Safety and Complications of Percutaneous Kidney Biopsies in 715 Children and 8573 Adults in Norway 1988–2010

Abstract

Summary Background and objectives Skepticism about performing renal biopsies is often because of uncertainty regarding risk of complications. The aim of this study was to evaluate safety and relevant complications of renal biopsies in pediatric and adult patients in a large national registry study. Design, setting, participants, & measurements Kidney biopsies reported in the Norwegian Kidney Biopsy Registry from 1988 to 2010 were included. Risk factors for major complications (blood transfusion and/or surgical or catheter intervention) were analyzed using logistic regression statistics. Results Of the 9288 biopsies included, 715 were from children, and 8573 were from adults (≥18 years). Median age was 49 years (range=2 weeks to 94 years). Gross hematuria appeared after biopsy in 1.9% of the patients; 0.9% of patients needed blood transfusion, and 0.2% of patients needed surgical intervention/catheterization. The frequencies were 1.9%, 0.9%, and 0.2% in adults and 1.7%, 0.1% and 0.1% in children, respectively; 97.9% of the biopsies were without complications. In unadjusted analyses, risk factors for major complications were age>60 years, estimated GFR<60 ml/min per 1.73 m2, systolic hypertension, acute renal failure, and smaller clinical center size (<30 biopsies/yr). Adjusted analyses (adjusted for age and/or estimated GFR) showed higher odds ratios (OR) only for smaller clinical center (OR=1.60 [1.02–2.50]) and low estimated GFR (estimated GFR=30–59 ml/min per 1.73 m2 [OR=4.90 (1.60–14.00)] and estimated GFR<30 ml/min per 1.73 m2 [OR 15.50 (5.60–43.00)]). Conclusions Percutaneous renal biopsy is a low-risk procedure in all ages. Reduced estimated GFR and smaller center size are associated with an increased risk of major complications.

Nephrology and the Percutaneous Renal Biopsy

“…Over the 22-year period, there was a decrease in both the number of biopsies done by nephrologists (actual proportion not provided) and the proportion of biopsies done using 14-gauge needles (22% to #1%). This important study by Tondel et al (28) reconfirms that the PRB is a safe and successful procedure in a nationwide experience. However, it also serves as a wake-up call for the nephrology community that smaller biopsy needles are being used, and biopsies are increasingly being performed by radiologists rather than nephrologists.…”

“…In this issue of CJASN, Tondel et al (28) report on the 22-year experience (from 1988 to 2010) with PRB of native kidneys from the Norwegian Kidney Biopsy Registry, which includes 26 hospitals. The 9288 percutaneous biopsies in the study represented 96% of all biopsies performed during that time period.…”

“…The rationale for this is not clear but may be linked to the increasing number of biopsies being done by radiologists as suggested by the study of Tondel et al (28) and as reported by Gupta and Balogun (29), who found that an 18-gauge needle was used in 69% of biopsies performed by radiologists compared with only 14% of biopsies performed by nephrologists. Additionally, the study by Tondel et al (28) and other studies (7,(29)(30)(31)(32) continue to demonstrate that when using an 18-gauge needle, the sample size is significantly smaller (9 versus .12 glomeruli), and often, the quality of the sample (the number of intact glomeruli) is poorer. In the only study assessing the differences between 14-, 16-, and 18-gauge automated needles, Nicholson et al (32) demonstrated that using an 18-gauge needle resulted not only in a significantly smaller sample size (9 versus 11 versus 15 glomeruli) but was also associated with less diagnostic success (53% versus 76% versus 85%), despite no significant differences in complication rates.…”

Renal biopsy: Still a landmark for the nephrologist

“…The first one is reserved to paediatric patients because the internal diameter of the needle is barely bigger than an adult glomerulus (200250 pmol/L), while the other two are more appropriate for the adult patients [13,14] . On the other hand, the length of this device is almost the same and is around 20 cm.…”

“…July 6, 2016|Volume 5|Issue 4| WJN|www.wjgnet.com Fenerberg et al [24] 1998 1081 9.6 1.11 0.09 Prasad et al [28] 1998 1090 3 0.36 0 Preda et al [20] 2003 515 9.5 2.7 0 Whittier et al [51] 2004 750 6.7 6.4 0.13 Atwell et al [44] 2010 5832 -0.7 0 Stratta et al [29] 2007 1137 24.2 0.36 0 Korbet et al [23] 2014 1055 8.1 6.6 0.09 Mai et al [21] 2013 934 5.9 0.86 0 Tøndel et al [13] 2012 9288 1.9 0.9 0 Prasad et al [28] 2015 2138…”