Bleeding complications post ultrasound guided renal biopsy - A single centre experience from Pakistan

Abstract

IntroductionRenal biopsy is the diagnostic modality of choice for the diagnosis of renal parenchymal diseases. The advent of improved imaging techniques and biopsy needles over the years has increased the safety of the procedure and the ability to obtain adequate renal tissue for diagnosis. However, there is paucity of data in this regard from Pakistan. This study shall help in establishing the local perspective of the frequency of bleeding complications in percutaneous ultrasound guided renal biopsy.Materials and methodsThis is a prospective case series of hospitalized patients from January till December 2015 at Nephrology Department, Aga Khan University Hospital, Karachi, Pakistan. After enrolment, each participant was followed for 24 h after renal biopsy.ResultsA total of 220 patients were included. Mean age was 41.65 ± 8.627 years, 82 (37.2%) were male and 138 (62.8%) were female. Pre and post biopsy haemoglobin, pre and post biopsy haematocrit were 10.92 ± 1.25 and 10.60 ± 1.22, and 30.82 ± 4.73 and 30.49 ± 4.68 respectively. Out of 220 patients, 16 (7.27%) developed major complications and 26 (11.8%) developed minor complications in 24 h after renal biopsy.ConclusionsPercutaneous kidney biopsy is a relatively safe procedure. Complication rates following the procedure are minimal. It is important that all nephrology programs train the trainees in performing biopsies, so that there is a wider clinical use of this important investigation even in underprivileged & developing countries.

Complications and Risks of Percutaneous Renal Biopsy

“…Similar results were published by the Norwegian registry on 8573 biopsies [6]. Still, there were studies which did not confirm this association [8], [9] emphasising the history of hypertension as a factor and not the present blood pressure. In our study group, the vast majority of patients had a history of hypertension (74%), but only current hypertension increased the bleeding risk as an independent predictor.…”

“…In the assessment of the factors associated with biopsy complications, our results confirmed the previously recognised traditional bleeding factors. Higher serum creatinine and AKI were significant confounding factors in biopsy complications in a large multicentric study on 2563 patients [16] but were also found in smaller monocentric studies, as ours [8], [11]. In our results, these factors lost statistical significance in the multivariate model.…”

“…Chronic kidney disease is a worldwide problem and determination of the diagnosis by biopsy is of great value in the early treatment of those patients. Renal biopsy is usually recognised as a safe procedure in native and transplanted kidneys [6], [8], [9], [10]. Brachemi’s review on large clinical trials provided an estimate of the frequency of complications after renal biopsy with required blood transfusions from 0.3% to 10% and death due to biopsy in less than 0.1% (5).…”

Ultrasound-guided percutaneous renal biopsy at a university hospital: retrospective analysis of success and complication rates

“…Therefore, it is possible that complications with less pronounced clinical or biochemical features were not identified. In a study conducted by Azmat et al (22) , involving 220 patients, complications occurred in 42 patients (19.1%), major complications, including hypotension and a significant hematoma requiring blood transfusion, occurring in 16 patients (7.3%) and minor complications, including macroscopic hematuria and renal hematoma < 5 cm, occurring in 26 (11.8%).…”

A retrospective analysis of the utility and safety of kidney transplant biopsies by nephrology trainees and consultants

“…Major complications of transplant biopsies are variously described in the literature but predominantly comprise haemorrhage requiring transfusion, radiological intra-arterial embolization or surgical intervention. Recent studies of native kidney biopsies have described the risk of such bleeding complications as 2.2 to 7.4% [ [4] , [5] , [6] ]. Fewer data exist for transplant biopsies.…”