Kohli Harbir Singh, Jairam A, Bhat Ashok, Sud Kamal, Jha Vivekanand, Gupta Krishan Lal, Sakhuja Vinay
Department of Nephrology, PGIMER, Chandigarh, 160012, UT, India.
Int Urol Nephrol. 2006;38(3-4):815-20. doi: 10.1007/s11255-006-0088-0. Epub 2006 Dec 2.
Kidney biopsy plays an important role in the diagnosis and management of several renal diseases. There is a general reluctance to perform kidney biopsy in elderly due to fear of complications. There is no prospective head to head trial comparing complications of percutaneous kidney biopsy in elderly versus young. This prospective study was undertaken to know the frequency and type of biopsy related complications in elderly. Biopsy was performed using a spring loaded automatic 16 G biopsy gun. Post-biopsy, patients were confined to bed rest for 24 h. A record of intraprocedural problems and post-procedural complications was kept. A total of 210 native kidney biopsies were done of which 26 were performed in elderly patients (61-78 years). Co-morbid conditions were present in 17 patients, some having more than one, hypertension (11), diabetes mellitus (5), chronic obstructive airway disease (6), interstitial lung disease (2) and coronary artery disease (2). Mean serum creatinine was 5.6 mg/dl (range 0.8-14.1 mg/dl). Pre-biopsy dialysis was given to 10 patients. Adequate tissue for histopathological diagnosis was seen in 24 out of 26 biopsies. In two elderly patients biopsy had to be abandoned though indicated due to inability to hold the breath because of underlying lung and cardiac disease. Clinico-pathologic discorrelation was seen in eight patients. Incidence of gross hematuria was more in elderly than in young (4/26 vs. 7/184 P<0.01). Hematuria subsided within 1-2 days in three, one had persistent hematuria for 1 week. Other complications viz. gross hematuria with need of blood transfusions or hemodynamic compromise (0/26 vs. 4/184), perinephric hematoma (0/26 vs. 1/184) and need of intervention (0/26 vs. 1/184) were not higher in the elderly. We conclude that the standard precautions kidney biopsy in elderly is a safe procedure.
肾活检在多种肾脏疾病的诊断和治疗中发挥着重要作用。由于担心并发症，老年患者一般不太愿意接受肾活检。目前尚无前瞻性的头对头试验比较老年患者与年轻患者经皮肾活检的并发症情况。本前瞻性研究旨在了解老年患者活检相关并发症的发生率及类型。使用弹簧式自动16G活检枪进行活检。活检后，患者需卧床休息24小时。记录术中问题及术后并发症。共进行了210例自体肾活检，其中26例在老年患者（61 - 78岁）中进行。17例患者存在合并症，部分患者有一种以上合并症，包括高血压（11例）、糖尿病（5例）、慢性阻塞性气道疾病（6例）、间质性肺疾病（2例）和冠状动脉疾病（2例）。平均血清肌酐为5.6mg/dl（范围0.8 - 14.1mg/dl）。10例患者在活检前接受了透析。26例活检中有24例获得了足够用于组织病理学诊断的组织。2例老年患者因潜在的肺部和心脏疾病无法屏气，尽管有活检指征，但不得不放弃活检。8例患者出现临床病理不相关情况。老年患者肉眼血尿的发生率高于年轻患者（4/26 vs. 7/184，P<0.01）。3例患者的血尿在1 - 2天内消退，1例患者持续血尿1周。其他并发症，即需要输血或血流动力学不稳定的肉眼血尿（0/26 vs. 4/184）、肾周血肿（0/26 vs. 1/184）和需要干预的情况（0/26 vs. 1/184）在老年患者中并不更高。我们得出结论，老年患者肾活检的标准预防措施是一种安全的操作。
