JPMA. The Journal of the Pakistan Medical Association · 2025
Etiological spectrum and short-term outcomes of acute kidney injury in hospitalised patients of uncertain aetiology who underwent percutaneous renal biopsy.
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Huzaifa Qazi Muhammad, Elahi Tabassum, Jahangir Sunbal, Khan Kalimullah, Memon Irum
Аннотация
OBJECTIVES: To analyse the aetiological spectrum, clinical presentation and short-term renal outcomes of patients with acute kidney injury of uncertain aetiology subjected to percutaneous renal biopsy.
METHODS: The prospective, cohort study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from March 1 to October 30, 2024, and comprised hospitalised acute kidney injury patients of either gender aged 18- 75 years who had been subjected to percutaneous renal biopsy. The patients were followed up for at least three months from the time of the biopsy. Data was analysed using SPSS 26.
RESULTS: Of the 115 patients with mean age 32.61±10.20 years, 60(52.2%) were females and 55(47.8%) were males. The mean estimated glomerular filtration rate was 23.05±18.62ml/min/1.73m². Over half 62 (53.9%) required kidney replacement therapy at presentation. Most patients 104(90.4%) had renal involvement due to glomerulopathy, while the rest exhibited non-glomerular renal disease. The most common primary glomerular diseases were focal segmental glomerulosclerosis 26(22.6%), membranoproliferative glomerulonephritis 16(13.9%) and membranous nephropathy 4(3.5%). The leading secondary glomerular diseases were pauci-immune necrotising glomerulonephritis 18(15.7%), thrombotic microangiopathy 16(13.9%) and lupus nephritis 8(7.0%). At 3-month follow-up, 43(37.4%) achieved complete recovery, 34(29.6%) achieved partial recovery and 38(33%) showed no recovery, while 4(3.4%) patients from the no recovery group expired at the time of the last follow-up. Patients who required kidney replacement therapy on admission had lower rates of complete recovery (p <0.001), with more patients progressing to end-stage kidney disease (p=0.02) and increased mortality (p=0.08).
CONCLUSIONS: Most biopsied acute kidney injury patients had coexisting glomerular disease with worse renal recovery, while acute tubular necrosis alone was less frequent.
METHODS: The prospective, cohort study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, from March 1 to October 30, 2024, and comprised hospitalised acute kidney injury patients of either gender aged 18- 75 years who had been subjected to percutaneous renal biopsy. The patients were followed up for at least three months from the time of the biopsy. Data was analysed using SPSS 26.
RESULTS: Of the 115 patients with mean age 32.61±10.20 years, 60(52.2%) were females and 55(47.8%) were males. The mean estimated glomerular filtration rate was 23.05±18.62ml/min/1.73m². Over half 62 (53.9%) required kidney replacement therapy at presentation. Most patients 104(90.4%) had renal involvement due to glomerulopathy, while the rest exhibited non-glomerular renal disease. The most common primary glomerular diseases were focal segmental glomerulosclerosis 26(22.6%), membranoproliferative glomerulonephritis 16(13.9%) and membranous nephropathy 4(3.5%). The leading secondary glomerular diseases were pauci-immune necrotising glomerulonephritis 18(15.7%), thrombotic microangiopathy 16(13.9%) and lupus nephritis 8(7.0%). At 3-month follow-up, 43(37.4%) achieved complete recovery, 34(29.6%) achieved partial recovery and 38(33%) showed no recovery, while 4(3.4%) patients from the no recovery group expired at the time of the last follow-up. Patients who required kidney replacement therapy on admission had lower rates of complete recovery (p <0.001), with more patients progressing to end-stage kidney disease (p=0.02) and increased mortality (p=0.08).
CONCLUSIONS: Most biopsied acute kidney injury patients had coexisting glomerular disease with worse renal recovery, while acute tubular necrosis alone was less frequent.