title: Predictors of kidney biopsy complication among patients with systemic lupus erythematosus.
abstract: Kidney biopsy is essential for the diagnosis and management of lupus nephritis. The risk of bleeding complication, however, is not defined in the systemic lupus erythematosus population. A retrospective cohort study was conducted to determine predictors of major and minor complications among patients with systemic lupus erythematosus undergoing percutaneous ultrasound-guided kidney biopsy. Major complications included bleeding necessitating intervention, hypotension requiring vasopressors or higher level of care or death. Minor complications included moderate or large (≥ 4 cm in largest diameter) perinephric hematoma, gross hematuria or voiding difficulties. All patients were observed for at least 23 h post-procedure. The overall incidence of bleeding was 10.5% (2.7% major, 7.8% minor). Adjusted logistic regression showed that for every 10,000 cells/mm(3) decrease in platelet count, risk for major and any complication increased by 27% (odds ratio 1.27; 95% confidence intervals 1.06-1.51; p = 0.01) and 8% (odds ratio 1.08; 95% confidence intervals 1.02-1.15; p = 0.01), respectively. Patients with a platelet count <150,000 cells/mm(3) were 30 times more likely to experience a major complication (p = 0.002). Other candidate predictors, including steroid exposure, kidney function, hematocrit and histopathology, were not significant. Kidney biopsies are well tolerated in patients with systemic lupus erythematosus. However, patients with pre-biopsy platelet counts <150,000 cells/mm(3) are at markedly increased risk for a major bleeding complication.
authors.affiliation: Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, USA. tchen39@jhmi.edu
authors.forename: T K
authors.initials: TK
authors.lastname: Chen
authors.forename: M M
authors.initials: MM
authors.lastname: Estrella
authors.forename: D M
authors.initials: DM
authors.lastname: Fine
mesh_terms: D001706:Biopsy / Q000009:adverse effects; D016001:Confidence Intervals; D006406:Hematoma / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007668:Kidney / Q000473:pathology*; D016015:Logistic Models; D008181:Lupus Nephritis / Q000097:blood* / Q000473:pathology*; D016017:Odds Ratio; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014555:Urination Disorders / Q000209:etiology