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Safety and diagnostic yield of renal biopsy in the intensive care unit

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Abstract

Purpose

Renal biopsy (RB) is occasionally performed in critically ill patients. The safety and impact of RB in this setting have not been reported.

Methods

A 10-year (2000–2009) retrospective multicentre study was conducted in ten French intensive care units (ICU) on patients who underwent RB during their management. Medical files were retrieved for data analysis.

Results

Seventy-seven patients underwent an RB of which 68 (88 %) were on a native kidney and 9 (12 %) on a transplanted kidney. Percutaneous ultrasound-guided RB was used in most cases (87 %). Fifty-seven per cent of the patients were on mechanical ventilation at the time of RB. RB-related complications occurred in 17 (22 %) patients, two were graded as severe (requirement for kidney embolization, eventually successful). In 35 (51 %) non-transplanted patients, RB established a specific diagnosis other than acute tubular necrosis (ATN), which was diagnosed in only 18 % of patients. In the remaining patients, only non-specific lesions were observed. Therapeutic modifications followed RB in 14 (21 %) non-transplanted patients. Presence of signs of systemic disease involving the renal tract, occurrence of renal failure before hospital admission, and absence of any factor usually associated with ATN significantly predicted the presence of a specific diagnosis at RB other than ATN.

Conclusions

In this cohort, the contribution of RB to diagnosis and treatment was undeniable, but at the expense of frequent adverse events although most of them were not considered severe.

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Abbreviations

AKI:

Acute kidney injury

AKIN:

Acute Kidney Injury Network

ATN:

Acute tubular necrosis

ICU:

Intensive care unit

RB:

Renal biopsy

SAPS II:

Simplified acute physiology score

SOFA:

Sequential organ failure assessment

RRT:

Renal replacement therapy

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Conflicts of interest

The investigators declare they have no conflicts of interest related to this manuscript and that they have full control of all primary data and that they agree to allow the journal to review their data if requested.

Author information

Authors and Affiliations

  1. Service de Néphrologie-Dialyse-Transplantation, CHU Angers, 49933, Angers, France

    Jean-François Augusto

  2. Département de Réanimation médicale et Médecine hyperbare, CHU Angers, Université d’Angers, 4 rue Larrey, 49933, Angers Cedex 9, France

    Jean-François Augusto & Nicolas Lerolle

  3. Service de Réanimation médico-chirurgicale, Centre Hospitalier du Mans, 72000, Le Mans, France

    Vincent Lassalle

  4. Service de Réanimation médicale et maladies infectieuses, Hôpital Pontchaillou, CHU de Rennes, 35033, Rennes, France

    Pierre Fillatre

  5. Service de Réanimation médicale, Hôpital Bretonneau, CHU de Tours, 37044, Tours, France

    Dominique Perrotin

  6. Service de Réanimation médicale, Nouvel Hôpital Civil, Hôpitaux universitaires de Strasbourg, 67091, Strasbourg, France

    Ferhat Meziani

  7. Service de Réanimation médicale, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, avenue Molière, 67098, Strasbourg, France

    Maleka Schenck-Dhif

  8. Service de Réanimation médicale, Hôpital Central, CHU de Nancy, 54035, Nancy, France

    Pierre Edouard Bollaert

  9. Service de Réanimation médicale, Hôpital Côte de Nacre, CHU de Caen, 14033, Caen, France

    Damien du Cheyron

  10. Service de Réanimation médicale, Hôpital Charles Nicolle, CHU de Rouen, 76031, Rouen, France

    Gaetan Beduneau

  11. Service de Réanimation médicale, Hôpital Marc Jacquet, 77011, Melun, France

    Christophe Vinsonneau

  12. Service de Réanimation Médicale Polyvalente, CHU de Nantes, 44000, Nantes, France

    Christophe Guitton

  13. Faculté de Médecine, France et Institut de Transplantation Uro-Néphrologie, INSERM; UMR 1064, Université, 44000, Nantes, France

    Christophe Guitton

Authors
  1. Jean-François Augusto
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  2. Vincent Lassalle
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  3. Pierre Fillatre
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  4. Dominique Perrotin
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  5. Ferhat Meziani
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  6. Maleka Schenck-Dhif
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  7. Pierre Edouard Bollaert
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  8. Damien du Cheyron
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  9. Gaetan Beduneau
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  10. Christophe Vinsonneau
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  11. Christophe Guitton
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  12. Nicolas Lerolle
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Corresponding author

Correspondence to Nicolas Lerolle.

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Augusto, JF., Lassalle, V., Fillatre, P. et al. Safety and diagnostic yield of renal biopsy in the intensive care unit. Intensive Care Med 38, 1826–1833 (2012). https://doi.org/10.1007/s00134-012-2634-9

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  • DOI: https://doi.org/10.1007/s00134-012-2634-9

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