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Minerva Anestesiologica 2013 January;79(1):53-61


lingua: Inglese

Kidney biopsy in the critically ill patient, results of a multicentre retrospective case series

Philipponnet C. 1, Guérin C. 2, Canet E. 3, Robert R. 4, Mariat C. 5, Dijoud F. 6, Azoulay E. 3, Souweine B. 1, Heng A. E. 7

1 Service de Réanimation Médicale, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, F-63003, Clermont Université d’Auvergne, Clermont-Ferrand, France; 2 Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université de Lyon, Lyon, France; 3 Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France; 4 Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France; 5 Service de Néphrologie, Hôpital Nord, CHU Saint Etienne, Saint Etienne, France; 6 Laboratoire d’Anatomie Pathologie, Centre de Pathologie-Est, Hospices Civils de Lyon, Université de Lyon, Lyon, France; 7 Service de Néphrologie, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France


Background: The impact of a contributive result of kidney biopsy on the management of patients in the intensive care unit (ICU) has not been extensively investigated yet.
Methods: This was a retrospective study conducted between 2000 and 2011 in five French ICUs. The study included 56 patients. They had at least one non-renal organ failure, as defined by a Sequential Organ Failure Assessment (SOFA) score ≥3 on ICU admission, and kidney biopsy was performed during ICU stay. Kidney samples were obtained by percutaneous (N.=55) or transjugular biopsy (N.=1).
Results: The mean Simplified Acute Physiology Score II and total SOFA scores on ICU admission were 52±19 years and 10.3±3.6, respectively. ICU mortality was 23%. The median (interquartile range) time between ICU admission and kidney biopsy was 9 days (5-21). Pathologic findings in the 54 analyzable kidney biopsies were acute tubular necrosis (N.=26), glomerulonephritis (N.=14), acute vascular nephritis (N.=11), acute interstitial nephritis (N.=6), and deposit disease (N.=3). Kidney biopsy was contributive to the management of 40 patients. In 23 of these, new treatments were started, in 13 ongoing treatments were stopped, including four life-sustaining therapies, and in 13 it was decided to start chronic renal replacement. Severe bleeding was observed in 7 patients, with fatal outcome in one case.
Conclusion: Kidney biopsy may have a significant impact on the management of critically ill patients. Further studies should be done to identify the groups of ICU patients likely to benefit from the procedure with minimum risk.

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