Predictors of kidney biopsy complication among patients with systemic lupus erythematosus

T. K. Chen, M. M. Estrella, D. M. Fine

Research output: Contribution to journalArticlepeer-review

Abstract

Kidney biopsy is essential for the diagnosis and management of lupus nephritis. The risk of bleeding complication, however, is not defined in the systemic lupus erythematosus population. A retrospective cohort study was conducted to determine predictors of major and minor complications among patients with systemic lupus erythematosus undergoing percutaneous ultrasound-guided kidney biopsy. Major complications included bleeding necessitating intervention, hypotension requiring vasopressors or higher level of care or death. Minor complications included moderate or large (≥ 4cm in largest diameter) perinephric hematoma, gross hematuria or voiding difficulties. All patients were observed for at least 23 h post-procedure. The overall incidence of bleeding was 10.5% (2.7% major, 7.8% minor). Adjusted logistic regression showed that for every 10,000 cells/mm3 decrease in platelet count, risk for major and any complication increased by 27% (odds ratio 1.27; 95% confidence intervals 1.06-1.51; p=0.01) and 8% (odds ratio 1.08; 95% confidence intervals 1.02-1.15; p=0.01), respectively. Patients with a platelet count <150,000 cells/mm3 were 30 times more likely to experience a major complication (p=0.002). Other candidate predictors, including steroid exposure, kidney function, hematocrit and histopathology, were not significant. Kidney biopsies are well tolerated in patients with systemic lupus erythematosus. However, patients with pre-biopsy platelet counts <150,000 cells/mm3 are at markedly increased risk for a major bleeding complication.

Original languageEnglish (US)
Pages (from-to)848-854
Number of pages7
JournalLupus
Volume21
Issue number8
DOIs
StatePublished - Jul 2012

Keywords

  • Renal lupus
  • bleeding complication
  • kidney biopsy
  • nephritis
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Rheumatology

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