Acute renal failure:renal biopsy: necrotising vasculitis, crescentic glomerulonephritis and acute tubulointerstitial nephritis accounted for half of diagnoses.

Clinical bottom line (level 2b)

  1. The commonest diagnoses in patients with acute renal failure who had renal biopsy were necrotising vasculitis, crescentic glomerulonephritis, acute tubulointerstitial nephritis and acute tubular necrosis.
Schena : Nephrology Dialysis and Transplantation 1997; 12: 418-426
Expires April 2003

The study

Setting: 74 renal centres, Italy, 1987 to 1993

1272 patients (aged ?, ?% male) acute renal failure (not specifically defined) who had renal biopsy registered at a national database (Italian Registry of Renal Biopsies)

Excluded if
  • inadequate material



    • The evidence


    differential diagnosis number of patients prevalence
    (95% CI)
    necrotising vasculitis 254 20.0%
    (17.8% to 22.2%)
    crescentic glomerulonephritis 178 14.0%
    (12.1% to 15.9%)
    acute tubulointerstitial nephritis 140 11.0%
    (9.29% to 12.7%)
    acute tubular necrosis 100 7.86%
    (6.38% to 9.34%)
    systemic lupus erythematosus 66 5.20%
    (3.97% to 6.41%)
    multiple myeloma 65 5.10%
    (3.90% to 6.32%)
    poststreptococcal glomerulonephritis 58 4.60%
    (3.41% to 5.71%)
    thrombotic microangiopathy 42 3.30%
    (2.32% to 4.28%)
    Henoch-Schonlein purpura 34 2.70%
    (1.79% to 3.56%)
    IgA nephropathy 32 2.50%
    (1.66% to 3.38%)

    Comments

    1. Patients included children.
    2. In patients with acute renal failure selected for renal biopsy, a large proportion of biopsies are diagnostic and the majority identify treatable intrarenal pathology.
    3. While there are some established guidelines as to which patient with ARF need a kidney biopsy, there is wide variation in actual practice among nephrologists.
    4. This study underlines the need for kidney biopsy in a small subset of selected patients with ARF.

    Citation

    1. Schena FP, : Survey of the Italian Registry of Renal Biopsies. Frequency of the renal diseases for 7 consecutive years. Nephrology Dialysis and Transplantation 1997; 12: 418-426
    Search Terms: reference list
    Contributor: Catherine Clase, Chris Ball and Clare Wotton, April 2000
    Reviewer: Mohammad Saklayen

    Clinical Question.
    Patient acute renal failure
    Intervention or Exposure prevalence
    Outcome biopsy diagnosis