Kidney biopsy in very elderly patients: indications, therapeutic impact and complications

Abstract Background Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients. Methods Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. Results 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. Conclusions KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.

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Kidney biopsy in very elderly patients: indications, therapeutic impact and complications.

10.21203/rs.3.rs-373642/v1 ◽

2021 ◽

Author(s):

Mathilde Fedi ◽

Mickaël Bobot ◽

Julia Torrents ◽

Pierre Gobert ◽

Eric Magnant ◽

...

Keyword(s):

Elderly Patients ◽

Kidney Biopsy ◽

Renal Involvement ◽

Specific Treatment ◽

Kidney Injury ◽

Severe Bleeding ◽

Very Elderly ◽

Hypertensive Nephropathy ◽

Glomerular Diseases ◽

Therapeutic Impact

Abstract Background: Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients.Methods: Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. Results: 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 mmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. Median renal survival was higher in patients without AKI (p=0.007) or treated with corticosteroids (p=0.046). Dialysis-free survival censored for death was higher in patients without AKI (p=0.019), or treated (p=0.022), especially with corticosteroids (p=0.006).Conclusions: KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.

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Renal involvement in pediatric patients with COVID-19: an up-to-date

Current Pediatric Reviews ◽

10.2174/1573396317666210924121550 ◽

2021 ◽

Vol 17 ◽

Author(s):

Yuri Márcio Campos ◽

André Luís Vieira Drumond ◽

Mariane de Matos Gamonal ◽

Milena Pereira Parreira ◽

Ana Cristina Simões e Silva

Keyword(s):

At Risk ◽

Acute Kidney Injury ◽

Pediatric Patients ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Renal Involvement ◽

Kidney Injury ◽

Renal Diseases ◽

Glomerular Diseases ◽

Report Data

Background: In pediatric patients, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been mostly associated with mild symptoms. However, as in adults, renal involvement has been reported in children and adolescents with Coronavirus Disease 2019 (COVID-19). Objective: This review aimed to report data about renal involvement in pediatric COVID-9. The focuses were on the pathophysiology of acute kidney injury in Pediatric Inflammatory Multisystem Syndrome Temporally Associated (PIMS-TS) with SARS-CoV-2 and the possible impact of SARS-CoV-2 infection upon kidney function, as well as data concerning patients with previous kidney diseases, including Nephrotic Syndrome and Chronic Renal Disease. The implications for COVID-19 outcome in pediatric patients were also discussed. Methods: This integrative review searched for articles on renal involvement in pediatric COVID-19 patients. The databases evaluated were PubMed and Scopus. Results: The emergence of PIMS-TS with SARS-CoV-2 has shown that pediatric patients are at risk of severe COVID-19, with multi-organ involvement and dysfunction. In addition to intense inflammation, several systems are affected in this syndrome, collectively creating a combination of factors that results in acute kidney injury. Several studies have proposed that kidney cells, including the podocytes, might be at risk of direct infection by SARS-CoV-2, as high levels of ACE2, the virus receptor, are expressed on the membrane of such cells. Some cases of glomerular diseases triggered by SARS-CoV-2 infection and relapses of previous renal diseases have been reported. Conclusion: Further studies are necessary to establish risk factors for renal involvement in pediatric COVID-19 and to predict disease outcome.

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Acute kidney injury associated with COVID-19 infection: a case report

Portuguese Journal of Nephrology & Hypertension ◽

10.32932/pjnh.2021.10.146 ◽

2021 ◽

Vol 35 (3) ◽

Author(s):

Tiago Duarte ◽

◽

Fernando Caeiro ◽

Mário Góis ◽

António Matos ◽

...

Keyword(s):

Acute Kidney Injury ◽

Proximal Tubule ◽

Kidney Biopsy ◽

Renal Involvement ◽

Kidney Injury ◽

Electronic Microscopy ◽

Tubular Necrosis ◽

Kidney Lesion ◽

Transmissible Disease

SARS-Cov2 infection is a highly transmissible disease associated with serious pulmonary disease. Renal involvement is frequent and associated with poor prognosis; however, mechanisms of kidney injury are not well established. We present a SARS-Cov2 patient with severe acute kidney injury. Kidney biopsy findings revealed a pattern of acute tubular necrosis with isometric vacuolization of the proximal tubule. The interstitium and glomeruli were normal. Electronic microscopy showed multiple viral-like particles in both the glomeruli and proximal tubule. This case study shows how SARS-Cov 2 infection can result in different kinds of kidney lesion.

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Associations of serum sodium levels with mortality in very elderly acute kidney injury patients

10.21203/rs.3.rs-16898/v1 ◽

2020 ◽

Author(s):

Qinglin Li ◽

Liang Pan ◽

Zhi Mao ◽

Hongjun Kang ◽

Feihu Zhou

Keyword(s):

Acute Kidney Injury ◽

Elderly Patients ◽

Serum Sodium ◽

Kidney Injury ◽

Mortality Rates ◽

Very Elderly ◽

Adjusted Analysis ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: Patients suffering from acute kidney injury (AKI) have been associated with impaired sodium. However, studies on the association of dysnatremia with all-cause mortality risk in AKI patients are particularly lacking. We examined the relationship between different levels of serum sodium and mortality among very elderly patients with AKI. Methods: We retrospectively enrolled very elderly patients (≥ 75 years) from Chinese PLA General Hospital from 2007, to 2018. All-cause mortality was examined according to eight predefined sodium levels: <130.0 mmol/L, 130.0–134.9 mmol/L, 135.0–137.9 mmol/L, 138.0–141.9 mmol/L, 142.0–144.9 mmol/L, 145.0–147.9 mmol/L, 148.0–151.9 mmol/L, and ≥152.0 mmol/L. We estimated the risk of all-cause mortality using a multivariable adjusted Cox proportional hazard model, with a normal serum potassium level of 135.0–137.9 mmol/L as a reference. Results: In total, 744 geriatric patients were suitable for the final evaluation. Among them, 260 (34.9%) died within 90 days; during the 1-year follow-up, 5 patients were lost to follow-up, and 383 (51.8%) died. After 90 days, the mortality rates in the eight strata were 36.1, 27.8, 19.6, 24.4, 30.7, 48.6, 52.8, and 57.7%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L [hazard ratio (HR): 2.247; 95% confidence interval (CI): 1.117–4.521], from 142.0 to 144.9 mmol/L (HR: 1.964; 95% CI: 1.100–3.508), from 145.0 to 147.9 mmol/L (HR: 2.942; 95% CI: 1.693–5.114), from 148.0 to 151.9 mmol/L (HR: 3.455; 95% CI: 2.009–5.944), and ≥152.0 mmol/L (HR: 3.587; 95% CI: 2.151–5.983) had an increased risk of all-cause mortality. After 1 year, the mortality rates in the eight strata were 58.3, 47.8, 33.7, 38.9, 45.5, 64.3, 69.4, and 78.4%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L (HR: 1.944; 95% CI: 1.125–3.360), from 142.0 to 144.9 mmol/L (HR: 1.681; 95% CI: 1.062–2.660), from 145.0 to 147.9 mmol/L (HR: 2.631; 95% CI: 1.683–4.112), from 148.0 to 151.9 mmol/L (HR: 2.411; 95% CI: 1.552–3.744), and ≥152.0 mmol/L (HR: 3.037; 95% CI: 2.021–4.563) had an increased risk of all-cause mortality. Conclusion: Sodium levels outside the interval of 130.0–141.9 mmol/L were associated with increased risks of 90-day mortality and 1-year mortality in very elderly AKI patients.

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Primary Coronary Intervention in Octogenarians and Nonagenarians With ST-Segment Elevation Myocardial Infarction: A Canadian Single-Center Perspective

Angiology ◽

10.1177/0003319717746520 ◽

2017 ◽

Vol 69 (8) ◽

pp. 718-723

Author(s):

Rajat Sharma ◽

Brett Hiebert ◽

David Cheung ◽

Davinder S. Jassal ◽

Kunal Minhas

Keyword(s):

Myocardial Infarction ◽

Elderly Patients ◽

Care Center ◽

Kidney Injury ◽

Coronary Intervention ◽

Control Group ◽

Very Elderly ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

The proportion of individuals >80 years of age constitute an increasing proportion of patients who present with ST-segment elevation myocardial infarction (STEMI). The objective of this study is to evaluate in-hospital outcomes and 1-year survival of very elderly patients who present with an STEMI and undergo primary percutaneous coronary intervention (pPCI). Between 2009 and 2015, individuals >80 years of age (very elderly patients) with an STEMI presenting at a single tertiary Canadian care center were included in the study. A random sample of 100 individuals aged 65 to 69 years over the same time period were selected as a control group. A total of 284 patients were included in the study population including 100 controls, 164 octogenarians, and 20 nonagenarians. Of total, 1661 pPCIs occurred during this study period with the very elderly population (>80 years) comprising 11.1% of the total pPCIs. Compared with controls, individuals aged >80 are more likely to have a delay in treatment with increased rates of bleeding, acute kidney injury, rehospitalization, and a trend toward longer hospital stays following pPCI for STEMI. Although in-hospital and 1-year mortality were similar between both cohorts >80 years of age with STEMI, their overall survival was reduced compared with controls.

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INVESTIGATING ETIOLOGIES AND RENAL HISTOLOGIC PATTERNS IN 6 ELDERLY PATIENTS WITH NEPHROTIC SYNDROME

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2015.3.12 ◽

2015 ◽

pp. 85-92

Author(s):

Bach Nguyen ◽

Thi Thuy Trang Le ◽

Ngoc Linh Huynh

Keyword(s):

Nephrotic Syndrome ◽

Elderly Patients ◽

Kidney Biopsy ◽

The Elderly ◽

Minimal Change ◽

Renal Pathology ◽

Invasive Technique ◽

Renal Amyloidosis ◽

Glomerular Diseases

Background: Nephrotic syndrome (NS) is the most common manifestation of glomerular diseases in the elderly and a most common indication of kidney biopsy. NS in the elderly is not as common as the young but more difficult to make diagnosis of etiologies, classification of renal histologic patterns and treatment because NS is frequently associated with various coexisting conditions. In Vietnam, the elderly population has been increased significantly therefore frequency of the elderly patients with NS is also increasing. Kidney biopsy is an invasive technique that is useful in diagnosing etiologies and classifying renal pathology. During recent years, renal pathology and biochemical immunology have been progressing rapidly. Therefore, the results of kidney biopsy are usually potential and valuable in clinical practice. We reported 6 elderly patients with NS performed kidney biopsy in Department of Nephrology, HCMCity during the period from 2/2012 to 12/2014 to investigate etiologies and renal histologic patterns. Materials and method: case report. The reported clinical cases were primary renal amyloidosis, IgA nephropathy secondary to liver cancer, minimal change NS associated with diabetes, NS caused by renal lymphoma infiltration, NS with minimal change associated by interferon and thrombotic microangiopathy. Conclusions: Nephrotic syndrome in the elderly might be associated with coexisting conditions and caused by several primary and secondary causes. Therefore, kidney biopsy should be considered to perform to make exact diagnosis in etiology, and to classify histologic patterns. Key words: Nephrotic syndrome, elderly, histologic patterns, kidney biopsy

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Adrenocortical carcinoma complicated by renal thrombotic microangiopathy, a case-series

BMC Nephrology ◽

10.1186/s12882-020-1703-5 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Tristan de Nattes ◽

Lucile Moreau-Grangé ◽

Delphine Vezzosi ◽

Julien Hadoux ◽

Miguel Hie ◽

...

Keyword(s):

Hemolytic Anemia ◽

Thrombotic Microangiopathy ◽

Adrenocortical Carcinoma ◽

Renal Involvement ◽

Specific Treatment ◽

Case Series ◽

Kidney Injury ◽

Surgical Removal ◽

First Case ◽

Dismal Prognosis

Abstract Background Cancer-related thrombotic microangiopathy (CR-TMA) is a rare entity associated with a dismal prognosis. Usually, CR-TMA is associated with mucin-producing carcinomas among which stomach, breast, prostate, lung and pancreas tumours are the most frequent. Cases presentation We describe for the first time three cases of CR-TMA due to adrenocortical carcinoma (ACC). All of them had mechanical hemolytic anemia and thrombocytopenia without any other identifiable cause. Bicytopenia was diagnosed either simultaneously with ACC or at the time of metastatic evolution. Two patients had acute kidney injury (AKI) with severe pathological findings on kidney biopsy. Despite total adrenalectomy, chemotherapy, and specific treatment of TMA with plasma-exchanges, renal failure and hemolytic anemia remained. The only manifestation of CR-TMA in the third patient was hemolytic anemia, which resolved after surgical removal of ACC. The evolutions in these patients suggests ACC-related TMA may be related to a circulating factor. Conclusions CR-TMAs are rare. Here we describe the first case series of ACC-related TMA, among which two had renal involvement. This entity is associated with dismal renal prognosis despite specific treatment of TMA. According to patients’ evolution, the persistence of TMA may reflect an uncontrolled malignancy.

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Renal Diseases Associated with Hematologic Malignancies and Thymoma in the Absence of Renal Monoclonal Immunoglobulin Deposits

Diagnostics ◽

10.3390/diagnostics11040710 ◽

2021 ◽

Vol 11 (4) ◽

pp. 710

Author(s):

Antoine Morel ◽

Marie-Sophie Meuleman ◽

Anissa Moktefi ◽

Vincent Audard

Keyword(s):

Kidney Diseases ◽

Specific Treatment ◽

Kidney Injury ◽

Myeloproliferative Disorders ◽

Hematologic Malignancies ◽

Lymphocytic Leukemia ◽

Renal Diseases ◽

Diagnostic Strategy ◽

Monoclonal Immunoglobulin ◽

Glomerular Diseases

In addition to kidney diseases characterized by the precipitation and deposition of overproduced monoclonal immunoglobulin and kidney damage due to chemotherapy agents, a broad spectrum of renal lesions may be found in patients with hematologic malignancies. Glomerular diseases, in the form of paraneoplastic glomerulopathies and acute kidney injury with various degrees of proteinuria due to specific lymphomatous interstitial and/or glomerular infiltration, are two major renal complications observed in the lymphoid disorder setting. However, other hematologic neoplasms, including chronic lymphocytic leukemia, thymoma, myeloproliferative disorders, Castleman disease and hemophagocytic syndrome, have also been associated with the development of kidney lesions. These renal disorders require prompt recognition by the clinician, due to the need to implement specific treatment, depending on the chemotherapy regimen, to decrease the risk of subsequent chronic kidney disease. In the context of renal disease related to hematologic malignancies, renal biopsy remains crucial for accurate pathological diagnosis, with the aim of optimizing medical care for these patients. In this review, we provide an update on the epidemiology, clinical presentation, pathophysiological processes and diagnostic strategy for kidney diseases associated with hematologic malignancies outside the spectrum of monoclonal gammopathy of renal significance.

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Biopsy-Proven Kidney Involvement in Hypocomplementemic Urticarial Vasculitis

10.21203/rs.3.rs-471283/v1 ◽

2021 ◽

Author(s):

Alice Corthier ◽

Marie Jachiet ◽

Daniel Bertin ◽

Aude Servais ◽

Christelle Barbet ◽

...

Keyword(s):

Kidney Disease ◽

Kidney Biopsy ◽

Systemic Vasculitis ◽

Renal Involvement ◽

Kidney Injury ◽

Urticarial Vasculitis ◽

Kidney Involvement ◽

National Cohort ◽

Hypocomplementemic Urticarial Vasculitis

Abstract Background. Hypocomplementemic urticarial vasculitis (HUV) is a rare systemic vasculitis. We aimed to describe the kidney involvement of HUV in a multicenter national cohort with an extended follow-up. Methods. All patients with HUV (international Schwartz criteria) with a biopsy-proven kidney involvement, identified through a survey of the French Vasculitis Study Group, were included. A systematic literature review on kidney involvement of HUV was performed. Results. Twelve patients were included, among whom 8 had positive anti-C1q antibodies. All presented with proteinuria, from mild to nephrotic, and 8 displayed acute kidney injury (AKI), requiring temporary haemodialysis in 2. Kidney biopsy showed membrano-proliferative glomerulonephritis (GN) in 8 patients, pauci-immune crescentic GN or necrotizing vasculitis in 3 patients (with a mild to severe interstitial inflammation), and an isolated interstitial nephritis in 1 patient. C1q deposits were observed in the glomeruli (n=6), tubules (n=4) or renal arterioles (n=3) of 8 patients. All patients received corticosteroids, and 9 were also treated with immunosuppressants or apheresis. After a mean follow-up of 8.9 years, 6 patients had a preserved renal function, but 2 patients had developed stage 3-4 chronic kidney disease (CKD) and 4 patients had reached end-stage kidney disease (ESKD), among whom 1 had received a kidney transplant. Conclusion. Renal involvement of HUV can be responsible for severe AKI, CKD and ESKD. It is not always associated with circulating anti-C1q antibodies. Kidney biopsy shows mostly membrano-proliferative GN or crescentic GN, with frequent C1q deposits in the glomeruli, tubules or arterioles.

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Duration of acute kidney injury, 90-day mortality, and chronic kidney disease progression in very elderly patients

10.21203/rs.2.19575/v1 ◽

2019 ◽

Author(s):

Qinglin Li ◽

Liang Pan ◽

Zhi Mao ◽

Hongjun Kang ◽

Feihu Zhou

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Elderly Patients ◽

Kidney Injury ◽

Prognostic Impact ◽

Very Elderly ◽

Long Duration ◽

Clinical Research Center ◽

Multiple Covariates ◽

New Onset

Abstract Background: This study evaluated the prognostic impact of AKI duration on 90-day mortality and new-onset chronic kidney disease (CKD) progression in very elderly patients. Methods: We retrospectively enrolled very elderly patients (≥75 years) with normal RF from the hospital information system of the National Clinical Research Center for Geriatric Diseases of Chinese PLA General Hospital January 1, 2007 and December 31, 2018. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. AKI patients were divided into T-AKI and P-AKI groups based on whether serum creatinine level returned to baseline within 48 h post-AKI. Results: In total, 760 geriatric patients developed AKI, and 693 were suitable for the final evaluation. Among them, 62 (8.9%) patients had T-AKI (1–2 days), 104 (15.0%) had short-duration AKI (3–4 days), 140 (20.2%) had medium-duration AKI (5–7 days), and 387 (55.8%) had long-duration AKI (>7 days). In total, 209 (30.2%) of 693 patients died within 90 days, including 5 (8.1%) with T-AKI and 204 (32.3%) with P-AKI. Of the 484 survivors with AKI, 122 (25.2%) developed CKD. After adjusting for multiple covariates, duration of AKI (3–4 days: hazard ratio [HR] = 2.512; 95% confidence interval [CI]: 1.021–6.181; 5–7 days: HR = 3.154; 95% CI: 1.250–7.960; >7 days: HR = 6.212; 95% CI: 2.383–16.192;), more advanced AKI stages (stage 2: HR = 7.365; 95% CI: 4.114–13.183; stage 3: HR = 28.414; 95% CI: 16.360–49.350); and low body mass index (HR = 0.910; 95% CI: 0.870–0.953) were significantly associated with a higher 90-day mortality and longer AKI duration (3–4 days: odds ratio [OR] = 0.982; 95% CI: 0.247–3.900; 5–7 days: HR = 1.322; 95% CI: 0.381–4.592; > 7days: HR = 7.007; 95% CI: 2.417–20.311), and baseline eGFR (OR = 0.928; 95% CI: 0.901–0.956) was significantly associated with new-onset CKD of the survivors. Conclusion: AKI duration is a useful parameter to predict of worse clinical outcomes in very elderly patients, emphasizing the importance of identifying an appropriate treatment window for early intervention.

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