估计肾小球滤过率 < 30 ml/min/1.73 m 患者行肾活检的安全性和实用性。
Safety and utility of kidney biopsy in patients with estimated glomerular filtration rate < 30 ml/min/1.73 m.
机构信息
Nephrology, Medanta Hospital, Indore, Madhya Pradesh, India.
Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India.
出版信息
Nephrology (Carlton). 2021 Aug;26(8):659-668. doi: 10.1111/nep.13879. Epub 2021 Apr 14.
AIM
Kidney biopsy (KBx) is the gold standard for evaluation of kidney disease, but is associated with a higher risk of complications in patients with reduced glomerular filtration rate (GFR). We studied the safety and utility of KBx in patients with eGFR <30 ml/min/1.73 m .
METHODS
Consecutive adult patients with eGFR <30 ml/min/1.73 m , who were planned for a KBx and consented to participate were prospectively enrolled. Patients with solitary/transplant kidney or acute kidney injury were excluded. Haemoglobin was checked on the day of KBx and repeated 18-24 h later along with a screening ultrasound. Post-KBx complications were noted and their risk-factors analysed. The utility of the KBx was graded as effecting significant, some, or no change to subsequent management.
RESULTS
Of the 126 patients included, 75% were male, 27.7% were diabetic, and the median eGFR was 13.5 ml/min/1.73m . Major complications occurred in 5.6%. Peri-renal haematomas were detected in 37.3%, and haematomas ≥2 cm were significantly more frequent in those with eGFR <15 ml/min/1.73 m (29.2% vs. 13%, p = .032). Dialysis was a risk factor, while pre KBx blood transfusion, diabetes and higher serum albumin were protective against any complication. KBx was more likely to make a significant difference in management in those with eGFR 15-29 ml/min/1.73m (44.1% vs. 11.1%, p < .001). Increasing age, lower serum creatinine and albumin were independently associated with KBx utility.
CONCLUSION
KBx is relatively safe in severe kidney disease but its risk to benefit balance needs to be carefully considered when eGFR is <15 ml/min/1.73m .
目的
肾活检（KBx）是评估肾脏疾病的金标准，但在肾小球滤过率（GFR）降低的患者中，与更高的并发症风险相关。我们研究了 KBx 在 eGFR<30ml/min/1.73m 患者中的安全性和实用性。
方法
连续纳入计划进行 KBx 且同意参与的 eGFR<30ml/min/1.73m 的成年患者。排除孤立/移植肾脏或急性肾损伤的患者。在 KBx 当天检查血红蛋白，并在 18-24 小时后重复检查，同时进行筛选超声检查。记录 KBx 后的并发症，并分析其危险因素。KBx 的实用性被评为对后续管理有显著、部分或无影响。
结果
在纳入的 126 例患者中，75%为男性，27.7%为糖尿病患者，中位 eGFR 为 13.5ml/min/1.73m。主要并发症发生率为 5.6%。37.3%患者出现肾周血肿，eGFR<15ml/min/1.73m 的患者血肿≥2cm 的发生率明显更高（29.2%比 13%，p=0.032）。透析是一个危险因素，而 KBx 前输血、糖尿病和较高的血清白蛋白可预防任何并发症。在 eGFR 为 15-29ml/min/1.73m 的患者中，KBx 更有可能对管理产生显著影响（44.1%比 11.1%，p<0.001）。年龄增加、血清肌酐和白蛋白降低与 KBx 的实用性独立相关。
结论
在严重肾脏疾病中，KBx 相对安全，但在 eGFR<15ml/min/1.73m 时，需要仔细考虑其风险效益平衡。
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