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      Risk Factors and Timing of Native Kidney Biopsy Complications

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          Abstract

          Background

          The appropriate observation period, rate and risk factors of complications after a percutaneous renal biopsy remain debated.

          Methods

          We retrospectively studied native kidney biopsies performed in our institution between January 2007 and July 2011. Outpatients had either an 8- (67%) or a 24-hour (33%) observation period.

          Results

          312 biopsies were reviewed (287 patients), 51% of patients were female and the mean age was 54 ± 15 years. Half of these biopsies were performed in outpatients. A total of 15% of patients developed a symptomatic hematoma, 9% received a red blood cell transfusion and 1% required an angio-intervention. Eighty-four percent of the complications manifested within the first 8 h, 86% at 12 h and 94% at 24 h. Outpatients experienced significantly less complications, all manifesting within the first 8 h, 14% required an observation period longer than planned. The risk of symptomatic hematoma increased to 11, 20, 35 and 40% in patients with >200, 140-200, 100-140 and <100 × 10 9/l platelets, respectively (p = 0.002). It also increased in hemodialysis patients (29% compared to 14%, p = 0.02). We found no association of risk with the number of biopsy passes and only a trend with needle size.

          Conclusion

          Symptomatic hematomas occurred in 15% of kidney biopsies and were strongly associated with platelet count and hemodialysis. Outpatients experienced fewer complications; therefore, we can conclude that same-day discharge in selected patients is safe.

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          Most cited references25

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          Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

          Ann E. Gordon, Ethan Balk, L. Chen … (2012)
          Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. Meta-analysis of randomized controlled trials and prospective or retrospective observational studies. Adults undergoing native kidney biopsy in an inpatient or outpatient setting. MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more. Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance. Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes. 34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant. Publication bias, few randomized controlled trials, and missing data. Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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            Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010.

            Leif Bostad, Camilla Tøndel, Einar Svarstad … (2012)
            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. 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. 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 m(2), 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 m(2) [OR=4.90 (1.60-14.00)] and estimated GFR<30 ml/min per 1.73 m(2) [OR 15.50 (5.60-43.00)]). 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.
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              Timing of complications in percutaneous renal biopsy.

              William L. Whittier, Stephen M. Korbet (2004)
              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 > or = 5.0 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 or = 33% of complications.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nephron Extra
                Journal ID (iso-abbrev): Nephron Extra
                Journal ID (publisher-id): NNE
                Title: Nephron Extra
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                ISSN (Print): 1664-5529
                ISSN (Electronic): 1664-5529
                Publication date Collection: Jan-Apr 2014
                Publication date (Electronic): 22 March 2014
                Publication date PMC-release: 22 March 2014
                Volume: 4
                Issue: 1
                Pages: 42-49
                Affiliations
                [1] aDivision of Nephrology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada
                [2] bDivision of Radiology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada
                [3] cDivision of Nephrology Division, Hôpital du Sacré-Cœur de Montréal, Montreal, Que., Canada
                Author notes
                *Soumeya Brachemi, MD, FRCP, Service de Néphrologie, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montreal, QC H2X 3J4 (Canada), E-Mail soumeya.brachemi.chum@ 123456ssss.gouv.qc.ca
                Article
                Publisher ID: nne-0004-0042
                DOI: 10.1159/000360087
                PMC ID: 4000304
                PubMed ID: 24803920
                SO-VID: 4068cd82-ec42-4f44-90e0-2653150c8ebe
                Copyright © Copyright © 2014 by S. Karger AG, Basel
                License:

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                History
                Page count
                Figures: 3, Tables: 4, References: 23, Pages: 8
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Nephrology
                Keywords: kidney biopsy,timing of complications,hematoma,risk factors

                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: kidney biopsy, timing of complications, hematoma, risk factors


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