Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Abstract

<jats:sec><jats:title>Background and Objectives:</jats:title><jats:p> The risk and timing of bleeding events following ultrasound-guided percutaneous renal biopsy are not clearly defined. </jats:p></jats:sec><jats:sec><jats:title>Design setting, participants, and measurements:</jats:title><jats:p> We performed a retrospective study of 617 consecutive adult patients who underwent kidney biopsy between 2012 and 2017 at a tertiary academic hospital in London, Canada. We assessed frequency and timing of minor (not requiring intervention) and major (requiring blood transfusion, surgery, or embolization) bleeds and developed a personalized risk calculator for these. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]: 10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI: 8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI: 1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%) and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three of 79 events were identified immediately on post-procedure ultrasound (92.4% of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients (0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not recognized immediately; both required blood transfusions only. There were no deaths or nephrectomies. A risk calculator using age, body mass index, platelet count, hemoglobin concentration, size of the target kidney, and whether the kidney is native, or an allograft predicted minor (C-statistic, 0.70) and major bleeding (C-statistic, 0.83). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> This retrospective study of 617 patients who had percutaneous ultrasound-guided renal biopsies supports the safety of short post-biopsy monitoring for most patients. A risk calculator can further personalize estimates of complication risk ( http://perioperativerisk.com/kbrc ). </jats:p></jats:sec>

Evaluation of percutaneous renal biopsy complications based on outcomes and indicators of the Nursing Outcomes Classification

“…Biopsies were performed on both native kidneys and kidney grafts, which did not interfere with the occurrence of complications, since all the patients remained well, without complications. Differently from the present study, the literature on rates of complications after PRB points out that those performed in native kidneys are higher compared to allografts, because the latter are easier to access, in addition to allowing easier compression of the site, in bleeding cases 18 , 22 .…”

“…Regarding the characteristics of the patients, the study sample consisted, predominantly, by those with chronic diseases with chronic diseases, with half of the sample being kidney transplanted, which is corroborated by the literature 18 , 21 - 22 .…”

“…In addition to nursing care and monitoring of potential biopsy complications, it is relevant to note that the technique used in performing the procedure, as well as the prediction of risk factors, are aspects that also minimize the chances of the patient presenting complications 2 - 3 , 22 , 25 . According to the literature, the advancement of technology with the use of automatic devices and of smaller gauge needles, as well as the use of real-time ultrasound to perform the puncture, greatly reduced the complications of biopsy 2 , 19 , 26 - 28 .…”

What happens after the kidney biopsy? The findings nephrologists should know

“…Timing of complications is also variable, and this has led to controversy regarding the optimal length of post-procedure monitoring. Some studies advocate for observation periods up to 24 hours while others suggest that shorter observation times are sufficient to catch major complications [ 8 , 10 – 12 ]. Many of these published reports include biopsies performed by other specialists such as urologists and radiologists.…”

Experience and results after the implementation of a radiology day unit in a reference hospital

“…Many of these procedures have low complication rates, which would allow for the post-procedure monitoring to be performed within the Radiology Service itself, given an adequate selection of patients, techniques [ 2 – 6 ] and trained staff. This will permit the early detection and treatment of these potential complications.…”