Simple risk score for prediction of haemorrhagic complications after a percutaneous renal biopsy

Mejía-Vilet, Juan M.; Márquez-Martínez, Manuel A; Córdova-Sánchez, Bertha M; Ibargüengoitia, Mónica Chapa; Correa‐Rotter, Ricardo; Morales‐Buenrostro, Luis E.

doi:10.1111/nep.13055

Cited by 21 publications

(23 citation statements)

References 27 publications

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“…Guided by prior evidence, 1,11,20,[26][27][28][29] we collected data on characteristics that may influence the risk of bleeding including age, platelet count, hemoglobin concentration, kidney size, body mass index (BMI), severity of kidney dysfunction, coagulation status, the type of kidney (native or allograft), comorbidities, number of passes with the biopsy needle, and the indications for biopsy.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Schorr

Roshanov

Weir

et al. 2020

Can J Kidney Health Dis

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Background and Objectives: The risk and timing of bleeding events following ultrasound-guided percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: We performed a retrospective study of 617 consecutive adult patients who underwent kidney biopsy between 2012 and 2017 at a tertiary academic hospital in London, Canada. We assessed frequency and timing of minor (not requiring intervention) and major (requiring blood transfusion, surgery, or embolization) bleeds and developed a personalized risk calculator for these. Results: Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]: 10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI: 8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI: 1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%) and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three of 79 events were identified immediately on post-procedure ultrasound (92.4% of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients (0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not recognized immediately; both required blood transfusions only. There were no deaths or nephrectomies. A risk calculator using age, body mass index, platelet count, hemoglobin concentration, size of the target kidney, and whether the kidney is native, or an allograft predicted minor (C-statistic, 0.70) and major bleeding (C-statistic, 0.83). Conclusions: This retrospective study of 617 patients who had percutaneous ultrasound-guided renal biopsies supports the safety of short post-biopsy monitoring for most patients. A risk calculator can further personalize estimates of complication risk ( http://perioperativerisk.com/kbrc ).

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Section: Patient Characteristicsmentioning

confidence: 99%

Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Schorr

Roshanov

Weir

et al. 2020

Can J Kidney Health Dis

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“…Peri-nephric hematomas in particular are very common, occurring in between 20–86% of cases depending on the timing and modality of the post-biopsy imaging. 35–38 However, while the absence of a hematoma does appear to be associated with a lower risk of major complications, immediate post-biopsy hematomas are not useful in predicting clinically significant bleeding later. 39,40 Arteriovenous fistulae occur in approximately 15% of cases and appear to be more common after allograft biopsies.…”

Section: Safety Of Kidney Biopsies In Akimentioning

confidence: 99%

“…The rates of major complications following percutaneous kidney biopsy range from approximately 2–8% in published series. 38,40,43,44 A large, well done meta-analysis by Corapi et al of studies of post-biopsy bleeding complications identified a number of independent risk factors. These included the use of larger biopsy needles, lower pre-biopsy hemoglobin, higher baseline serum creatinine, and higher pre-biopsy systolic blood pressure.…”

Section: Safety Of Kidney Biopsies In Akimentioning

confidence: 99%

Expanding the Role for Kidney Biopsies in Acute Kidney Injury

Waikar

McMahon

2018

Seminars in Nephrology

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Acute kidney injury (AKI) is a highly heterogeneous, common, and potentially devastating condition associated with markedly increased hospital length of stay, cost, mortality, and morbidity. Expanding the role for kidney biopsies in AKI may offer fresh insights into disease heterogeneity, molecular mechanisms, and therapeutic targets. A number of challenges face investigators and clinicians considering research biopsies in AKI: ensuring patient safety, ensuring the ethical conduct of research studies, and maximizing the scientific yield of the kidney tissue obtained. The societal benefits of research that lead to novel strategies for preventing and treating AKI would be enormous. Rethinking our current approach to the role of kidney biopsy for AKI diagnosis and research may be a major step toward the promise of personalized medicine in nephrology.

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“…has been previously described to be associated with renal hemorrhage. [ 2 , 3 , 7 , 37 , 38 ] The addition of the histologic features associated with a significant risk for major post-biopsy hemorrhage in our study (not previously described), could greatly enhance the sensitivity and specificity of such a risk score. In many centers, PRB is mainly performed as an outpatient procedure with shortening of in-hospital post- procedure surveillance.…”

Section: Discussionmentioning

confidence: 78%

“…formulated a risk score for major bleeding after PRB, which had a good discrimination capacity. [ 37 ] Each of the parameters used by Mejia-Vilet et al . has been previously described to be associated with renal hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the “core” of the Problem? A Retrospective Case–control Study

Nance

Tarim

Nguyen

et al. 2020

JCIS

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Objectives: Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting. Material and Methods: A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated. Results: A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage. Conclusion: There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.

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Simple risk score for prediction of haemorrhagic complications after a percutaneous renal biopsy

Abstract: The risk of major complications after a percutaneous renal biopsy can be assessed by a simple risk score calculated from readily available information.

Cited by 21 publications

References 27 publications

Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Expanding the Role for Kidney Biopsies in Acute Kidney Injury

Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the “core” of the Problem? A Retrospective Case–control Study

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