Complications associated with percutaneous renal biopsy in Spain, 50 years later

Abstract

The renal biopsy is essential for the diagnostic of glomerular disease However, it is an aggressive procedure with risk of complications. The aim of our study was to evaluate the complications directly related to percutaneous renal biopsy procedure in our centre. This retrospective study was performed using the data obtained from all patients who underwent percutaneous renal biopsy of the native kidney from January 1992 to December 2008. A semiautomatic 18 G needle biopsy was used until 2004 and thereafter we used a 16 G needle. From January 2009 to January 2010 we prospectively analyzed changes induced by renal biopsy. We analysed age, sex, indication for biopsy, histopathological diagnosis, hypertension, serum creatinine, GFR-MDRD-4, proteinuria, hemoglobin pre and post biopsy. Minor complications were defined as a decrease in hemoglobin levels greater than 1 g/dL. Mayor complications were: need for blood transfusion, surgery, nephrectomy, angiography, embolization, or death. The renal biopsy was performed by the nephrologist with the help of ultrasound. Anticoagulant therapy was removed prior to the biopsy. Total number of renal biopsies were 867. Seven hundred and ninety five renal biopsies were performed between 1992 and 2008. The prospective part of the study included 70 additional biopsies. Considering all patients, the mean age was 46.8 ± 19 and 60.7% were male. There were only six major complications (0.75%). Three of these mayor complications occurred in liver transplanted patients and required vascular embolization or nephrectomy. The remaining 3 major complications were observed in: one patient with liver disease, another patient had trait of hemophilia and a third patient required nephrectomy which after examination demonstrated epithelioid hemangioma. During the prospective analysis the rate of major and minor complications did not change, 1.4 and 2.0 % respectively. Switching from 18 to 16 G biopsy needle did not result in an increase of major complications. Major complications derived from all renal biopsy during the last 18 years were observed in only 0.75-1.4 %. Major complications occurred mainly in liver transplant patients. The use of 16 G needle provided greater diagnostic yield than the 18 G and it did not cause an increase in complications.