Complications and Risks of Percutaneous Renal Biopsy

Abstract

BACKGROUND: Renal biopsy performed in native and transplant kidneys is generally considered a safe procedure.
 AIM: In this study, we evaluated renal biopsy complications and risk factors in one nephrology facility.
 MATERIAL AND METHODS: We conducted a three-year retrospective study on patients who underwent renal biopsy between January 2014 and December 2016. Strict written biopsy protocol was followed. Clinical and laboratory data were obtained from medical charts. Complications were categorised as minor and major, according to the need for intervention. Minor complications included macrohematuria and/or hematoma that did not require intervention. Major complications included hematuria or hematoma with fall of hematocrit that required a blood transfusion, surgery or caused death. A binary logistic regression model was used to analyse the possible factors associated with complications after the biopsy.
 RESULTS: We analysed 345 biopsies; samples were taken from patients aged from 15-81 years, of whom 61% were men. A total of 21 (6%) patients developed a complication, 4.4% minor and 1.7% major complications. There were no nephrectomy or death due to biopsy intervention. Overweight patients, as well as those with higher creatinine, lower hemoglobin, higher blood pressure and biopsy due to AKI had higher chances to develop complications (p = 0.037, p = 0.023, p = 0.032, p = 0.002, p = 0.002, respectively). The patients’ age, gender, kidney dimension, number of passes and uninterrupted aspirin therapy were not found as significant predictors of complications. In the multivariate logistic model, body weight (OR = 1.031, 95%CI = 1.002-1.062), lower hemoglobin (OR = 0.973, 95%CI = 0.951–0.996) and hypertension (OR = 1.025, 95%CI = 1.007-1.044) increased the risk of complications in biopsied patients.
 CONCLUSION: Renal biopsy is a safe procedure with a low risk of complications when strict biopsy protocol is observed. Correction of anaemia and blood pressure is to be considered before the biopsy.

A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

“…Thirty-nine articles 4,8,[15][16][17] were eligible for data extraction, reporting on 19,500 kidney biopsies performed on 19,338 patients in 18 countries located in six regions of the world (Figure 1 -Prisma flow chart). These regions include Sub-J o u r n a l P r e -p r o o f Saharan Africa (5 studies); 24,[27][28][29]52 South Asia (15 studies); 15,22,23,[30][31][32][33][34][35][36][37][38][39]54,55 Middle East and North Africa (7 studies); 8,17,25,26,[40][41][42] Latin America and Caribbean (2 studies); 50,51 Europe and Central Asia (3 studies); 48,49,53 and East Asia and Pacific (7 studies). 4,16,[44][45][46][47]56 There were 5 studies from low-income countries 15,[22][23]…”

“…4,16,[44][45][46][47]56 There were 5 studies from low-income countries 15,[22][23][24]55 ; 18 from lower middle-income countries 8,17,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]54 and 16 studies from upper middle-income countries. 4,16,[40][41][42][44][45][46][47][48][49][50][51][52][53]56 Based on quality assessment (with an interrater agreement of 79.4%), most studies (22/39; 56.4%) were moderate quality, 8,15,22,23,25,…”

“…The biopsy techniques using USS-RT were in 20 studies (48.8%), 4,15,16,24,31,32,34,[37][38][39][40][41]44,47,48,[50][51][52][53][54] USS-PM in 15 studies (36.6%), 8,15,16,22,23,27,33,35,36,42,45,46,49,55,56 one study (2.4%) was performed with fluoroscopic technique, 26 and 5 (12.2%) studies were performed with no imaging guidance (blind technique). 17,25,[28][29][30] In 11 studies, the biopsies were performed by nephrology staff (6 by nephrologists and another 5 by nephrology trainees), 15,16,22,34,51 it was performed by a nephrologist assisted by radiologists in 5 studies, 23,31,32,…”

“…17,25,[28][29][30] In 11 studies, the biopsies were performed by nephrology staff (6 by nephrologists and another 5 by nephrology trainees), 15,16,22,34,51 it was performed by a nephrologist assisted by radiologists in 5 studies, 23,31,32,50,55 and in 3 studies was performed by radiologists only. 38,41,52 However, twenty (51.4%) of the studies did not document the level of experience or specialty of the individuals performing the procedure 4,8,17,[24][25][26][27][28]30,33,35,36,43,[45][46][47][48][49]53,54 ( Table 1).…”

“…The main indication for the biopsy was nephrotic syndrome in 17 studies (43.6%), 8,15,16,[23][24][25]27,28,[30][31][32]34,47,48,50,54,55 sub-nephrotic proteinuria in 3 studies, 22,35,53 and nephritic syndrome in 3 studies. 39,41,42 Other indications included CKD evaluation in two studies, 26,41 lupus nephritis in one study 51 and asymptomatic urine abnormalities in another study.…”