Risk Factors Associated with Major Complications after Ultrasound-Guided Percutaneous Renal Biopsy of Native Kidneys

Abstract

Introduction: Percutaneous renal biopsy (PRB) of native kidneys is an important tool for diagnosis and management of renal disease. In this study, we analyzed the success, safety, and risk complications of PRB in our center. Methods: A retrospective review of ultrasound-guided PRB done at our institution from January 1998 to December 2017 was performed. Clinical and laboratory data were collected for 661 PRBs. Statistical analysis was performed using the Mann-Whitney U test for continuous variable and chi-square test for categorical variables. Multivariate analysis using logistic regression was performed to assess factors associated with increased risk of complications after PRB. Results: The median age was 56 (42–68) years old, the majority were male (64%) and white (82%). Ten glomeruli were present in 63.5% of PRBs. Overall, the rate of complications was 16.6%, where 15.1% of them were minor complications and 1.5% were major complications. Perinephritic hematoma accounted for the minor complication that occurred most frequently, whereas the need of a blood transfusion was the prevalent for major complications. By multivariate analysis, increased activated partial thromboplastin time (aPTT; OR 1.11, 95% CI 1.035–1.180) and prebiopsy lower hemoglobin (Hgb; OR 1.61, 95% CI 1.086–2.304) were identified as independent risk factors for major complications. In addition, older patients (OR 1.057, 95% CI 1.001–1.117) were identified as an independent risk factor for blood transfusion requirement. Conclusion: The current risk of complications after native PRB is low. Major complications are most common in case of increased aPTT and decreased Hgb baseline level.

Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: The Con View

“…A retrospective review of ultrasound-guided kidney biopsy done from January 1998 to December 2017 found an overall rate of complications of 16.6% of which 1.5% were major. [23] In addition, a review of all adult patients enrolled in the Boston Kidney Biopsy Cohort reported that major bleeding events occurred in 28 of 644 (4.3%) patients (28 required transfusion, 4 underwent angiographic intervention, and 1 had open surgery to control bleeding). We note that there were higher complication rates when biopsies were performed in an urgent setting .…”

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

“…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 .…”

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

“…One study from Nigeria reported 100% minor complication as a result of pain, 29 otherwise, the rate of minor complications in this study is similar to other studies. 59 Our study has some limitations. Some studies did not report some important data on complications.…”

“…The complication rates in our study is similar to that reported from a study in Spain that documented complications from PNKB using only ultrasound guidance and automated needles and showing overall complication to be 16.6% with major and minor complications in 1.5% and 15.1%, respectively. 59 In one of the studies we included, even though rate of complications was not significantly different between ultrasound guided and blind procedures, ultrasound guided procedures had better tissue yield than blind procedures. 16 Other studies from developed countries that have used automated needles only and imaging guidance have also reported similar or even higher rates of complications.…”