Timing of Complications in Percutaneous Renal Biopsy

Abstract

Abstract. Percutaneous renal biopsy (PRB) is a safe and effective tool in the diagnosis and management of renal disease; however, the optimal timing of observation after biopsy is not clearly established. With the use of real-time ultrasound guidance, PRB of native kidneys was performed in 750 adult patients at an academic institution by an attending nephrologist or fellow between June 1983 and June 2002. All patients were observed for 23 to 24 h after biopsy for the presence, severity, and timing of complications. Biopsy-related complications occurred in 98 (13%) patients; minor complications occurred in 50 (6.6%) patients, and major complications occurred in 48 (6.4%) patients. One (0.1%) patient died as a result of the biopsy. Multivariate analysis using logistic regression found only serum creatinine at baseline predictive of a complication. Patients with a serum creatinine Ն5.0 mg/dl were 2.3 times as likely to have a complication (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.1; P Ͻ 0.005). Complications were identified in 38 (42%) patients by Յ4 h, in 61 (67%) patients by Յ8 h, in 77 (85%) patients by Յ12 h, and in 81 (89%) patients at Յ24 h. The PRB remains a safe procedure, but the risk of complication is higher in patients with advanced renal insufficiency. After biopsy, an observation time of up to 24 h remains optimal as an observation period of Յ8 h risks missing Ն33% of complications.

Kidney Biopsy Patterns in a Brazilian Elderly Population

“…As the demographic profile of the world population is changing, particularly due to an overall life expectancy increase, the diagnosis and management of kidney diseases in the elderly has gained increasing attention [8][9]. It is of note that kidney biopsy is a useful tool in the investigation of nephropathies, but its indication has not been consensual in the elderly.…”

“…Although highly variable in severity, common findings are age-related kidney fibrosis associated with increased collagen accumulation [7][8][9][10] and advanced vascular changes, similar to chronically damaged kidneys [4,7,8]. This is a different spectrum of pathologies as compared with the younger population and requires a careful assessment of risks and benefits of any potential therapeutic intervention.…”

“…Kidney biopsies are increasingly being performed in the elderly and very elderly [7][8][9]. Although highly variable in severity, common findings are age-related kidney fibrosis associated with increased collagen accumulation [7][8][9][10] and advanced vascular changes, similar to chronically damaged kidneys [4,7,8].…”

“…This is a different spectrum of pathologies as compared with the younger population and requires a careful assessment of risks and benefits of any potential therapeutic intervention. Advanced age is no longer considered a contraindication for renal biopsy, renal replacement therapy and consequently the number of diagnostic kidney biopsies performed in the elderly is increasing [1][2][3][4][5][6][7][8][9][10].…”

Predictors of Complication after Percutaneous Ultrasound-Guided Kidney Biopsy in HIV-Infected Individuals

“…Several studies have assessed predictors of bleeding complications of ultrasoundguided biopsy in the general population (4,5), but, to date, the HIV-infected population has not been examined separately. Coagulopathies, thrombocytopenia, and endothelial dysfunction have been reported to exist at a higher frequency in HIVinfected patients (6 -8) and may modify bleeding risk.…”