Utility of percutaneous renal biopsy in chronic kidney disease.
BACKGROUND
We tested the hypothesis that patterns of serum creatinine concentrations (S-cr) prior to percutaneous renal biopsy (PRB) predict the utility of PRB in safely making renal diagnoses, revealing treatable disease, and altering therapy in chronic kidney disease patients.


METHODS
PRB specimens (170 patients) were assigned to 1 of 5 groups: S-cr never greater than 0.11 mM for at least 6 months prior to PRB (Group 1); S-cr greater than 0.11 mM but less than 0.18 mM during the 6 months prior to PRB (Groups 2); S-cr less than 0.18 mM during the 6 months prior to PRB but greater than 0.18 mM prior to these 6 months (Group 3); S-cr greater than 0.18 mM for less than 6 months prior to PRB (Group 4); S-cr greater than 0.18 mM for more than 6 months prior to PRB (Group 5).


RESULTS
Histopathology chronicity score (0-9) increased with increasing group number: 2.1 (Group 1); 4.4 (Group 2); 4.5 (Group 3); 5.4 (Group 4); 7.0 (Group 5). Post-PRB bleeding was more common with increasing group number. New therapy was instituted after PRB most frequently in Group 4 (62%) and least frequently in Group 5 (24%).


CONCLUSIONS
After more prolonged elevations of S-cr, PRB may be less safe and less likely to reveal treatable disease and opportunities for therapy.
Joseph
Anthony J
AJ
Medical University of South Carolina, Ralph H. Johnson VA Hospital, Charleston, South Carolina 29425-6290, USA.
Compton
Susan P
SP
Holmes
Lewis H
LH
Annand
Andrew
A
Self
Sally E
SE
Fitzgibbon
Wayne R
WR
Ullian
Michael E
ME
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy / Q000009:adverse effects / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D007674:Kidney Diseases / Q000097:blood / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013022:South Carolina; D013997:Time Factors; D015854:Up-Regulation
D015415:Biomarkers; D003404:Creatinine