Bronchoscopy in Uremic Patients

Abstract

Uremia is associated with an increased risk of bleeding by virtue of alteration in platelet adhesion. Pulmonologists are frequently called upon to perform flexible bronchoscopy in patients with chronic renal insufficiency. The high blood urea nitrogen levels may predispose these patients to a high risk of bleeding complications with bronchoscopic procedures. We carried out a literature review to evaluate the myth that bronchoscopy is unsafe in uremic patients.

Managing Massive Hemoptysis

“…Some recommend desmopressin as an adjunct to mitigate this risk because it has been proven to decrease bleeding time in patients with uremia in small studies. 25,26 Limited data exist on the safe minimum threshold for platelet count when performing endobronchial or transbronchial lung biopsies. 27 Papin et al 28 reported a series of 24 patients with thrombocytopenia (mean platelet count, 30,000/mm 3 AE 16,500/mm 3 ) undergoing transbronchial lung biopsies wherein 20.8% had bleeding complications.…”

Iatrogenic bleeding during flexible bronchoscopy: risk factors, prophylactic measures and management

“…An increased risk of bleeding with TBLB [ 1 , 22 ] could not be documented in a recent retrospective study [ 33 ]. Patients on chronic haemodialysis received haemodialysis and desmopressin intravenously before the procedure, and some authors suggest this approach [ 34 ]. Most pulmonologists, however, do not consider a high creatinine value as a contraindication to perform TBLB, and only 37% of them consider it appropriate to administer desmopressin prior to TBLB in uraemic patients [ 26 ].…”