Desmopressin Acetate in Percutaneous Ultrasound-Guided Kidney Biopsy: A Randomized Controlled Trial

Manno, Carlo; Bonifati, Carmen; Torres, Diletta Domenica; Campobasso, Nicla; Schena, Francesco Paolo

doi:10.1053/j.ajkd.2010.12.019

Cited by 93 publications

(103 citation statements)

References 21 publications

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“…All patients with eGFR <30-45 mL/min/1.73 m 2 received DDAVP to prevent bleeding, according to current recommendations in uremic patients [14,15]. We also employed strict control of coagulation parameters, and omitting of antiplatelet or anticoagulant agents for several days prior to biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned, the haemorrhagic diathesis present in uremic patients with advanced chronic kidney disease is associated with higher risk for bleeding. Desmopressin (DDAVP) is the most common agent used to treat or prevent bleeding in uremic patients [14,15]. DDAVP improves haemostasis by releasing factor VIII: von Willebrand factor multimers from endothelial cells.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Outpatient Kidney Biopsies

Šimunov

Gunjača

Čingel

et al. 2018

Nephron

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Background: Kidney biopsy is frequently performed in our centre as an outpatient procedure. The aim of this study was to evaluate the safety of biopsy in the outpatient setting. Methods: We analysed kidney biopsies performed from March 2013 to February 2017. Seven hundred twenty-five biopsies performed in the outpatient setting were identified: There were 592 transplant and 133 native biopsies including 3 solitary kidney biopsies. All were performed under ultrasound guidance using a 16G or 18G needle, with freehand technique. In all patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² desmopressin was administered. Patients were observed for 6h before discharge, with a complete blood count and urine test after 4 h. Major complications were haemorrhage requiring therapeutic intervention or transfusion. Minor complications were significant reduction in haemoglobin (Hb) levels (>10%), without need for transfusion or intervention and macrohaematuria. Results: There were 506 (69.8%) male patients. Average age was 50.3 ± 12.7 years. Indications for native kidney biopsy included nephrotic syndrome (39.8%), nephritic syndrome (42.9%), follow-up biopsy (15.8%), and other (1.5%). There were no major complications. A decline in Hb was observed in 72% of patients. Average Hb decline was 4.2 ± 6.3 g/L. In 10.1% patients there was >10% reduction in Hb level, with no evident bleeding, including by ultrasonography. In 2.5% of patients, macrohaematuria was present. In a multivariate analysis, male gender, lower eGFR, higher pre-biopsy Hb and native kidney biopsy were predictive for Hb decline. No therapeutic interventions were required. Conclusion: We found that kidney biopsy performed in an outpatient setting in select patients is only rarely associated with adverse events and is a safe procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of Outpatient Kidney Biopsies

Šimunov

Gunjača

Čingel

et al. 2018

Nephron

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“…Manno et al (50) explored the use of desmopressin acetate (0.3 mg/kg 1 hour before the procedure) in native, ultrasound-guided kidney biopsies in a placebo-controlled, double-blind, randomized, controlled trial in 162 patients with preserved renal function (creatinine ,1.5 mg/dl and/or eGFR.60 ml/min per 1.73 m 2 ) and normal coagulation parameters. Desmopressin use was associated with fewer (13.7% versus 31%) and smaller ultrasound-detected hematomas after biopsy but did not result in fewer transfusions or interventions, and no serious adverse events were observed.…”

Section: Desmopressinmentioning

confidence: 99%

The Native Kidney Biopsy

Hogan

Mocanu

Berns

2016

Clinical Journal of the American Society of Nephrology

236

228

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The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training. These data are presented to develop best practice strategies for this essential procedure.

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“…Administration of this drug systematically regardless of bleeding time values appears to be cost-ineffective, considering that approximately 80% of patients had normal bleeding times, and it could be related to serious side effects such as hypertension and hyponatremia (Mattix & Singh, 1999;Korbet, 2002). However, a recent randomized controlled trial showed a significant advantage of a systematic DDAVP administration in patients without a significant renal impairment (Manno et al, 2011).…”

Section: Role Of Bleeding Time In Predicting Bleeding Complicationsmentioning

confidence: 99%