Hemoptysis in patients with renal insufficiency - The role of flexible bronchoscopy

Study objectives: To assess the indications, yield, and therapeutic impact of flexible bronchoscopy (FB) in patients with hemoptysis and renal insuffi ciency. Design: Retrospective cohort analysis. Setting: Tertiary-care university hospital. Patients: Thirty-four patients over a 7.5-year period who underwent FB to e valuate hemoptysis in the setting of renal insufficiency (ie, serum creatin ine level, > 1.5 mg/dL), Measurements and results: The etiology of hemoptysis was undetermined in 41 % of cases. Defined causes of bleeding included infections (29%), pulmonary renal syndromes (15%), airway injury (9%), and pulmonary embolism (6%). No specific bleeding site was identified, but FB lateralized hemorrhaging to one lung in 24% of patients. FB results influenced therapy in 29% of patien ts overall and in 8% of patients without respiratory tract infection. The h ospital survival rate was 47% and did not differ based on the presence or a bsence (presence vs absence) of the following variables: a defined etiology for hemoptysis (45% vs 50%); lateralized bleeding (38% vs 50%); or managem ent alterations prompted by other FB findings (50% vs 46%), Factors associa ted with survival included the onset of bleeding prior to hospital admissio n (80% vs 33%; p = 0.02), the absence of respiratory failure requiring mech anical ventilation at the time of FB (90% vs 29%; p = 0.002), sind lack of prohemorrhagic factors (other than uremia) such as disseminated intravascul ar coagulation, recent treatment with warfarin, heparin, or antiplatelet ag ents (78% vs 33%; p = 0.05). During the 6 months following hospital dischar ge, hemoptysis recurred in 14% of patients, and 5 patients died, for an ove rall mortality rate of 62%. Conclusions: These data suggest that FS in hospitalized patients with hemop tysis and renal insufficiency, and without radiographic findings suggesting neoplastic disease, has a low yield and limited impact. Whether FB influen ces outcome in selected patients in this setting requires prospective inves tigation.