Patient management after percutaneous renal biopsy

Since the first successful percutaneous renal biopsy in 1951, this procedur e has become a standard diagnostic tool in the assessment of kidney disease . It has greatly contributed to the diagnostic precision and the understand ing of especially the glomerular disorders and it has become the cornerston e for evaluating the prognosis and choosing the treatment of many nephropat hies. However in recent years some authors have questioned the ethical just ification of percutaneous kidney biopsy. Our aim was to assess the influence of renal biopsy on patient management. We studied prospectively 225 kidney biopsies, 213 of them percutanoeus, car ried out over ? years. We report the methods used and their complications. We review the conditions for which for renal biopsy was performed: acute re nal failure (31%), nephrotic syndrome (27%), haematuria plus proteinuria, h aematuria alone, proteinuria alone and chronic renal failure. Renal biopsy had its highest impact in acute renal failure and nephrotic syndrome. The b iopsy changed the diagnosis in 39% of patients with acute renal failure, th e prognosis in 36% and the treatment in 16%. In nephrotic syndrome it chang ed the diagnosis in 49%, the prognosis in 48% and the treatment in 28%. Twenty per cent of biopsies were for proteinuria plus haematuria; these rar ely changed the prognosis or treatment. Biopsy had even less effect on prog nosis and treatment in isolated proteinuria and chronic renal failure and n one at all in isolated haematuria. In summary, our study demonstrates that the efficacy of percutaneous renal biopsy outweighs its complications. Acute renal failure and nephrotic syndr ome are the most appropriate indications for kidney biopsy.