Hemoptysis in patients with renal insufficiency : the role of flexible bronchoscopy.
OBJECTIVE
To assess the indications, yield, and therapeutic impact of flexible bronchoscopy (FB) in patients with hemoptysis and renal insufficiency.


METHODS
Retrospective cohort analysis.


METHODS
Tertiary-care university hospital.


METHODS
Thirty-four patients over a 7.5-year period who underwent FB to evaluate hemoptysis in the setting of renal insufficiency (ie, serum creatinine level, > 1.5 mg/dL).


RESULTS
The etiology of hemoptysis was undetermined in 41% of cases. Defined causes of bleeding included infections (29%), pulmonary renal syndromes (15%), airway injury (9%), and pulmonary embolism (6%). No specific bleeding site was identified, but FB lateralized hemorrhaging to one lung in 24% of patients. FB results influenced therapy in 29% of patients overall and in 8% of patients without respiratory tract infection. The hospital survival rate was 47% and did not differ based on the presence or absence (presence vs absence) of the following variables: a defined etiology for hemoptysis (45% vs 50%); lateralized bleeding (38% vs 50%); or management alterations prompted by other FB findings (50% vs 46%). Factors associated with survival included the onset of bleeding prior to hospital admission (80% vs 33%; p = 0.02), the absence of respiratory failure requiring mechanical ventilation at the time of FB (90% vs 29%; p = 0.002), and lack of prohemorrhagic factors (other than uremia) such as disseminated intravascular coagulation, recent treatment with warfarin, heparin, or antiplatelet agents (78% vs 33%; p = 0.05). During the 6 months following hospital discharge, hemoptysis recurred in 14% of patients, and 5 patients died, for an overall mortality rate of 62%.


CONCLUSIONS
These data suggest that FB in hospitalized patients with hemoptysis and renal insufficiency, and without radiographic findings suggesting neoplastic disease, has a low yield and limited impact. Whether FB influences outcome in selected patients in this setting requires prospective investigation.
Department of Internal Medicine, Section on Pulmonary and Critical Care, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1054, USA. nkallay@wfubmc.edu
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Kallay
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Dunagan
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Adair
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Chin
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Haponik
D001999:Bronchoscopy / Q000379:methods* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006469:Hemoptysis / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D051437:Renal Insufficiency / Q000150:complications* / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors