Manual compression and reflex syncope in native renal biopsy

Yoichi Takeuchi,Yoshie Ojima,Saeko Kagaya,Tasuku Nagasawa,Satoshi Aoki

doi:10.1007/s10157-018-1560-8

Abstract

BackgroundComplications associated with diagnostic native percutaneous renal biopsy (PRB) must be minimized. While life threatening major complications has been extensively investigated, there is little discussion regarding minor bleeding complications, such as a transient hypotension, which directly affect patients’ quality of life. There is also little evidence supporting the need for conventional manual compression following PRB. Therefore, this study evaluated the relationship between minor and major complications incidence in patients following PRB with or without compression.MethodsThis single-center, retrospective study included 456 patients (compression group: n = 71; observation group: n = 385). The compression group completed 15 min of manual compression and 4 h of subsequent strict bed rest with abdominal bandage. The observation group completed 2 h of strict bed rest only. The primary outcome of interest was transient symptomatic hypotension (minor event).ResultsOf the 456 patients, 26 patients encountered intraoperative and postoperative transient hypotension, which were considered reflex syncope without tachycardia. Univariate analysis showed that symptomatic transient hypotension was significantly associated with compression. This association remained significant, even after adjustment of covariates using multivariate logistic regression analysis (adjusted odds ratio 3.27; 95% confidential interval 1.36–7.82; P = 0.0078).ConclusionManual compression and abdominal bandage significantly increased the frequency of reflex syncope during native PRB. It is necessary to consider the potential benefit and risk of compression maneuvers for each patient undergoing this procedure.

Highlights

Ultrasound-guided renal biopsy is a very useful tool for the diagnosis of kidney diseases
Major complications associated with native percutaneous renal biopsy (PRB) are often defined as those resulting in the need for interventions, such as blood transfusion and radiological or surgical intervention [1]
Among the minor complications in this study (16.7%, 76/456 patients), there was no difference in the incidence of gross hematuria after PRB between groups; transient hypotension or syncope was significantly greater in the compression group than in the observation group

Summary

Introduction

Ultrasound-guided renal biopsy is a very useful tool for the diagnosis of kidney diseases. Major complications associated with native percutaneous renal biopsy (PRB) are often defined as those resulting in the need for interventions, such as blood transfusion and radiological or surgical intervention [1]. In this regard, many clinicians have examined the preoperative risks of major bleeding. In spite of the fact that the potential risk of complications should be assessed for every step of the PRB procedure, there is little evidence on the usefulness of manual compression for PRB, and the compression technique is different at each facility. Univariate analysis showed that symptomatic transient hypotension was significantly associated with compression. Conclusion Manual compression and abdominal bandage significantly increased the frequency of reflex syncope during native PRB. It is necessary to consider the potential benefit and risk of compression maneuvers for each patient undergoing this procedure

Methods

Results

Conclusion