KHA‐CARI Guideline recommendations for renal biopsy

Abstract

SUMMARY AT A GLANCE This KHA‐CARI Guideline laid down principles for the care of patients undergoing kidney biopsy, and provides management guidelines from with‐holding of antiplatelet and anticoagulant agents, application of desmopressin to postbiopsy bleeding care.

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

“…azotaemia, thrombocytopenia, abnormal international normalized ratio and PTT, etc) and elevated blood pressure. 4,5,60 Our study showed that the rate of red cell transfusions was 0.24%, much lower than that in the studies of Corapi et al (0.9%) 5 and Varnell et al (0.9%). 58 Although the reasons for this are unclear, however, it might be related to differences in J o u r n a l P r e -p r o o f thresholds of instituting blood transfusion at different centres.…”

“…The KHA-CARI guidelines do not recommend post-biopsy imaging as a part of all patients assessment. 60 The inclusion of pain as a minor complication in this study may have contributed to the higher rate of minor complications. One study from Nigeria reported 100% minor complication as a result of pain, 29 otherwise, the rate of minor complications in this study is similar to other studies.…”

“…6,7 Although our study shows low rates of complication even as some studies used blind techniques for performing kidney biopsy, we however, strongly discourage the performance of kidney biopsy carried out without imaging J o u r n a l P r e -p r o o f guidance as some studies reported. 17,25,[28][29][30] The KHA-CARI guidelines 60 for kidney biopsy recommends that real-time ultrasound guidance to be used as the first line imaging for PNKB.…”

Lessons for the clinical nephrologist: ureteric obstruction secondary to blood clot after kidney biopsy

“…It has been seen to temporarily reduce in vitro bleeding time in patients on hemodialysis or with creatinine > 619 μmol/L (> 7 mg/dL) [13], but 3 single-center case series have each produced no convincing evidence of reduced rates of hemorrhage after kidney biopsy [14][15][16], and there is an approximately 7% risk of severe hyponatremia [17]. Current guidelines give no recommendation for desmopressin on the grounds of inadequate evidence [18][19][20].…”

“…Current guidelines discuss the risk of hematuria, perinephric hematoma formation and the risk of requiring blood transfusion, but not the risk of acute ureteric obstruction from blood clot [18][19][20]. As this complication is a devastating event which necessitates procedural intervention, it should be listed as a potential complication in kidney biopsy guidelines to raise awareness among proceduralists and the nephrology community, and it should be discussed and included in the informed consent process.…”