Novel Risk Factors for Complications in Lupus Nephritis Kidney Biopsy: Use of Point-of-Care Ultrasonography (POCUS) Renal Protocol and Inflammatory Markers

Background: Kidney biopsy is mandatory for diagnosis and management of lupus nephritis (LN). Bleeding complications (BC) are the most frequent (10–34%), with major complications (1–3%) Traditional risk factors include anemia, thrombocytopenia, coagulopathy, use of antithrombotic agents and antiphospholipid syndrome. Objective: evaluate risk factors for BC in percutaneous kidney biopsy (PKB) in LN patients and the use of novel pocus renal protocols (POCUSrp) and inflamatory variables Methods: Retrospective observational study in patients with Lupus who performed native PKB between July 2019 and December 2024 at Instituto Nacional de Cardiología in Mexico City. POCUSrp included anatomical and hemodynamic characteristics. PKB were real time ultrasound (US)-guided by an interventional nephrologist. A Doppler US post PKB permorfed in all patients to evaluate complications. Categorization for major complication (hematoma >2cm or gross hematuria with ≥1 g/dL hemoglobin (hb) drop and/or transfusion) and minor if they resolved without intervention. Results: A total of 132 patients were included, 88.6% female with mean age of 35 years. Hypertension diagnosis in 28%, and the most frequent indication for PKB was impaired renal function. 5.3% were on renal replacement therapy during the PKB. Minor complications presented in 20.5%, perinephric hematoma <2cm; and 1.5% for major complications .Patients with complications associated with lower hb levels, elevated ESR and CPR and altered renal hemodynamics on POCUrp (higher PSV and TDV) (Tab.1, 2). Class IV + V LN presented in(31.8%), followed by class V (22%) and class III/V (16%). Other histological findings were TIN (18.9%), and TMA (15.2%).Only class IV showed differences between both groups (Tab 3.).In logistic regression serum creatinine was associated with 40% higher bleeding complications (OR 1.4,CI 1.1-1.9,p 0.03) Conclusion: These findings suggest that inflammatory activity and renal disease severity may predict post PKB bleeding complications in SLE. And the use of POCUSrp will be a useful tool Funding: Government Support – Non-U.S.