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Impact of COVID 19 pandemic on patients requiring renal biopsy
Abhilash Chandra1, Namrata Rao2, Kiran Preet Malhotra3
1Department of Nephrology, Dr. RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India. acn393@gmail.com.
Insights
The COVID-19 pandemic led to younger patients with higher creatinine levels and rapidly progressive renal failure (RPRF) undergoing renal biopsies. Transplant recipients showed increased rejection rates, highlighting the need for better support systems.
Area of Science:
- Nephrology
- Transplant Surgery
- Epidemiology
Background:
- The COVID-19 pandemic significantly disrupted healthcare services globally due to lockdown measures.
- This disruption impacted various medical procedures, including renal biopsies, necessitating an evaluation of its effects.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on the characteristics of patients undergoing renal biopsies.
- To compare patient demographics, indications for biopsy, and outcomes between the pandemic period and the pre-pandemic era.
Main Methods:
- A comparative study design was employed, analyzing renal biopsies performed during the COVID-19 pandemic (April-December 2020) and a pre-COVID period (June 2019-February 2020).
- Data on patient demographics, laboratory results, and indications for biopsy were retrospectively collected from hospital records.
Main Results:
- Patients undergoing biopsy during the pandemic were younger and presented with significantly higher serum creatinine levels and a greater proportion of rapidly progressive renal failure (RPRF).
- Conversely, a higher percentage of nephrotic patients underwent biopsy in the pre-pandemic group.
- Transplant recipients during the pandemic showed a non-significant trend towards higher rejection rates.
Conclusions:
- Pandemic-related restrictions may have resulted in a selection bias, leading to more high-risk patients with RPRF and elevated creatinine undergoing renal biopsies.
- The observed increase in transplant rejections underscores the critical need for enhanced support systems to manage these vulnerable patients during health crises.
Introduction:
The disruption of healthcare services in coronavirus disease (COVID)19 pandemic was widespread particularly due to lockdown curbs. This study was undertaken to see the effect of this pandemic on subjects requiring renal biopsy.
Materials And Method:
Renal biopsies performed during the COVID 19 pandemic between April 2020 and December 2020 (Group 1) were compared with those in pre-COVID period between June 2019 and February 2020 (Group 2). Indication of biopsies, syndromic diagnosis and all baseline laboratory characteristics were retrieved from the hospital records.
Results:
130 and 191 patients were biopsied in groups 1 and 2, respectively. Patients in group 1 were younger compared with group 2 (32.55 ± 15.60 and 36.37 ± 16.96 years, respectively, p value 0.038). The mean serum creatinine value in group 1 was significantly higher than in group 2 (3.21 ± 2.08 and 2.68 ± 2.02 mg/dl respectively, p value: 0.023). Group 1 comprises a significantly higher percentage of rapidly progressive renal failure patients (RPRF) (39.3 vs 28, p value 0.046). A higher percentage of nephrotics was biopsied in group 2 vs group 1 (46.9 vs 30.4 respectively, p value 0.008). The treatment protocol remained similar in both the groups. Evaluation of the transplant biopsies revealed a nonsignificant higher number of rejections in group 1 (11 out of 18) as compared to group 2 (5 out of 16), p value 0.100. Combined rejection saw a lesser use of rATG in group 1.
Conclusion:
COVID pandemic induced restrictive measures could have led to selective high risk patients with RPRF as presumptive diagnosis and higher creatinine values getting biopsied. Higher rejections were noticed in transplant recipients pointing towards the need of establishing a more efficient support system for managing such patients.
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