Safety of Percutaneous Ultrasound-Guided Kidney Biopsy in Patients with AA Amyloidosis

Abstract

Background: Bleeding is the most frequent complication of kidney biopsy. Although bleeding risk in patients with AA amyloidosis after kidney biopsy has not been studied in a large population, AA amyloidosis has long been perceived as a risk factor for bleeding. The aim of the present study was to evaluate post-biopsy bleeding risk in patients with AA amyloidosis. Methods: We retrospectively analyzed bleeding complications in 88 patients with AA amyloidosis and 202 controls after percutaneous kidney biopsy. All the kidney biopsies were performed under the guidance of real-time ultrasound with the use of an automated core biopsy system after a standard pre-biopsy screening protocol. Bleeding events were classified as major when transfusion of blood products or surgical or radiological intervention was required, or if the bleeding caused hypovolemic shock or death. Bleeding events that did not meet these criteria were accepted as minor. Results: The incidence of post-biopsy bleeding was comparable between AA amyloidosis and control groups (5.7 vs. 5.0%, p = 0.796). Major bleeding events were observed in 3 patients from each group (p = 0.372). Selective renal angiography and embolization were applied to 2 patients from the AA amyloidosis group. One of these patients underwent colectomy and died because of infectious complications. Bleeding events were minor in 2.3% of the patients with AA amyloidosis and 3.5% of the controls (p = 0.728). Conclusions: AA amyloidosis was not associated with increased post-biopsy bleeding risk. Kidney biopsy is safe in AA amyloidosis when standard pre-biopsy screening is applied. Further data are needed to confirm these findings.

Confirming the Diagnosis of Amyloidosis

“…A review of complications of percutaneous renal biopsy from three teaching hospitals in the UK over a 25-year period showed that the bleeding risk was no higher among amyloidosis patients than those with other pathologies [10]. Similar findings were reported in a study of 101 amyloidosis patients at the Mayo Clinic [11] as well as a more recent study of 88 patients with systemic AA amyloidosis [12]. In the largest study evaluating the safety of endomyocardial biopsy in cardiac amyloidosis, 4 complications occurred after 73 procedures, resulting in a complication rate of approximately 5.5% [13], which is similar to that reported for endomyocardial biopsy in general patient cohorts [14].…”

Differential synchrotron X-ray imaging markers based on the renal microvasculature for tubulointerstitial lesions and glomerulopathy

“…To overcome this obstacle hindering earlier diagnosis and more efficient treatment of CKD 4–8 , it is imperative to develop a better understanding of the structure of the renal microvasculature highly correlated with the pathogenesis underlying CKD 9, 10 . However, certain concerns regarding the procedure for diagnosing CKD including: (1) the pathophysiology-based abnormal microvasculature remains to be refined; (2) conventional pathological diagnosis depends mainly on 2D structures, but 3D imaging is recommended to profile the abnormal areas from the pathology perspective, including the fine lesions in the kidney 11, 12 ; and (3) there is a risk of bleeding, infection or other complications in patients after undergoing renal biopsy 13–15 ; need to be addressed.…”

Amyloidosis and the Kidney

“…Diagnosis of renal amyloid is established by biopsy of the kidney [22]. Bleeding is a significant complication of biopsy due to amyloid involvement of the vasculature and abnormalities of hemostasis related to amyloidosis.…”