Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort

Pálsson, Ragnar; Short, Samuel A.P.; Kibbelaar, Zoe A.; Amodu, Afolarin; Stillman, Isaac E.; Rennke, Helmut G.; McMahon, Gearoid M.; Waikar, Sushrut S.

doi:10.1016/j.ekir.2020.01.012

Cited by 41 publications

(48 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This discrepancy could be explained by the difficulty in retrospectively identifying biopsy indications, with frequent overlaps, calling for a somewhat arbitrary priority system to assign an indication to each biopsy. Incidentally, we did not observe adverse events more frequently among patients with T2D than the frequencies reported in studies among patients without T2D [23, 47-49].…”

Section: Discussion/conclusioncontrasting

confidence: 89%

Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study

et al. 2021

View full text Add to dashboard Cite

Introduction: Kidney biopsies (KBs) are performed in patients with type 2 diabetes (T2D) to diagnose non-diabetic or hypertensive kidney disease (NDHKD) potentially requiring specific management compared to diabetic and or hypertensive nephropathy (absence of NDHKD). Indications for KB are based on the presence of atypical features compared to the typical course of diabetic nephropathy. In this study, we assessed the association of different patterns of atypical features, or KB indications, with NDHKD. Methods: Native KBs performed in patients with T2D were analyzed. Data were collected from the patients’ records. KB indications were determined according to the presence of different atypical features considered sequentially: (1) presence of any feature suggesting NDHKD which is not among the following ones, (2) recent onset of nephrotic syndrome, (3) low or rapidly declining estimated glomerular filtration rate (eGFR), (4) rapid increase in proteinuria, (5) short duration of diabetes, (6) presence of hematuria, or (7) normal retinal examination. Results: Among the 463 KBs analyzed, NDHKD was diagnosed in 40% of the total population and 54, 40, 24, and 7% of the KBs performed for indications 1–4 respectively. Conversely, no patient who underwent KB for indications 5–7 displayed NDHKD. Logistic regression analyses identified eGFRCKD-EPI >15 mL/min/1.73 m2, urinary protein-to-Cr ratio <0.3 g/mmol, hematuria, HbA1c <7%, and diabetes duration <5 years as predictors of NDHKD, independently from the indication group. Conclusion: NDHKD is frequent in T2D. Despite the association of hematuria with NDHKD, our results suggest that presence of hematuria and absence of DR are insufficient to indicate KB in the absence of concurrent atypical features. Conversely, rapid progression of proteinuria and rapid deterioration of eGFR are major signals of NDHKD.

show abstract

Section: Discussion/conclusioncontrasting

confidence: 89%

Kidney Biopsy in Type 2 Diabetes: A Multicenter Cross-Sectional Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…This study investigated over 100,000 patients and recorded 2125 deaths. All of the other studies together reported only 15 proportion of transfusions needed or study heterogeneity much (Table 1). Another common complication of kidney biopsy was perinephric hematoma.…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications

Poggio

McClelland

Blank

et al. 2020

CJASN

Self Cite

145

101

View full text Add to dashboard Cite

Background and objectivesNative kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases–sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.Design, setting, participants, & measurementsThis is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman–Tukey double-arcsine transformations were used to stabilize variance as complications were rare.ResultsA total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.ConclusionsAlthough the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.

show abstract

“…We note that there were higher complication rates when biopsies were performed in an urgent setting . [24] Another study reported grade 3 hemorrhage in 64 of 18,947 (0.3%) procedures, including three deaths associated with the biopsy event (0.02% or approximately 2/10,000), with bleeding complications greatest in native kidney biopsies. [25] Up to 24h post biopsy observation may be required and techniques and capabilities vary among institutions.…”

Section: Gabriel Richetmentioning

confidence: 99%