Measuring hemoglobin prior to early discharge without routine surveillance ultrasound after percutaneous native renal biopsy in children

Muthusami, Prakash; Sunder, Sunit; Gallibois, Claire; Kitamura, Evan; Parra, Dimitri A.; Amaral, João; John, Phillip; Noone, Damien; Connolly, Bairbre

doi:10.1007/s00467-017-3680-x

Cited by 5 publications

(10 citation statements)

References 31 publications

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“…Many biopsies are now performed on outpatients with discharge home on the day of the procedure. [8][9][10] The reported frequency and timing of complications associated with renal biopsy is variable and the appropriate duration of postprocedure monitoring remains controversial, 8,[10][11][12][13][14][15][16][17][18] with some suggesting that patients must be monitored for 24 hours to avoid missing serious complications. [19][20][21][22][23][24] We set out to (1) assess the type, frequency, and timing of kidney biopsy-related bleeding events at our center; (2) assess risk factors for complications and develop a calculator for estimating individual patient risk of bleeding; and (3) determine the optimal post-biopsy monitoring time for outpatient procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Many biopsies are now performed on outpatients with discharge home on the day of the procedure. 8-10 The reported frequency and timing of complications associated with renal biopsy is variable and the appropriate duration of post-procedure monitoring remains controversial, 8,10-18 with some suggesting that patients must be monitored for 24 hours to avoid missing serious complications. 19-24…”

Section: Introductionmentioning

confidence: 99%

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

Schorr

Roshanov

Weir

et al. 2020

Can J Kidney Health Dis

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Background and Objectives: The risk and timing of bleeding events following ultrasound-guided percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: 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. Results: 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). Conclusions: 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 ).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Schorr

Roshanov

Weir

et al. 2020

Can J Kidney Health Dis

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“…However, no association between hematoma as a complication and type of anesthesia (local vs. general) was found. In our care pathway, the resting time for children older than 12 years is 2 days while for children younger than 12 years it is 3 days, but as mentioned above, even 2 days is longer than the resting period in previous reports 4,24,27 . There was a high incidence of hematoma in older children but it is unclear whether the shorter resting time was directly related to this phenomenon.…”

Section: Discussionmentioning

confidence: 72%

“…Moreover, this study found no serious complications requiring an intervention, such as a blood transfusion, angiography with embolization, or a nephrectomy. The lower complication rate was likely due to the patients’ compliance with our instructions to take bed rest; the kidney biopsies were performed only during hospitalization, allowing a longer period of bed rest than in previous studies 4,24,25 . A light weight was also placed on the puncture site to suppress bleeding.…”

Section: Discussionmentioning

confidence: 99%

Predictors of hematoma as a complication in pediatric kidney biopsies

Nagata

Tamura

Hidaka

et al. 2022

Pediatrics International

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Background Kidney biopsies are crucial in the diagnosis of kidney diseases but they carry the risk of various complications, most commonly hematoma. Here we tried to identify the predictors of hematomas as a complication of kidney biopsies and we constructed an algorithm to stratify the risk. Methods The present report retrospectively reviewed 118 pediatric percutaneous kidney biopsies of native kidneys in 102 children (59 females) with the median age of 9 years (range: 1–19 years) at Kumamoto University Hospital between August 2008 and October 2019. We defined hematoma size using the hematoma index: the short axis of the hematoma/major axis of the kidney on ultrasonography. The inclusion criteria for a hematoma as a complication of a kidney biopsy were hematoma index ≥0.1 and the presence of concomitant, post‐kidney biopsy fever or flank pain. Results Eight patients presented with a hematoma as a complication. All had hematoma index ≥0.1 and age ≥6 years. On univariate logistic analysis, these patients had a larger hemoglobin (Hgb) decrease on post‐biopsy day 1, which was unrelated to a Hgb decrease 2 h after the biopsy, than the patients with no hematoma. All eight patients with a hematoma presented with a fever or flank pain on post‐biopsy days 5 to 7, underscoring the need to observe patients with decreased Hgb carefully for about 1 week after a biopsy. Conclusion Predictors of hematoma as a complication in children after a kidney biopsy were hematoma index ≥0.1, age >6 years, and Hgb decrease ≥15% on post‐biopsy day 1.

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“…However, cardiac probe can fit the skin better than the abdominal probe and the superficial probe due to its small size, and by adjusting appropriate parameters, it can also clearly display the anatomical structures such as the grafted kidney blood vessels, which is theoretically more suitable for guiding puncture. The normal renal inferior pole is routinely punctured, 4,5 but due to the special position of the transplanted kidney, the renal inferior pole is closer to the iliac vessels, which increased risk of bleeding from puncture of the inferior pole. The purpose of this paper is to investigate the application value and safety of cardiac probe-guided core needle biopsy through the upper pole of the transplanted kidney by comparing the use of ultrasound cardiac, abdominal and superficial probes to guide needle biopsy through the upper pole of the transplanted kidney in 540 patients after kidney transplantation.…”

mentioning

confidence: 99%

Application value of biopsy through the upper pole of transplanted kidney under the guidance of ultrasound cardiac probe

Tang

et al. 2022

Int J Artif Organs

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Objective: To investigate the value of needle biopsy of the upper pole of the transplanted kidney guided by the ultrasound cardiac probe. Methods: The success rates of biopsy at the upper pole of the transplanted kidney under the guidance of cardiac, abdominal and superficial probes were compared in 540 patients with impaired renal function after renal transplantation. The guidance was completed by an experienced sonographer and the puncture success rate was calculated. Pathologists make the diagnosis and count the success rate of diagnosis and the incidence of complications. Results: The success rates of puncture of the transplanted kidney under the guidance of the cardiac, abdomen and superficial probe were 100%, 85%,and 73%, respectively, the success rates of pathological diagnosis were 92.68%, 88.9%,and 80.7%, and the incidence of hematoma was 23.2%, 25.3%, respectively, 21.9%, and the pathological diagnosis was mainly acute and chronic rejection. Conclusion: The cardiac probe can clearly guide the puncture through the upper pole of the transplanted kidney, with high guidance success rate and good pathological tissue satisfaction and fewer complications. It is an effective guidance method after renal transplantation.

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Measuring hemoglobin prior to early discharge without routine surveillance ultrasound after percutaneous native renal biopsy in children

Abstract: Bleeding complications from US-guided native kidney biopsies in pediatric outpatients can be safely followed by a complete blood count at 6 h post procedure. A 10% hb decrease is strongly associated with requirement for further testing and/or admission.

Cited by 5 publications

References 31 publications

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

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

Predictors of hematoma as a complication in pediatric kidney biopsies

Application value of biopsy through the upper pole of transplanted kidney under the guidance of ultrasound cardiac probe

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