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

Abstract

Background Percutaneous kidney biopsies are important tools for the diagnosis of kidney diseases. Nephrologists must be familiar with the expected complications of the procedure to provide an adequate informed consent. Here, we present a quality improvement analysis that reviews the complication rate of percutaneous kidney biopsies performed over a 2-year period by nephrologists at a single center, and that tabulates the nature and timing of these events. Methods From a single center cohort, pre- and post-biopsy anthropomorphic and clinical measurements were collected. Post-biopsy complications were tracked and sorted into either major or minor complications. Statistical tests were used to analyze complication incidence across the pre- and post-biopsy measurements obtained. Results Of the 154 nephrologist-performed percutaneous native kidney biopsies, 2 biopsies (1.3%) were found to result in a major complication. Both major complications were detected within 4 hours of the biopsy. Analysis of the pre-biopsy and post-biopsy measurements found that the proportion of complications was higher in patients with hematuria prior to biopsy. It was also found that patients with complications were statistically younger and had fewer comorbidities. Under univariable analysis, older age was associated with a lower incidence rate ratio for complications. However, no pre-or-post biopsy measurement or characteristic had a statistically significant change in incidence rate ratio under multivariable analysis. Conclusions Percutaneous kidney biopsies were found to be low risk when performed by nephrologists in this single center cohort. Consistent with past literature, life threatening major complications rarely occurred and were reliably identified within 4 hours of biopsy, suggesting that centers can consider reduced observation times without compromising patient safety. Minor complications, such as pain, were more likely to occur in younger, healthier patients, and in those with hematuria prior to biopsy. This extensive tabulation of all biopsy adverse events is the first of its kind and will be beneficial for nephrologists to inform discussions with patients about expectations and risk-benefit of this procedure.

Participant Experience with Protocol Research Kidney Biopsies in the Kidney Precision Medicine Project

“…15 Recognizing the possibility of pain and anxiety with a kidney biopsy is an important part of participant education and preparation for the KPMP study procedure. 13 Comfort measures and support are provided according to the study site's standards of care. Interestingly, playing music during moments of distress with comparably uncomfortable procedures, for example, shock wave lithotripsy for kidney stones or hemodialysis, may provide relief and improve the overall experience.…”

“…Other studies have reported similar findings after clinically performed kidney biopsies. 13,14 However, surveys are not standardized pain assessments. Nevertheless, our survey data provide reassurance that kidney biopsies are generally well tolerated in KPMP.…”

“…15 In a study by Montes et al , pain assessed by a visual analog scale after clinical kidney biopsies was given a mean rating by patients of 3.1/10 at rest and 4.0/10 with activity. 13 According to a systematic review performed by Poggio et al , pain at the site of a kidney biopsy occurred in 4.3% of patients. 15 Recognizing the possibility of pain and anxiety with a kidney biopsy is an important part of participant education and preparation for the KPMP study procedure.…”

Transjuguläre Nierenbiopsie

“…In einer Studie mit 750 Patienten nach einer PNB wurden 2 Drittel der relevanten Komplikationen innerhalb von 8 Stunden bzw. 1,3 % (n = 2) der Komplikationen bei 154 Biopsien nach 4 Stunden detektiert 21 , 22 .…”