Abstract
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).
Highlights
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 found bleeding more commonly after biopsies of native kidneys than of allografts (19.4% vs. 8.4%; adjusted odds ratios (ORs): 3.3; 95% CI: 1.9%-5.6%)
The risk of complications could be predicted by a combination of patient age, body mass index (BMI), platelet count, hemoglobin concentration, size of the target kidney, and whether it was a native kidney or an allograft
Summary
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. The risk and timing of bleeding events following ultrasound-guided percutaneous renal biopsy are not clearly defined. 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. 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%). 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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