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Predictors of Complication after Percutaneous Ultrasound-Guided Kidney Biopsy in HIV-Infected Individuals: Possible Role of Hepatitis C and HIV Co-infection

Sayed Tabatabai^*, C. John Sperati^*, Mohamed G. Atta^*, Kashif Janjua, Christopher Roxbury^*, Gregory M. Lucas, and Derek M. Fine^*

^* Department of Medicine, Division of Nephrology, and Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Medicine, Capital Health Systems, Trenton, New Jersey

Correspondence: Dr. Sayed Tabatabai,1830 E. Monument Street, Suite 416, Baltimore, MD 21205. Phone: 410-955-5268; Fax: 410-955-0485; E-mail: sayedtab{at}yahoo.com

Background and objectives: HIV-infected patients often undergo kidney biopsy. The risks of percutaneous ultrasound-guided kidney biopsy in this population are not well established.

Design, setting, participants, & measurements: This was a case-control, single-center study of 1116 (243 with HIV infection and 873 without) consecutive ultrasound-guided biopsies from 1024 patients. The primary outcome was any major or minor complication. Major complications included biopsy-associated bleeding that required transfusion, angiography, or surgery; hypotension that required intervention; and death. Minor complications included development of a hematoma or gross hematuria. The odds of complication was assessed with logistic regression.

Results: Overall complication rates (8.6 versus 7.2%) did not significantly differ between HIV-infected and noninfected individuals. HIV-positive status did not predict complication. In the entire cohort, hepatitis C infection was associated with a 2.08 (95% confidence interval [CI] 1.47 to 2.93) increased odds of complication, and each 10,000-cells/mm³ decrease in prebiopsy platelet count a 1.05 (95% CI 1.02 to 1.08) increased odds of complication. In addition, prebiopsy hematocrit <30% and estimated GFR <30 ml/min per 1.73 m² were associated with major complication. Whereas the association of prebiopsy platelet count was not modified by HIV infection, hepatitis C/HIV co-infection was associated with a 5.71 (95% CI 1.89 to 17.2) increased odds of complication as compared with 1.27 (95% CI 0.73 to 2.19) in hepatitis C–positive/HIV-negative individuals.

Conclusions: Ultrasound-guided percutaneous kidney biopsy is a relatively safe, well-tolerated procedure in the HIV-infected population. HIV-infected individuals who are co-infected with hepatitis C seem to be at greatest risk.