The Incidence of Major Hemorrhagic Complications After Renal Biopsies in Patients with Monoclonal Gammopathies

Abstract

Background and objectives: Monoclonal gammopathies frequently cause renal disease, but they may be an incidental finding. Assessment of renal pathology in the context of renal dysfunction and a monoclonal gammopathy therefore serves as a useful diagnostic tool and, in addition, provides prognostic information. There is, however, a theoretical risk of increased hemorrhagic complications from renal biopsies in this setting. The purpose of this study was to determine the incidence of significant hemorrhagic complications after renal biopsies in patients with monoclonal gammopathies.Design, setting, participants, & measurements: The case notes of 1993 unselected patients from four teaching hospitals within the United Kingdom who underwent native or transplant renal biopsies between 1993 and 2008 were reviewed. Subjects were categorized as having a monoclonal gammopathy or not, and the incidence of major hemorrhagic complications between groups was compared.Results: In total, 74 (3.7%) patients (native and transplant biopsies) had a major hemorrhagic complication. One hundred forty-eight subjects with a monoclonal gammopathy were identified. The complication rate in this group was 4.1% compared with 3.9% in the control population (native biopsies only; P ‫؍‬ 0.88).Conclusions: In the population studied, the rate of major hemorrhagic complications after percutaneous renal biopsy was not significantly greater in patients with a monoclonal gammopathy.

Early Reduction of Serum-Free Light Chains Associates with Renal Recovery in Myeloma Kidney

“…Recent work from Fish et al demonstrated the relative safety of kidney biopsies in patients with multiple myeloma. 32 Therefore, before invasive treatment is started, clarification of the nature of the patient's renal injury would be reasonable, particularly given the potential importance of histologic findings to predict outcome. Any direct removal of FLC treatment should be accompanied by aggressive treatment of the patient's myeloma, with a regimen including novel chemotherapy agents such as bortezomib or thalidomide with dexamethasone.…”

Urinary Albumin Excretion Patterns of Patients with Cast Nephropathy and Other Monoclonal Gammopathy–Related Kidney Diseases

“…It is through renal biopsies that new renal diseases associated with MGs are being discovered. Recent studies show that bleeding is not a greater risk for biopsy in multiple myeloma and AL patients if the usual screening for coagulopathy is performed and should not be an impediment (30,31).…”

Comments and extensions to EFSUMB guidelines on renal interventional ultrasound (INVUS).

“…The risk of bleeding should be weighed against the risk of changing the anticoagulation treatment. Conditions without an increased bleeding risk include monoclonal gammopathies [88], diabetes mellitus [89], pediatric kidneys in most reports [90][91][92][93] and outpatients [94,95]. For advanced guidance, bleeding risk predictors are summarized in Table II.…”