Kidney biopsy in the elderly: diagnostic adequacy and yield
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NEPHROLOGY - ORIGINAL PAPER
Kidney biopsy in the elderly: diagnostic adequacy and yield Özant Helvacı1 · Berfu Korucu2 · Ipek İsik Gonul3 · Turgay Arınsoy2 · Galip Guz2 · Ulver Derici2 Received: 4 February 2020 / Accepted: 7 September 2020 © Springer Nature B.V. 2020
Abstract Purpose The number of kidney biopsies (KB) performed in elderly patients has been increasing. Safety and usefulness of elderly KB have been well established, whereas much less is known about diagnostic adequacy and yield in this patient population. Methods We performed a retrospective study of KBs in 428 patients from April 2015 to December 2017 at an academic institution. We compared KB from 50 patients aged over 64 (elderly) with KB from 378 patients aged between 18 and 64. Results Gender ratio, body mass index, systolic and diastolic BP, creatinine values, incidences of AKI at the time of biopsy, INR/aptt values, and platelets were similar between the two groups. eGFR and number of transplant biopsies were lower in the elderly biopsy group. The glomerular yield was similar between the two groups (22 ± 14 vs. 22 ± 13, p = 0.869). The likelihood of obtaining more than ten glomeruli was 87% and 88%, respectively, without a significant difference. Inadequate samples were encountered in 6% of the elderly and 5.6% of the non-elderly KB, again without a significant difference. Samples taken by nephrologist had higher glomerular yield for both groups (25 ± 13 vs. 18 ± 12 overall, 26 ± 14 vs. 18 ± 14 for elderly, p 65 years) and non-elderly (age: 18–64 years) patients were compared in terms of collected data. There were fifty elderly and 378 non-elderly patients. The performer was either the nephrologist or the interventional radiologist (IR). Each biopsy was performed under real-time ultrasound with either 16G (nephrologist) or 18G (IR) automated biopsy needles. Nephrologist also used bedside pathological evaluation with a dissecting scope. The IR team did not employ on-site assessment of KB and acquired two cores for each patient, while nephrologist took between one and four cores per patient. There were 369 native and 59 transplant KB. All transplant KB were indication biopsies. We excluded KB from pregnant patients. Demographical and clinical data in addition to the glomerular yield, adequacy, and complications were recorded. Information collected at the time of KB, included age, gender, body mass index (BMI), the existence of acute kidney injury (AKI), systolic and diastolic blood pressures (BP), serum creatinine (SCr), estimated glomerular filtration rate (CKD-EPI), prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelet count. The definition of AKI was an increase in SCr by ≥ 0.3 mg/dl within 48 h; or increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the previous 7 days; or urine volume
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