A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

Kajawo, Shepherd; Ekrikpo, Udeme; Moloi, Mothusi Walter; Noubiap, Jean Jacques; Osman, Mohamed A.; Okpechi-Samuel, Ugochi S; Kengne, André Pascal; Bello, Aminu K.; Okpechi, Ikechi G.

doi:10.1016/j.ekir.2020.10.019

Cited by 12 publications

(12 citation statements)

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“…Within the middle-income subgroups in the present review, the rate of gross hematuria was reported to be 6.4%, higher than the gross hematuria rate of 1.5% reported in a previous meta-analysis of adult native kidney biopsies in middle and low-income countries. 13 However, rates of blood transfusion (0.2% versus 0.24%), major complications (0.5% versus 1.6%), and radiological interventions (0.2% versus 0.2%) were comparable. A total of 14 studies with 1515 kidney allograft biopsies were included in the present review compared with 29 studies with almost 17 000 native kidney biopsies in the same timeframe, possibly reflecting a relative lack of experience for kidney allograft biopsies in low- to middle-income countries, which may be responsible for higher risk of gross hematuria in allograft biopsy.…”

Section: Discussionmentioning

confidence: 86%

“…A recent systematic review on native kidney biopsies in low-and middle-income countries also suggested that major complications were associated with lower income status. 13 The present review, to the best of our knowledge, is the first systematic review examining the outcomes of transplant kidney biopsies in both adult and pediatric populations. The review also examined several factors (age, reasons for biopsy, center biopsy volume, type of proceduralists, and income status) on the outcomes of biopsy.…”

Section: Discussionmentioning

confidence: 97%

“…A recent systematic review on native kidney biopsies in low- and middle-income countries also suggested that major complications were associated with lower income status. 13…”

Section: Discussionmentioning

confidence: 99%

“…Although there are meta-analyses on the bleeding complications of native kidney biopsies, 11-13 these findings may not be applicable to transplanted kidneys since the risks of biopsy-related complications for transplanted kidneys have been reported to be significantly lower than that of native kidneys. 3,14,15 A meta-analysis that included studies of both native and transplanted kidneys was limited to only studies of the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

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Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Lim

Tan

et al. 2022

Transplantation

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Background. Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. Methods. This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). Results. The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. Conclusions. The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 97%

“…A recent systematic review on native kidney biopsies in low- and middle-income countries also suggested that major complications were associated with lower income status. 13…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Lim

Tan

et al. 2022

Transplantation

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“…Percutaneous kidney biopsy is an essential procedure for confirming a pathological diagnosis in some types of acute and chronic kidney diseases [1,2], but several complications have been linked to this procedure, including gross hematuria, hematoma, transfusion, intervention, nephrectomy, bladder obstruction, and even death [3][4][5]. Nowadays, for safety reasons, real-time ultrasound-guided percutaneous kidney biopsy is most commonly performed as evidence shows that this procedure is associated with fewer complications than the traditional biopsy method without ultrasound [6]. In some cases, however, adverse events related to kidney biopsy are still reported [5,7].…”

Section: Introductionmentioning

confidence: 99%

Intravenous Tranexamic Acid in Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Izawa

Matsuzaki

Raita

et al. 2022

Nephron

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Background: Tranexamic acid is frequently reported to reduce bleeding-related complications in major surgery and trauma. We aimed to investigate whether tranexamic acid reduced hematoma size after percutaneous kidney biopsy. Methods: We conducted a double-blind, parallel three-group, randomized placebo-controlled trial at a teaching hospital in Japan between January 2016 and July 2018. Adult patients with clinical indication for ultrasound-guided percutaneous biopsy of a native kidney were included. Participants were randomly assigned into three groups: high-dose tranexamic acid (1,000 mg in total), low-dose tranexamic acid (500 mg in total), or placebo (counterpart saline). Intervention drugs were intravenously administered twice, as a bolus just before the biopsy and as a continuous infusion initiated just after the biopsy. Primary outcome was post-biopsy perirenal hematoma size as measured by ultrasound on the morning after the biopsy. Results: We assessed 90 adult patients for study eligibility, of whom 56 were randomly allocated into the three groups: 20 for high-dose tranexamic acid, 19 for low-dose tranexamic acid, and 17 for placebo. The median size of perirenal hematoma was 200 mm2 (interquartile range, 21–650) in the high-dose tranexamic acid group, 52 mm2 (0–139) in the low-dose tranexamic acid group, and 0 mm2 (0–339) in the placebo group (p = 0.048 for high-dose tranexamic acid vs. placebo). Conclusion: In this trial, the median size of post-kidney biopsy hematoma was unexpectedly larger in the high-dose tranexamic acid group than in the placebo group. Although our results do not support the routine use of tranexamic acid in percutaneous kidney biopsy at present, further studies are needed to confirm the results.

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Sonological predictors of complications of percutaneous renal biopsy—a prospective observational study

Bhattacharya,

Nagaraju,

Prabhu

et al. 2024

Ir J Med Sci

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Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters—kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications. Methods This was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted. Results Out of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis. Conclusion The incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.

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A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

Cited by 12 publications

References 46 publications

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Intravenous Tranexamic Acid in Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Sonological predictors of complications of percutaneous renal biopsy—a prospective observational study

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