Kidney biopsy practice amongst Australasian nephrologists

Abstract

Background Percutaneous kidney biopsy is the gold standard investigation for the diagnosis of kidney diseases. The associated risks of the procedure depend on the skill and experience of the proceduralist as well as the characteristics of the patient. The Kidney Health Australia – Caring for Australasians with Renal Impairment (KHA-CARI) guidelines on kidney biopsies, published in 2019, are the only published national kidney biopsy guidelines. As such, this study surveys current kidney biopsy practices in Australasia and examines how they align with the Australian guidelines, as well as international biopsy practice. Methods A cross-sectional, multiple-choice questionnaire was developed examining precautions prior to kidney biopsy; rationalisation of medications prior to kidney biopsy; technical aspects of kidney biopsy; complications of kidney biopsy; and indications for kidney biopsy. This was distributed to all members of the Australian and New Zealand Society of Nephrology (ANZSN). Results The response rate for this survey is approximately 21.4 % (182/850). Respondents found agreement (> 75.0 %) in only six out of the twelve questions (50.0 %) which assessed their practice against the KHA-CARI guidelines. Conclusions This is the first study of its kind where kidney biopsy practices are examined against a clinical guideline. Furthermore, responses showed that practices were incongruent with guidelines and that there was a lack of consensus on many issues.

A British Society for Haematology guideline on the assessment and management of bleeding risk prior to invasive procedures

“…78,79 c MacGinley et al 80 A survey of Australasian renal physicians found that 52% preferred a threshold of 100 × 10 9 /L. 81 placement in patients with platelet levels of <50 × 10 9 demonstrated no major bleeding complications. 74 For high bleeding risk procedures, it is reasonable to check an up-to-date platelet count of any patient at risk of thrombocytopenia.…”

“… c MacGinley et al 80 . A survey of Australasian renal physicians found that 52% preferred a threshold of 100 × 10 9 /L 81 …”

Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique, and Safety

“…The available evidence suggests that the histological diagnosis of both native and transplanted kidney biopsies has a direct therapeutic impact or significantly influences the patient's further treatment in about 40-60% of cases [12,13]. Apart from protocol biopsies for scientific purposes, the indication for performing a renal biopsy is determined in individual cases by the subjective assessment of the treating nephrologist with regard to the therapeutic benefit [14,15]. There are considerable differences in the indication and performance of a kidney biopsy locally in the nephrology departments and also in an international comparison [16,17].…”