Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

Abstract

Introduction The risk of bleeding associated with transjugular kidney biopsies is unclear, and which patients are the best candidates for this route is unknown. Methods This was a retrospective cohort study comparing proportion of bleeding associated with transjugular versus percutaneous native kidney biopsies in all patients in France in the 2010–2019 period. Major bleeding at day 8 (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, nephrectomy) and risk of death at day 30 were assessed, and we used a bleeding risk score initially developed for the percutaneous route. Results Our analysis included 60,331 patients (transjugular route: 5305; percutaneous route: 55,026 patients). The observed proportion of major bleeding varied widely (transjugular vs. percutaneous): 0.4% versus 0.5% for the lowest risk scores (0–4) to 19.1% versus 30.8% for the highest risk scores (≥35). Transjugular was more frequently used than percutaneous route (39% vs. 24%) when the risk score was ≥20 (15,133/60,331; 25% of all patients). Transjugular was associated with a lower risk of major bleeding than percutaneous route in multivariate analyses (odds ratio [OR]: 0.88 [0.78–0.99]), especially for scores ≥20 (OR: 0.83 [0.72–0.96], (i.e., 25% of patients). Major bleeding was associated with an increased risk of death both for transjugular (OR: 1.77 [1.00–3.14]) and percutaneous (OR: 1.80 [1.43–2.28]) routes. Conclusions The transjugular route is independently associated with a lower risk of bleeding than the percutaneous route, especially in high-risk patients identified by a preprocedure risk score ≥20 (i.e., 25% of patients). Major bleeding is associated with an increased risk of death for both routes.

Tertiary lymphoid structure signatures are associated with immune checkpoint inhibitor related acute interstitial nephritis

“…Kidney biopsies, especially in cancer patients, poses an increased risk of bleeding, and thus is not always a feasible option (9)(10)(11)(12). With the incidence of post-renal biopsy hematomas ranging up to 11%, a noninvasive approach that uses urine or plasma sampling represents an attractive solution for facilitating detection and monitoring of patients on ICI therapy (13).…”

“…Timely and accurate diagnosis of AIN is complicated due to the lack of non-invasive diagnostic tests; as such, kidney biopsy remains the gold standard. In patients with cancer, a kidney biopsy may not always be feasible and when performed may carry a significant risk of morbidity such as major bleeding complications in 1.6-5% of cases; consequently, steroid therapy is often initiated empirically for presumed ICI-AIN (9)(10)(11)(12)(13). Difficulties in diagnosing AIN, the low frequency of ICI-AIN occurrence, and delays in AKI management contribute to the development of permanent functional kidney loss in over 50% of ICI-AIN patients despite glucocorticoid therapy (14).…”

Characteristics and Prognosis of Patients With Hypertensive Encephalopathy: A French Nationwide Cohort Study

“…The reliability of PMSI data has already been assessed 10 and this database has previously been used to study patients with cardiovascular conditions. 11–18…”

“…10 and this database has previously been used to study patients with cardiovascular conditions. [11][12][13][14][15][16][17][18] The study was conducted retrospectively and, as patients were not involved in its conduct, there was no impact on their care. Ethical approval was not required, as all data were anonymized.…”

Transjuguläre Nierenbiopsie

“…In diesen Fällen waren weitere Prozeduren wie eine Katheterembolisation (0,4 %) notwendig. Eine Nephrektomie (0,1 %) oder der Tod von Patienten (0,15 %) waren selten 6 . Eine Metaanalyse bestätigt eine ähnliche Größenordnung in einer Kohorte von 118 064 Patienten, wobei das Vorhandensein einer akuten Niereninsuffizienz mit einem generell höheren Risiko verbunden war 7 .…”