NOVEL RISK FACTORS FOR COMPLICATIONS IN LUPUS NEPHRITIS KIDNEY BIOPSY: USE OF POINT-OF-CARE ULTRASONOGRAPHY (POCUS) RENAL PROTOCOL AND INFLAMMATORY MARKERS

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NOVEL RISK FACTORS FOR COMPLICATIONS IN LUPUS NEPHRITIS KIDNEY BIOPSY: USE OF POINT-OF-CARE ULTRASONOGRAPHY (POCUS) RENAL PROTOCOL AND INFLAMMATORY MARKERS

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Co-author 1

Brenda Cortez b.cortezflores@gmail.com Instituto Nacional de Cardiología Ignacio Chávez Nefrologia intervencionista Mexico City Mexico -

Co-author 2

Karime Ramos Santos krabs1106@gmail.com Instituto Nacional de Cardiología Ignacio Chávez Nefrologia Mexico City Mexico -

Co-author 3

Bernardo Moguel González bernardomoguel@hotmail.com Instituto Nacional de Cardiología Ignacio Chávez Nefrologia intervencionista Mexico City Mexico -

Co-author 4

Ruben Garrido Roldan drrubenmi@hotmail.com Instituto Nacional de Cardiología Ignacio Chávez Nefrologia intervencionista Mexico City Mexico -

Co-author 5

Omar Sánchez Vázquez omar.sanchezv@outlook.com Hospital Regional 180. Instituto Mexicano del Seguro Social Nefrología Guadalajara, Jalisco Mexico -

Co-author 6

Alejandro García Rivera garciarivera.dr@gmail.com Instituto Mexicano del Seguro Social Nefrología Guadalajara, Jalisco Mexico *

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Kidney biopsy is mandatory for diagnosis and management of lupus nephritis (LN). Bleeding complications (BC) are the most frequent (10–34%), with major complications (1–3%) Traditional risk factors include anemia, thrombocytopenia, coagulopathy, use of antithrombotic agents and antiphospholipid syndrome.

Our aim was to evaluate risk factors for BC in percutaneous kidney biopsy (PKB) in LN patients and the use of novel pocus renal protocols (POCUSrp) and inflamatory variables

Methods

Retrospective observational study in patients with Lupus who performed native PKB between July 2019 and December 2024 at Instituto Nacional de Cardiología in Mexico City. POCUSrp included anatomical and hemodynamic characteristics. PKB were real time ultrasound (US)-guided by an interventional nephrologist. A Doppler US post PKB permorfed in all patients to evaluate complications.
Categorization for major complication (hematoma >2cm or gross hematuria with ≥1 g/dL hemoglobin (hb) drop and/or transfusion) and minor if they resolved without intervention.

Results

A total of 132 patients were included, 88.6% female with mean age of 35 years. Hypertension diagnosis in 28%, and the most frequent indication for PKB was impaired renal function. 5.3% were on renal replacement therapy during the PKB. Minor complications presented in 20.5%, perinephric hematoma <2cm; and 1.5% for major complications .Patients with complications associated with lower hb levels, elevated ESR and CPR and altered renal hemodynamics on POCUrp (higher PSV and TDV) (Table 1 and 2). Class IV + V LN presented in(31.8%), followed by class V (22%) and class III/V (16%). Other histological findings were TIN (18.9%), and TMA (15.2%).Only class IV showed differences between both groups (Table 3.).In logistic regression serum creatinine was associated with 40% higher bleeding complications (OR 1.4,CI 1.1-1.9,p 0.03).

Conclusion

Inflammatory activity and altered renal hemodynamics were associated with higher bleeding risk during PKB in LN. POCUS renal protocols may help identify high-risk patients and improve procedural safety.

Kewords