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      Complications and Risks of Percutaneous Renal Biopsy

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          Abstract

          BACKGROUND:

          Renal biopsy performed in native and transplant kidneys is generally considered a safe procedure.

          AIM:

          In this study, we evaluated renal biopsy complications and risk factors in one nephrology facility.

          MATERIAL AND METHODS:

          We conducted a three-year retrospective study on patients who underwent renal biopsy between January 2014 and December 2016. Strict written biopsy protocol was followed. Clinical and laboratory data were obtained from medical charts. Complications were categorised as minor and major, according to the need for intervention. Minor complications included macrohematuria and/or hematoma that did not require intervention. Major complications included hematuria or hematoma with fall of hematocrit that required a blood transfusion, surgery or caused death. A binary logistic regression model was used to analyse the possible factors associated with complications after the biopsy.

          RESULTS:

          We analysed 345 biopsies; samples were taken from patients aged from 15-81 years, of whom 61% were men. A total of 21 (6%) patients developed a complication, 4.4% minor and 1.7% major complications. There were no nephrectomy or death due to biopsy intervention. Overweight patients, as well as those with higher creatinine, lower hemoglobin, higher blood pressure and biopsy due to AKI had higher chances to develop complications (p = 0.037, p = 0.023, p = 0.032, p = 0.002, p = 0.002, respectively). The patients’ age, gender, kidney dimension, number of passes and uninterrupted aspirin therapy were not found as significant predictors of complications. In the multivariate logistic model, body weight (OR = 1.031, 95%CI = 1.002-1.062), lower hemoglobin (OR = 0.973, 95%CI = 0.951–0.996) and hypertension (OR = 1.025, 95%CI = 1.007-1.044) increased the risk of complications in biopsied patients.

          CONCLUSION:

          Renal biopsy is a safe procedure with a low risk of complications when strict biopsy protocol is observed. Correction of anaemia and blood pressure is to be considered before the biopsy.

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          Most cited references19

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

          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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            The Native Kidney Biopsy: Update and Evidence for Best Practice.

            The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training. These data are presented to develop best practice strategies for this essential procedure.
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              Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010.

              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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                Author and article information

                Journal
                Open Access Maced J Med Sci
                Open Access Maced J Med Sci
                Open Access Macedonian Journal of Medical Sciences
                Republic of Macedonia (ID Design 2012/DOOEL Skopje )
                1857-9655
                30 March 2019
                29 March 2019
                : 7
                : 6
                : 992-995
                Affiliations
                [1]University Clinic of Nephrology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
                Author notes
                [* ] Correspondence: Aleksandar Sikole. University Clinic of Nephrology, Faculty of Medicine, University Ss Cyril and Methodius of Skopje, Skopje, Republic of Macedonia. E-mail: asikole@ 123456hotmail.com
                Article
                OAMJMS-7-992
                10.3889/oamjms.2019.226
                6454172
                30976347
                58a8b8d7-9318-4270-80ec-78d18f32cd9e
                Copyright: © 2019 Lada Trajceska, Galina Severova Andreevska, Pavlina Dzekova Vidimliski, Igor Nikolov, Gjulsen Selim, Goce Spasovski, Irena Rambabova Busletik, Vesna Ristovska, Ladislava Grcevska, Aleksandar Sikole

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                : 12 February 2019
                : 18 March 2019
                : 19 March 2019
                Categories
                Clinical Science

                renal biopsy,complications,hematoma,hematuria,predictors
                renal biopsy, complications, hematoma, hematuria, predictors

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