12 Apr, 2021
Reviewers invited
Invitations sent on 10 Apr, 2021
Editor assigned
On 08 Apr, 2021
Editor invited
On 08 Apr, 2021
Submission checks complete
On 08 Apr, 2021
First submitted
On 29 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Urology & Nephrology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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 mmol/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. Median renal survival was higher in patients without AKI (p=0.007) or treated with corticosteroids (p=0.046). Dialysis-free survival censored for death was higher in patients without AKI (p=0.019), or treated (p=0.022), especially with corticosteroids (p=0.006).
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.
Figure 1
Figure 2
Figure 3
Figure 4
No competing interests reported.
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