Percutaneous Renal Biopsy of the Solitary Kidney: A Contraindication?

Abstract

We recently were presented with a patient from the nephrology service, with the request to perform open renal biopsy because of a solitary functioning kidney. We performed the open biopsy and the patient subsequently had a wound infection, leading us to question the recommendation in the literature stating that a solitary kidney is an absolute contraindication for percutaneous renal biopsy. In a review of the literature from 1951 to 1990, a total of 19,459 percutaneous renal biopsies has been reported with an overall complication rate of 2.1 to 10.8%, the majority (90%) of which did not require definitive treatment. Only 13 nephrectomies (0.06%) were required secondary to complications. The overall mortality rate was 0.08%. We reviewed 157 percutaneous renal biopsies done at this institution from 1985 to 1990 with a minor complication rate of only 5% and no major complications or loss of kidney function. The mortality rate was 0. Based on our study and a review of the literature, both showing an extremely small percentage of permanent loss of kidney function or mortality, we propose that a solitary kidney no longer be recommended as an absolute contraindication to percutaneous renal biopsy.

Percutaneous Renal Biopsy of Native Kidneys: A Single-Center Experience of 1,055 Biopsies

“…The need for more invasive intervention such as angiography with embolization is much less common but still occurs in up to 0.8% of biopsies even in recent reports [4,7,12,21,23]. While life-threatening complications resulting in death or nephrectomy are extremely rare and have not been observed in a number of recent reports [13,14,15,16,17,18,19,21,23], they still occur, with a reported risk of death of 0.02-0.08% and a risk of nephrectomy of 0.01-0.06% [3,4,5,7,12,22,23,48]. The overall complication rate and need for intervention observed in our current study are consistent with previous reports.…”

The Early Natural History of Nephropathy in Type 1 Diabetes

“…Confirmation that important renal structural changes are not present should give assurance to diabetic patients and their families; such findings are expected in at least 65% of cases, and this is similar to the service provided to patients with persistent microscopic hematuria (22,23). Finally, given current technologies of ultrasound renal localization and biopsy guidance (24,25), and given that only experienced nephrologists would perform the biopsies, the anticipated complication rate is low.…”

Pediatric biopsy of a single native kidney

“…The most common side effect of a kidney biopsy is hemorrhage, but this usually resolves by itself [1][2][3]. Permanent kidney damage due to a biopsy is uncommon [4][5][6][7].…”