Acute renal failure: renal biopsy led to changes in management.

Clinical bottom line (level 4)

  1. In patients with acute renal failure, renal biopsy results altered management in 70% of cases.
Richards et al: Nephrology Dialysis Transplantation 1994; 9: 1255-1259
Expires July 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, UK

31 patients (aged ?, ?% male) acute renal failure who underwent diagnostic renal biopsy. Clinical indications for renal biopsy were not explicitly described. Management was considered altered if:
  • medication was added
  • medication withdrawn or withheld
  • investigational procedure was performed




Outcomes studied:
  • altered management with knowledge of renal histology

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    altered management ? 22/31 71%
    (55% to 87%)

    Comments

    1. Histological diagnoses were not reported separately for the acute renal failure patients.
    2. The patients in this study underwent biopsy for clinical indications and represent a group selected by physicians to have a high pretest probability of benefiting from the diagnostic or prognostic information obtained from the biopsy.
    3. The indications for biopsy in these patients were not reported, nor whether they directly led to the change in management. Unfortunately there is no well-designed study in the literature that has objectively defined the clinical criteria for kidney biopsy in ARF.
    4. Changes included withholding of medication (9), prednisone (1), prednisone and cyclophosphamide (2), prednisone, cyclophosphamide and plasma exchange (6), fresh frozen plasma and prostacyclin (2), renal angiography and angioplasty (1) and administration of enalapril (1).

    Citation

    1. Richards NT, Darby S, Howie AJ, et al: Knowledge of renal histology alters patients management in over 40% of cases. Nephrology Dialysis Transplantation 1994; 9: 1255-1259
    Search Terms: author's files
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Mohammad Saklayen

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure renal biopsy
    Outcome management after