Acute renal failure: renal biopsy was useful and relatively safe in selected patients.

Clinical bottom line (level 2c)

  1. The commonest lesions in patients with acute renal failure who had a renal biopsy were vascular, glomerular and tubular.
  2. Around 4% of patients had a clinically significant bleed, few of these required nephrectomy for this.
Sraer et al: Kidney International 1975; 8: 60-61
Expires July 2003

The study

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

Setting: university hospital, France (1966 to 1973)

145 patients (aged ?, ?% male) acute renal failure (12% of total) who had renal biopsy. Indications for biopsy were:
  • oligoanuria persisting longer than 3 weeks
  • clinical signs suggestive of primary renal disease, vascular lesion or systemic disease
  • patiens without an obvious cause for acute renal failure
  • those with suspected drug toxicity




Outcomes studied:
  • clinically important bleeding
  • nephrectomy for prolonged bleeding (>30 days)
  • final diagnosis vascular
  • final diagnosis glomerular
  • final diagnosis tubular
  • final diagnosis interstitial

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    clinically important bleeding ? 6/145 4.1%
    (0.9% to 7.4%)    		 24
    (14 to 112)
    nephrectomy for prolonged bleeding (>30 days) ? 1/145 0.7%
    (-0.7% to 2.0%)    		 145
    (-152 to 49)
    final diagnosis vascular ? 46/145 32%
    (24% to 39%)    		 3
    (3 to 4)
    final diagnosis glomerular ? 42/145 29%
    (22% to 36%)    		 3
    (3 to 5)
    final diagnosis tubular ? 35/145 24%
    (17% to 31%)    		 4
    (3 to 6)
    final diagnosis interstitial ? 19/145 13%
    (7.6% to 19%)    		 8
    (5 to 13)

    • Two patients had an unsuitable sample.

    Comments

    1. This work appears in abstract only. The exact histopathological diagnoses were not reported.
    2. The study was conducted more than twenty years ago and the selection of patients for biopsy, and techniques may have changed since. However, this series is remarkable in that the indications for biopsy, and the complication rate of patients with acute renal failure were recorded.

    Citation

    1. Sraer JD, Kanfer A, Marsae J, et al: Renal biopsy in acute renal failure. Kidney International 1975; 8: 60-61
    Search Terms: reference list
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Catherine Clase

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure prevalence
    Outcome various lesions