Nephrologists’ Attitudes Toward Native Kidney Biopsy: A Qualitative Study

RATIONALE & OBJECTIVE: Although kidney biopsy is a useful tool, nephrologists’ approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy. STUDY DESIGN: Qualitative study using semistructured interviews. SETTING & PARTICIPANTS: Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation. ANALYTICAL APPROACH: A modified grounded theory was used to identify dominant themes reflecting the nephrologists’ decision-making styles about kidney biopsy. RESULTS: Twenty nephrologists were interviewed: 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks and benefits of the procedure for an individual patient. Five overarching themes were identified: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about the invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. LIMITATIONS: Generalizability was limited because the nephrologists sampled may not have been broadly representative. CONCLUSIONS: Multiple factors influence nephrologists’ decision to pursue kidney biopsy, with substantial variability among nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized.