Percutaneous renal biopsy of native kidneys: efficiency, safety and risk factors associated with major complications

Abstract

IntroductionThe use of an automated biopsy device and real-time ultrasound (current technology) for percutaneous renal biopsies (PRBs) has improved the likelihood of obtaining adequate tissue for diagnosis and has reduced the complications associated with renal biopsies. Our objective was to evaluate the efficacy and safety of the current PRB procedure and identify possible risk factors for the development of major complications.Material and methodsWe collected all native kidney PRBs performed with current technology in our institute from January 1998 to April 2008. Studied variables were collected from the patient's chart at the time of the biopsy.ResultsWe analyzed 623 (96.4%) of 646 renal biopsies performed with the current automated procedure guided by real-time ultrasound. Although the effectiveness was 97.6%, there were 110 complications. Fourteen (2.24%) of these complications were major: 9 cases of renal hematoma, 2 cases with macroscopic hematuria (which needed blood transfusion), 1 case of intestinal perforation (which required exploratory laparotomy), 1 nephrectomy and 1 case of a dissecting hematoma. The logistic regression analysis demonstrated the following risk factors for developing major complications: diastolic blood pressure ≥ 90 mmHg, RR 7.6 (95% CI 1.35-43); platelet count ≤ 120×103/µl; RR 7.0 (95% CI 1.9-26.2); and blood urea nitrogen (BUN) ≥ 60 mg/dl, RR 9.27 (95% CI 2.8-30.7).ConclusionsThe observed efficacy and safety of the current technique in the present study were similar to observations in previous studies. Diastolic blood pressure ≥ 90 mmHg, platelets ≤ 120×103/µl and BUN ≥ 60 mg/dl were independent risk factors for the development of major complications following PRB.

Risk of Bleeding after Native Renal Biopsy as a Function of Preprocedural Systolic and Diastolic Blood Pressure

“…The major bleeding complication rate in the present study (3.1%) is half those in the studies by Shidham et al (6) (6.2%) and Korbet et al (5) (6.6%) but slightly more than the rate in the study by Torres Munoz et al (19) (2.2%). Moreover, the risk of major bleeding complication in patients with SBP lower than 140 mm Hg and DBP lower than 90 mm Hg was less than 1% in the present study, compared with more than 5% in the study of Shidham et al (6).…”

“…Likewise, major bleeding complications occurred more frequently in patients with higher versus lower DBP (8.7% for DBP 4 90 mm Hg vs 5.2% for DBP o 90 mm Hg), but that stratification also did not show a significant difference between the groups (P ¼ .11). Two more recent studies (5,19) have also shown an effect of SBP on the rate of bleeding complications after native renal biopsy. Torres Munoz et al (19) analyzed risk factors for 14 major complications that occurred in 2.2% of 623 native renal biopsies performed with realtime US guidance using automated biopsy devices; a DBP higher than 90 mm Hg conferred an OR of 7.6 (95% CI, 1.35-43) for major complications.…”

“…Two more recent studies (5,19) have also shown an effect of SBP on the rate of bleeding complications after native renal biopsy. Torres Munoz et al (19) analyzed risk factors for 14 major complications that occurred in 2.2% of 623 native renal biopsies performed with realtime US guidance using automated biopsy devices; a DBP higher than 90 mm Hg conferred an OR of 7.6 (95% CI, 1.35-43) for major complications. Additionally, Korbet et al (5) most recently reported a 6.6% major complication rate in 1,055 biopsies that used realtime US guidance with a 14-gauge needle; an SBP higher than 170 mm Hg conferred an OR of 4.2 (95% CI, 1.8-9.8) for major complications.…”

Risk Factors and Timing of Native Kidney Biopsy Complications

“…A higher transfusion rate was also found when compared to previously reported studies (9 vs. 0.4-6%) [19,20,21,22]. Indeed, a large number of patients had a low Hb concentration prior to biopsy as a mild decrease in Hb can lead to transfusion and a low Hb itself might be a risk factor for bleeding [11].…”

Renal Biopsy in 2015 - From Epidemiology to Evidence-Based Indications

“…Although AKI patients are notoriously at high risk for post-biopsy bleeding [88,89] , in subjects with no evidence of pre-renal or obstructive diseases, the benefits of renal biopsy may outweigh the risks as the histological diagnosis might be useful to guide therapy and to predict outcomes.…”