Nephrologists’ Attitudes Towards Native Kidney Biopsy: A Qualitative Study

ABSTRACT Rationale & Objective Although kidney biopsy is a useful tool, nephrologists approach biopsies inconsistently for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists in the decision to perform native kidney biopsy. Study Design Qualitative study using semi-structured interviews Setting and Participants Purposive sampling was used to select nephrologists from different regions in the United States (US). semi-structured interviews continued until thematic saturation. Analytical Approach Modified grounded theory to identify dominant themes reflecting nephrologists' decision-making around kidney biopsy. Results Twenty nephrologists were interviewed; 16 (80%) from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than ten years. Median years of practice was 14 years. We found substantial variability across nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks versus benefits of the procedure for an individual patient. Five overarching themes emerged: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. Limitations Generalizability is limited as the nephrologists sampled may not be broadly representative. Conclusions Multiple factors enter into nephrologists' decision to pursue kidney biopsy, with substantial variability across nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized.