Study objectives: To assess the indications, yield, and
therapeutic impact of flexible bronchoscopy (FB) in patients with
hemoptysis and renal insufficiency.
Retrospective cohort analysis.
Patients: Thirty-four patients
over a 7.5-year period who underwent FB to evaluate hemoptysis in the
setting of renal insufficiency (ie, serum creatinine
level, > 1.5 mg/dL).
Measurements and results: The
etiology of hemoptysis was undetermined in 41% of cases. Defined
causes of bleeding included infections (29%), pulmonary renal
syndromes (15%), airway injury (9%), and pulmonary embolism (6%). No
specific bleeding site was identified, but FB lateralized hemorrhaging
to one lung in 24% of patients. FB results influenced therapy in 29%
of patients overall and in 8% of patients without respiratory tract
infection. The hospital survival rate was 47% and did not differ based
on the presence or absence (presence vs absence) of the following
variables: a defined etiology for hemoptysis (45% vs 50%);
lateralized bleeding (38% vs 50%); or management alterations prompted
by other FB findings (50% vs 46%). Factors associated with survival
included the onset of bleeding prior to hospital admission (80% vs
33%; p = 0.02), the absence of respiratory failure requiring
mechanical ventilation at the time of FB (90% vs 29%; p = 0.002),
and lack of prohemorrhagic factors (other than uremia) such as
disseminated intravascular coagulation, recent treatment with
warfarin, heparin, or antiplatelet agents (78% vs 33%; p = 0.05).
During the 6 months following hospital discharge, hemoptysis recurred
in 14% of patients, and 5 patients died, for an overall mortality rate
Conclusions: These data suggest that FB in
hospitalized patients with hemoptysis and renal insufficiency, and
without radiographic findings suggesting neoplastic disease, has a low
yield and limited impact. Whether FB influences outcome in selected
patients in this setting requires prospective