Injecting hemostatic matrix in the path of biopsies: efficacy, potential complications, and the management of such complications

Rahal, Antônio; Falsarella, Priscila Mina; Ferreira, Vinicius Tadeu Rodrigues; Mariotti, Guilherme Cayres; Queiroz, Marcos Roberto Gomes de; Garcia, Rodrigo Gobbo

doi:10.1590/0100-3984.2017.0011

Cited by 7 publications

(3 citation statements)

References 13 publications

(18 reference statements)

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“…Other alternatives such as conjugated oestrogens and recombinant human epoietin take between several hours to days to improve platelet function and are thus impractical for use as a prophylactic agent before kidney biopsies 5 . Injection of haemostatic gelatin matrix in the path of the percutaneous kidney biopsy and transjugular biopsies have been proposed for individuals at high bleeding risk, 31,32 but these techniques require specialised skills and lack strong evidence to recommend them. It may be that the absence of good alternatives to prevent post‐biopsy bleeding in at‐risk uraemic individuals prompted the proposed KHA‐CARI guideline to suggest that nephrologists should continue their existing practices, but to be wary of excessive fluid intake should DDAVP be used 12…”

Section: Discussionmentioning

confidence: 99%

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Lim

Tan

et al. 2021

Internal Medicine Journal

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Background Kidney biopsy is the gold standard for diagnosing kidney disease but may result in bleeding, especially in uraemia. DDAVP (1‐deamino‐8‐d‐arginine vasopressin) may reduce uraemic bleeding but guidelines on its use are lacking. Aim To evaluate whether DDAVP reduced bleeding complications after percutaneous kidney biopsies. Methods We searched CENTRAL, PubMed, Embase, LILACS, WHO Trials Registry and http://clinicaltrials.gov until May 2019 for randomised controlled trials (RCT), quasi‐RCT and prospective cohort studies that compared DDAVP with placebo or no intervention, prior to native or allograft kidney biopsy. The primary outcome was post‐biopsy bleeding. Secondary outcome was adverse events related to DDAVP. Results Abstracts of 270 identified papers were examined and 24 selected for evaluation. Two studies, one RCT and one prospective cohort that collectively evaluated 738 native kidney biopsies, met the inclusion criteria. One enrolled individuals with serum creatinine ≤1.5 mg/dL (132 μmol/L) and/or estimated glomerular filtration rate ≥60 mL/min/1.73 m2 while the other evaluated biopsies with serum creatinine >150 μmol/L. DDAVP was administered as a single subcutaneous dose of 0.3 μg/kg in both studies. Data were not pooled for meta‐analysis due to clinical heterogeneity. GRADE quality of evidence from these two studies was low for DDAVP preventing any bleeding complication after native kidney biopsy. Low quality evidence suggested that adverse effects were not increased in DDAVP therapy. No prospective studies evaluated DDAVP in transplant kidney biopsies. Conclusion Currently available prospective data are insufficient to support the routine use of DDAVP prior to percutaneous kidney biopsies hence high quality trials are required.

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Section: Discussionmentioning

confidence: 99%

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Lim

Tan

et al. 2021

Internal Medicine Journal

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“…Although angiographic techniques are highly effective, non‐angiographic techniques are also effective, and offer a potentially less invasive alternative for preventing hemorrhage‐related morbidity associated with renal or liver biopsy 25 . For example, introduction of hemostatic matrix, such as gelatin matrix, via coaxial needles used for percutaneous kidney and liver biopsies has been reported to be an effective measure to prevent hemorrhage 26 . It has been demonstrated that percutaneous “plugging” of biopsy tracks with PVA foam may help prevent post liver biopsy hemorrhage 27 .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies

Hoegger

Middleton

2021

J of Ultrasound Medicine

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The purpose of this study was to describe the technique and outcomes of percutaneous thrombin injection into the superficial aspect of actively bleeding liver and kidney biopsy tracks identified with color Doppler ultrasound with the aim of hemorrhage termination. After percutaneous thrombin injection, 15/16 (94%) patients did not require further intervention. Ultrasound‐guided thrombin injection into the superficial site of active bleeding is an effective technique for terminating bleeding in the immediate post‐procedure period following kidney and liver biopsies and should be considered if active bleeding persists on color Doppler after ≥30 minutes of compression and observation.

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“…Due to concerns of hyponatremia [10], further trials are suggested prior to routine usage [11]. In addition, injecting hemostatic matrix in the path of renal biopsies has been used to treat bleeding [12] and to prevent post biopsy bleeding [13].…”

Section: Discussionmentioning

confidence: 99%

An unusual case of delayed and recurrent bleeding after renal biopsy in a patient with malignant hypertension

Teng¹,

Wong²,

Leo³

et al. 2021

J Clin Images Med Case Rep

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We report a 35-year-old Asian man who presented with symptomatic malignant hypertension with complications of acute kidney injury, thrombocytopenia and microangiopathic haemolytic anemia. A renal biopsy done led to recurrent bleeding needing repeated embolization. We highlight the importance of continued monitoring for post biopsy bleeding even weeks after the biopsy for high-risk cases and discuss the aspects of prevention of severe post biopsy bleeding. Keywords: Renal biopsy; Malignant hypertension; Embolization; Desmopressin.

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Injecting hemostatic matrix in the path of biopsies: efficacy, potential complications, and the management of such complications

Cited by 7 publications

References 13 publications

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Ultrasound‐Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies

An unusual case of delayed and recurrent bleeding after renal biopsy in a patient with malignant hypertension

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