A24(T)
RENAL BIOPSY IN ELDERLY PATIENTS: INDICATION, DIAGNOSIS, SAFETY AND
CLINICAL USE
Greenhall, G, Jones, C, Shah, S, Jayawardene, S
King’s College Hospital, London
BACKGROUND: As the elderly population increases, the incidence of acute and chronic renal failure is
rising. Age is no longer considered a contra-indication to renal biopsy or subsequent treatment, including
immunosuppression. Studies have shown renal biopsy to be safe, yielding treatable diagnoses in up to 70%
of elderly patients.
AIMS: to examine the indications, complications, diagnoses, treatment and outcomes of native renal
biopsies in an elderly population.
METHODS: Retrospective cohort study of all patients aged over 70 years undergoing native renal biopsy
between 2005 and 2010 in a large tertiary referral centre. Data collected from hospital databases included
demographics, laboratory reports, treatment and outcomes. Data was analysed using SPSS v17.
RESULTS: In total 531 biopsies were performed between January 2005 and August 2010. Of 66 performed
on patients aged 70 or over, 61 were native kidney biopsies and were included in this study. 51% of the
study population were male, with mean age of 77.5 years (70-94). 31% had pre-existing renal impairment,
18% were diabetic; 48% of biopsies were performed electively. 38% of patients required blood transfusion
pre-biopsy; 11% were performed under x-ray guidance. The primary indications for biopsy and subsequent
diagnosis are listed in the table below. One patient required blood transfusion and embolisation for a postbiopsy bleed. The mean length of stay post-biopsy was 2 days in elective cases, and 11 days in acute cases.
Biopsy findings resulted in a change in management for 67% of patients; this comprised immunosuppression
(68%,) chemotherapy (20%), stopping immunosuppression (12%), antibiotics (5%), or plasma exchange
(5%). At biopsy, 31% of patients were on haemodialysis; six months post-biopsy, 22% were on
haemodialysis and 7% had died; one year post-biopsy, 16% were on haemodialysis, and 14% had died.
Absence of pre-existing kidney disease was positively associated with a change in management (p=0.02).
CONCLUSION: Biopsy in our elderly population is safe, yields valuable information, and alters the
management of a significant proportion of patients.
Table: Primary biopsy indication and diagnosis
Biopsy diagnosis
TIN /
Diabetic /
ATN hypertensiv
e
nephropath
y
5
1
Pauci immune
GN
Other
GN
Renal
Myelom
a
other /
unclear
Positive acute
screen
Acute kidney
injury
CKD/progressiv
e renal
impairment
Nephrotic or
Haem/proturia
13
7
5
3
34(56%)
0
2
1
1
2
2
8(13%)
0
3
4
2
0
2
11(18%)
0
6
0
1
1
0
8(13%)
Total
13
(21%)
18
(30%)
10
(16%
)
5
(8%)
8
(13%)
7
(12%)
61
(100%
Biopsy
indication
Total