The outcome of percutaneous renal biopsy in children: an analysis of 120 consecutive cases

Abstract

One hundred and twenty percutaneous renal biopsies performed in 104 patients aged 1 month to 15 years were analysed. Ultrasound examination was used for localization of the kidneys. Adequate renal tissue was obtained in 103 biopsies, with an overall success rate of 85.8%. The most frequent complication was gross haematuria, which occurred in 32 biopsies, but only 5 children required blood transfusion. Nineteen patients developed perirenal haematoma; 2 of these were symptomatic. Arteriovenous fistula was diagnosed in 2 patients. One patient died secondary to intestinal perforation. Serious complications were noted in patients with chronic renal failure. The success and complication rates in 10 patients less than 1 year of age were comparable with the rest of the group. The frequency of serious complications on renal biopsy in the present study was slightly higher than in the more developed countries.

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

“…To our knowledge, the current study is the only nationwide registry-based and largest report of renal biopsy complications, and our findings confirm the general impression of low complication rates and improved safety of modern renal biopsy procedures (19). Similar low complication rates have been reported in recent studies (16,19,20) in contrast to earlier studies (reporting 5%-7% complication rates) (21)(22)(23)(24)(25). The crucial safety evaluation of kidney biopsies is characterized by the overall risk and frequency of major complications, which in our study, are defined as need of blood transfusion and/or surgery or catheterbased intervention (embolization) secondary to bleeding, and they should not be jeopardized by procedural events of minor clinical relevance.…”

“…In fact, the relative risk was 16 times higher when eGFR was below 30 ml/min per 1.73 m 2 (Table 4). Although elevated risk has been shown previously, the increased risk incurred by kidney failure may be underscored in many reports (14,21,33,34), and the work by Whittier and Korbet (25) found that serious complications were about two times as common in patients with serum creatinine above 5.0 mg/dl. It is conceivable that this observation is associated with the general increased bleeding tendency seen in kidney failure patients (33).…”

Renal Biopsy in the Pediatric Patient

“…As noted above, immediate post-biopsy images are also obtained by ultrasound to assess for hematoma formation and to provide a postbiopsy baseline. Others employ routine post-biopsy ultrasound from 24 hours to two weeks following renal biopsy in all patients to detect peri/intra renal hematoma formation with consideration of Doppler studies to assess for arteriovenous fistula formation (Al Rasheed et al, 1990;Kamitsuji et al, 1999;Mahajan et al, 2010), though it is unclear whether this changes clinical care of the stable patient (Castoldi et al, 1994). It is also our practice to observe patients for at least 6 to 8 hours post-procedure and to check a hemoglobin and hematocrit level at 4-6 hours post biopsy and again the next morning as long as there is no concern to warrant repeat laboratory work sooner.…”

“…Death is extremely rare. One early review (Al Rasheed et al, 1990, as cited in White, 1963 reported 17 deaths in more than 10,000 biopsies (0.17%). Similarly, another large review at that time reported a mortality rate of 0.12% in 4000 biopsies (Simckes et al, 2000, as cited in Dodge et al, 1962.…”

“…Given the use of different definitions and thresholds to report complications, it is worth noting, however, that rates of so-called minor and major complications post-biopsy are somewhat difficult to compare between individual centers. For example, one study included microscopic hematuria as a minor complication, a finding almost universally seen in all patients undergoing renal biopsy (Al Rasheed et al, 1990). Some studies include gross hematuria as a major complication, while others only include it if persistent and associated with hemodynamic instability and transfusion requirement.…”