Acute renal failure:renal biopsy: crescentic glomerulonephritis and acute tubulointerstitial nephritis were common.

Clinical bottom line (level 2c)

  1. In patients who had renal biopsy for acute renal failure, the commonest diagnoses were crescentic glomerulonephritis, acute tubulointerstitial nephritis and acute tubular necrosis.
Wilson et al: British Medical Journal 1976; 2: 459-461
Expires July 2003

The study

Setting: renal unit of teaching hospital, UK

84 patients (aged range 2 months to 82 years; mean 37, ?% male) acute renal failure who were selected for renal biopsy for clinical indications from a population of 650 patients (between 1964 and 1974) evaluated for acute renal failure (13% of total biopsies performed). Clinical indications for renal biopsy were:
  • establish or confirm a diagnosis (67) in cases that suggested another cause from acute tubular necrosis (eg. no precipitating factors or presence of factors suggesting vasculitis- purpuric rash, acute haemolytic anaemia- tubulointerstitial disease- drug reaction-, glomerular disease- profuse proteinuria-, or systemic disease- bone pain and hypercalcaemia)
  • assess prognosis (17)


The evidence


differential diagnosis number of patients prevalence
(95% CI)
glomerular disease 44 52%
(42% to 63%)
crescentic glomerulonephritis 21 25%
(16% to 34%)
vascular disease (hypertension, ischaemia, haemolytic-uremic syndrome, acute cortical necrosis) 15 18%
(9.7% to 26%)
acute tubular necrosis 14 17%
(8.7% to 25%)
interstitial nephritis 9 11%
(4.1% to 17%)
multiple myeloma 2 2.4%
(-0.9% to 5.6%)

Comments

  1. Definitions of diagnoses were not given.
  2. Of the patients who did not recover (54%), the majority underwent post-mortem examination and pathological examination of the kidneys altered the diagnosis in only two patients.
  3. In patients with acute renal failure selected for renal biopsy, a large proportion of biopsies are diagnostic and the majority identify treatable intrarenal pathology.

Citation

  1. Wilson DM, Turner DR, Cameron JS, et al: Value of renal biopsy in acute intrinsic renal failure. British Medical Journal 1976; 2: 459-461
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Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
Reviewer:

Clinical Question.
Patient acute renal failure
Intervention or Exposure common
Outcome diagnoses