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Multicenter Study
. 2021 Nov 2;22(1):362.
doi: 10.1186/s12882-021-02559-9.

Kidney biopsy in very elderly patients: indications, therapeutic impact and complications

Mathilde Fedi  1 , Mickaël Bobot  1   2 , Julia Torrents  3 , Pierre Gobert  4 , Éric Magnant  5 , Yannick Knefati  6 , David Verhelst  7 , Gaëtan Lebrun  8 , Valérie Masson  9 , Philippe Giaime  10 , Julien Santini  11 , Stanislas Bataille  2   10 , Philippe Brunet  1   2 , Bertrand Dussol  1   2 , Stéphane Burtey  1   2 , Julien Mancini  12 , Laurent Daniel  2   3 , Noémie Jourde-Chiche  13   14
Affiliations
Multicenter Study

Kidney biopsy in very elderly patients: indications, therapeutic impact and complications

Mathilde Fedi et al. BMC Nephrol. .

Abstract

Background: Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients.

Methods: Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed.

Results: 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months.

Conclusions: KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.

Keywords: Acute kidney injury; Advanced age; Adverse events; Elderly patient; Glomerulonephritis; Kidney biopsy; Nephrotic syndrome; Pathology; Survival; Treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Indication for kidney biopsy in the 104 very elderly patients. (AKI, acute kidney injury; NS, nephrotic syndrome; PU, proteinuria)
Fig. 2
Fig. 2
Patient outcome
Fig. 3
Fig. 3
Kaplan Meier survival analyses. A) Overall survival. B) Renal survival
See this image and copyright information in PMC

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