New research reveals global gaps in diagnosing kidney disease

A recent Northern Ireland study has identified that renal specialists around the world have significantly different approaches on when they feel a kidney biopsy is needed to diagnose their patients.

In the largest study of its kind, researchers from the Centre for Public Health at Queen’s University Belfast surveyed over 1,100 nephrologists from 83 countries.

The findings, published in the Clinical Journal of the American Society of Nephrology, reveal a high degree of agreement among kidney specialists working in the UK and the Republic of Ireland.

In contrast, internationally, there were wide variations among experts as to whether a biopsy was needed in specific situations.

Dr Michael Toal, lead author of the paper and Clinical Research Fellow at the Centre for Public Health at Queen’s commented: “A kidney biopsy is an essential investigation for diagnosis, but is invasive and associated with complications. Delaying or missing the opportunity to diagnose kidney disease could result in adverse patient outcomes. This study aimed to examine attitudes to kidney biopsy across the world.”

Via an online questionnaire, nephrologists took part in the worldwide survey, which found that males, younger clinicians, and individuals who perform biopsies more frequently, had an increased propensity to recommend a kidney biopsy.

Dr Toal added: “The research also highlighted that a kidney biopsy was most often recommended in the setting of higher urinary protein levels and preserved kidney function.”

Furthermore, the propensity-to-biopsy scores were significantly different between the 13 countries with the highest participation, with Mexico shown to have the highest propensity to biopsy and the Philippines the lowest.

Prof Peter Maxwell from the School of Medicine, Dentistry and Biomedical Sciences at Queen’s, a senior author of the paper, said the variations in attitudes in nephrologists across the globe likely reflect differences in training, experience in performing a biopsy, as well as tolerance for risk among clinicians relative to the value of information obtained from a kidney biopsy.

The study was funded by the Northern Ireland Kidney Research Fund. Available at: https://journals.lww.com/cjasn/fulltext/2025/03000/an_international_study_of_variation_in_attitudes.10.aspx