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Clinicians avoid biopsy in Chronic Kidney Disease (CKD) as there is high risk of bleed. However there are conditions where benefits outweigh risks like ascertaining cause of CKD in patients going for transplant and in those where reversibility is expected after some therapeutic intervention.There is paucity of data on the outcomes of renal biopsy in CKD patients. This study aims to study the clinical profile, diagnosis, therapeutic intervention and complications in biopsied CKD patients.
All CKD patients who underwent biopsy from March 2003 to March 2023 were included in the study. Demographic details and clinical data was retrieved from hospital information system and analysed.
Out of 9425 biopsies done during study period,535 biopsies (5.7%) were included in our study. Mean age of the cohort was 50.32 ± 17.01 years with males constituting 69.3% of total population. Mean duration between biopsy and symptom onset was 3.7 ± 1.5 months. A total of 370 patients (68%) underwent renal replacement therapy before biopsy. 462 biopsies (84.7%) showed chronic glomerulonephritis (CGN) while 83 biopsies (15.3%) revealed chronic interstitial pattern. Among patterns based on histopathological examination, diffuse global glomerulosclerosis was seen in 200 patients (53.3%). Among glomerular diseases, C3GN (n=100;18.3%), pauci immune GN (n=64; 11.7%) followed by IgAN (n=55;10.1%) dominated. Among interstitial nephritis etiologies, CIN pattern with unknown etiologies was the commonest (n=43;7.9%) followed by cast nephropathy (n=15;2.8%) and granulomatous interstitial nephritis (n=10;1.8%). In terms of therapeutic intervention,146 patients (26.7%) were added new therapy post biopsy, mostly receiving immunosuppression(n=100; 18.3%). In total, 143 patients (26.2%) became dialysis dependent on follow up, amongst which 73 patients (13.3%) became dialysis independent after adding specific therapy. Post biopsy complications were seen in 84 patients (15.4%); 43 patients (7.9%) were managed conservatively, 25 patients (4.6%) required coil and embolization to manage post biopsy bleed and 6 patients (1.1%) succumbed to post procedure complications.
In view of substantial CKD population who underwent renal biopsy, with less post biopsy complications and good response to therapeutic intervention in half of the patients who received it, this study encourages renal biopsy for diagnosis in CKD.