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Native kidney biopsies in older adults: disease spectrum, long-term kidney and patient survival and safety

  • Nephrology - Original Paper
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Abstract

Purpose

Patients undergoing kidney biopsy are increasingly older. We aimed to evaluate the clinical utility of kidney biopsy, long-term clinical outcomes, and safety of high-risk biopsies in older adults undergoing kidney biopsy in a multi-ethnic Southeast Asian cohort.

Methods

We performed a single-center retrospective study of older patients (age ≥ 60 years) who underwent native kidney biopsies between June 2011 and March 2015. The primary long-term outcome of interest was a composite of ESKD or death. The safety outcome of interest was post-biopsy bleeding in the high-risk subgroup, defined by serum creatinine > 150 µmol/l.

Results

Older adults accounted for 153 of 545 (28.1%) native renal biopsies performed. The median age of these older adults was 66.6 (IQR 63.0, 70.6) years. Kidney dysfunction was frequent and severe in this cohort, with 41.2% having eGFR < 30 ml/min/m2 and 71.2% having nephrotic-range proteinuria at presentation. A significant proportion (124 patients; 81.0%) had treatable diagnoses. Of these, 90 (72.6%) received immunosuppressive therapy. On Kaplan–Meier analysis, patients with pauci-immune glomerulonephritis (p = 0.004) and diabetic nephropathy (p = 0.005) were at a significantly increased risk of the composite outcome of ESKD or death. On multivariate analysis, older age and lower eGFR were independently associated with ESKD or death and ESKD alone. Lupus nephritis and diabetic nephropathy were independently associated with ESKD or death, while immunosuppressant therapy was associated with reduced ESKD alone. In the high-risk subgroup, post-biopsy bleeding occurred in 19 (22.8%) patients. Desmopressin use was not associated with reduced bleeding complications.

Conclusion

Our study confirmed the utility of kidney biopsy in older adult patients for diagnosis and management, although risk counselling and close monitoring for bleeding complications is necessary.

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Authors and Affiliations

  1. Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore

    Hui Zhuan Tan, Jason Chon Jun Choo, Irene Mok, Choong Meng Chan, Chieh Suai Tan, Keng Thye Woo & Cynthia Ciwei Lim

  2. Department of Pharmacy, Singapore General Hospital, Singapore, Singapore

    Benson Siow & Fiona Hui Ing Yeo

  3. Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore

    Alwin Hwai Liang Loh & Puay Hoon Tan

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  1. Hui Zhuan Tan
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Contributions

THZ, CL and JC contributed to the study conception and design. Material preparation, data collection and analysis were performed by THZ, BS and CL. The first draft of the manuscript was written by THZ and CL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hui Zhuan Tan.

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The authors declare no conflicts of interest.

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The study abided by the Declaration of Helsinki and waiver of informed consent for retrospective electronic medical review was approved by the SingHealth Centralized Institutional Review Board (2015/2882).

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Tan, H.Z., Siow, B., Choo, J.C.J. et al. Native kidney biopsies in older adults: disease spectrum, long-term kidney and patient survival and safety. Int Urol Nephrol 54, 2365–2373 (2022). https://doi.org/10.1007/s11255-022-03143-2

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