Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
BMC Nephrol. 2023 Mar 15;24(1):56. doi: 10.1186/s12882-023-03097-2.
Impaired renal function was not a recognized indication for renal biopsy. The effects of receiving renal biopsy on the renal functional prognosis for chronic kidney disease (CKD) patients with impaired renal function need to be explored.
This study retrospectively enrolled 300 renal function impaired CKD patients in Renji Hospital from January 2015 to December 2017, 150 of them received percutaneous renal biopsy while the others did not. The endpoint was ≥ 50% estimated glomerular filtration rate (eGFR) decline from baseline or development of end-stage renal disease (ESRD). Kaplan-Meier analysis with log-rank test was performed to compare the renal survival probability between patients receiving renal biopsy or not. Univariate and multivariate analysis with Cox regression were conducted with predictors of poor renal outcomes in the study cohort.
The median follow-up period was 37.6 months. During the follow-up period, the eGFR of the biopsy group increased from 52.2 ± 14.4 to 67.4 ± 37.8 ml/min/1.73 m², but decreased from 55.3 ± 17.1 to 29.8 ± 19.1 ml/min/1.73 m² in the non-biopsy group. Patients who received renal biopsy had significantly higher renal survival probability (P < 0.001). Cox regression analysis revealed that 24-hour urine protein excretion (24 h UPE) more than 1 g/d was an independent predictor for poor renal outcomes in the non-biopsy group but not in the renal biopsy group (HR = 1.719, P = 0.040).
CKD patients with impaired renal function are recommended to receive renal biopsy to make pathological diagnoses, especially for those with the 24-hour urine protein excretion more than 1 g/d.
肾功能不全不是肾活检的适应证。需要探讨接受肾活检对肾功能不全的慢性肾脏病（CKD）患者肾功能预后的影响。
本研究回顾性纳入 2015 年 1 月至 2017 年 12 月在仁济医院就诊的 300 例肾功能不全的 CKD 患者，其中 150 例行经皮肾活检，其余未行肾活检。终点是肾小球滤过率（eGFR）较基线下降≥50%或进展为终末期肾病（ESRD）。采用 Kaplan-Meier 分析和对数秩检验比较行肾活检和未行肾活检患者的肾脏生存概率。采用单因素和多因素 Cox 回归分析研究队列中预测不良肾脏结局的因素。
中位随访时间为 37.6 个月。随访期间，活检组的 eGFR 从 52.2±14.4 增加到 67.4±37.8 ml/min/1.73 m²，但未行肾活检组从 55.3±17.1 下降到 29.8±19.1 ml/min/1.73 m²。行肾活检的患者肾脏生存概率显著更高（P<0.001）。Cox 回归分析显示，24 小时尿蛋白排泄量（24 h UPE）>1 g/d 是未行肾活检组不良肾脏结局的独立预测因素，但不是肾活检组的独立预测因素（HR=1.719，P=0.040）。
推荐肾功能不全的 CKD 患者接受肾活检以做出病理诊断，特别是 24 小时尿蛋白排泄量>1 g/d 的患者。
