title: Kidney biopsy in the critically ill patient, results of a multicentre retrospective case series.
abstract: BACKGROUND
  The impact of a contributive result of kidney biopsy on the management of patients in the intensive care unit (ICU) has not been extensively investigated yet.
  
  
  METHODS
  This was a retrospective study conducted between 2000 and 2011 in five French ICUs. The study included 56 patients. They had at least one non-renal organ failure, as defined by a Sequential Organ Failure Assessment (SOFA) score ≥3 on ICU admission, and kidney biopsy was performed during ICU stay. Kidney samples were obtained by percutaneous (N.=55) or transjugular biopsy (N.=1).
  
  
  RESULTS
  The mean Simplified Acute Physiology Score II and total SOFA scores on ICU admission were 52±19 years and 10.3±3.6, respectively. ICU mortality was 23%. The median (interquartile range) time between ICU admission and kidney biopsy was 9 days (5-21). Pathologic findings in the 54 analyzable kidney biopsies were acute tubular necrosis (N.=26), glomerulonephritis (N.=14), acute vascular nephritis (N.=11), acute interstitial nephritis (N.=6), and deposit disease (N.=3). Kidney biopsy was contributive to the management of 40 patients. In 23 of these, new treatments were started, in 13 ongoing treatments were stopped, including four life-sustaining therapies, and in 13 it was decided to start chronic renal replacement. Severe bleeding was observed in 7 patients, with fatal outcome in one case.
  
  
  CONCLUSIONS
  Kidney biopsy may have a significant impact on the management of critically ill patients. Further studies should be done to identify the groups of ICU patients likely to benefit from the procedure with minimum risk.
authors.affiliation: Service de Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, F-63003, Clermont Université d'Auvergne, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Philipponnet
authors.forename: C
authors.initials: C
authors.lastname: Guérin
authors.forename: E
authors.initials: E
authors.lastname: Canet
authors.forename: R
authors.initials: R
authors.lastname: Robert
authors.forename: C
authors.initials: C
authors.lastname: Mariat
authors.forename: F
authors.initials: F
authors.lastname: Dijoud
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
authors.forename: B
authors.initials: B
authors.lastname: Souweine
authors.forename: A E
authors.initials: AE
authors.lastname: Heng
mesh_terms: D000368:Aged; D001706:Biopsy; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy; D012189:Retrospective Studies