The impact of percutaneous renal biopsies on clinical management

Percutaneous renal biopsy (PRB) is now standard practice in clinical nephrology. One hundred consecutive non-transplant PRBs performed on adult patients at the Department of Renal Medicine, Singapore General Hospital, between January and August 1990, were analysed to examine the impact and complications of PRBs in a single institution. The study population consisted of 37 male and 63 female patients with a mean age of 32 +/- 11.9 years. The most frequent indications for PRB were systemic lupus erythematosus with renal involvement (41 patients), haematuria and proteinuria (27 patients) and the nephrotic syndrome (26 patients). Histological diagnoses included lupus nephritis in 45 patients, IgA nephritis in 19 patients, minimal change/focal global sclerosis in 14, non-IgA mesangioproliferative glomerulonephritis in seven and other histologies in the remainder. Eighty-two of our patients received renal-specific therapy, including 72 who received prednisolone or other immunosuppression, and 11 who received persantin and warfarin, in contrast to only 18 patients who received non-specific therapy including diuretics, antihypertensive drugs or dialysis. PRB led to change in therapy in 54% of all our patients, including 42 who had immunosuppressive drugs added to their therapeutic regimen and 11 who were commenced on persantin and/or warfarin. Complications of the procedure were minimal with flank pain in 6% and gross haematuria in 4%. As the inherent risks of inappropriate immunosuppression are well established, these results suggest that PRBs have a major impact on clinical management.