Complications Of Kidney Biopsy Research Articles

Frequency and Risk Factors of Ultrasound-Guided Kidney Biopsy Complications

Frequency and Risk Factors of Ultrasound-Guided Kidney Biopsy Complications

ОПЫТ ПРОВЕДЕНИЯ И ДИАГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ ПУНКЦИОННОЙ НЕФРОБИОПСИИ В СТАЦИОНАРЕ РЕГИОНАЛЬНОГО УРОВНЯ

Modern diagnosing of kidney diseases is based on a complex of clinical, laboratory, and instrumental studies, among which kidney biopsy occupies an important place. The study aims to assess the diagnostic value of kidney biopsy in patients with nephrological pathology. The study included 70 patients (n = 70) who underwent percutaneous puncture kidney biopsy from 2019 to 2022 for the following causes: nephrotic syndrome (42 %), chronic nephritic syndrome (35 %), and acute kidney injury of unclear etiology (23 %). The morphological examination revealed that two-thirds of all patients with kidney diseases (60 %) (p = 0,05) had glomerulopathy. Among glomerular diseases, IgA-nephropathy prevails (26 %) (p < 0,05), as well as membranous nephropathy (14 %). Amyloidosis (AA/Al) is registered in every seventh patient (14 %), while diabetic nephropathy – in every tenth (10 %). Complications of kidney biopsy develop in a quarter of cases (26 %). Anti-neutrophil cytoplasmic antibody-associated vasculitis, thrombotic microangiopathies and tubulointerstitial nephritis manifest more often in the form of acute kidney injury, IgA-nephropathy manifests itself in the onset of the disease with nephritic syndrome, while diabetic nephropathy, membranous nephropathy, focal segmental glomerulosclerosis, amyloidosis start with nephrotic syndrome in most cases. Kidney biopsy often has a significant impact on patient management tactics: according to the results of the morphological study, active pathogenetic therapy was initiated or corrected, and the vector of diagnostic search was also changed in 83 % of patients (p = 0,005). The data obtained confirm the need for the widespread introduction of kidney biopsy in order to optimize the quality of medical care provided to patients with a nephrological profile.

#5475 SAFETY OF NATIVE AND TRANSPLANT KIDNEY BIOPSY IN A NATIONAL COHORT

Abstract Background and Aims Safety of kidney biopsy is variably reported in different published series. Since 2014, all native kidney biopsies undertaken in the 9 adult renal units in Scotland have been recorded by the Scottish Renal Registry (SRR) and since 2015 all transplant kidney biopsies were included. In this complete national dataset, we report data on safety of kidney biopsy in a current real world setting. Method Major complications of kidney biopsy are recorded using pre-defined terms and include: arteriography and embolisation, arteriography no embolisation, clot retention, blood transfusion only, death within 28 days directly attributable to biopsy, nephrectomy and other. Biopsies are undertaken under ultrasound guidance using 16G or 18G spring loaded biopsy guns. All centres discontinue clopidogrel, DOACs and warfarin. Some centres continue aspirin. In some centres biopsy is performed by nephrologists and in others by radiologists Results In total, 6979 biopsies in 5755 patients were recorded between 2014 and 2021 (5095 native biopsies and 1884 transplant biopsies), with an adequacy for diagnosis of 98.1%. Table 1 describes the demographics, indications, operator and diagnoses made by biopsy type. Overall, in patients undergoing native kidney biopsy 2.4% suffered a major complication and 1.4% of patients undergoing transplant biopsy. The commonest complication was the requirement for arteriography, with or without embolisation. We included CT angiography in this group. There were 8 deaths within 28 days attributable to renal biopsy. Conclusion Kidney biopsy remains safe for the vast majority of patients and complications are less likely with transplant biopsy.

Complications of ultrasound-guided percutaneous native kidney biopsies in children: A single center experience

Introduction: Percutaneous kidney biopsy is a necessary tool to diagnose many kidney diseases. However, major complications were reported in adults, including bleeding in the kidney or around it, creation of arteriovenous fistula, wound infection, damage to adjacent organs, or even loss of the kidney. Such complications can rapidly develop serious consequences. Exploring risk factors might help in preventing them. Objective: The current study aims to evaluate and explore the complications that happened after percutaneous kidney biopsy in children and associated risk factors. Methodology: A retrospective record-based study was conducted by reviewing the medical records of children with post-ultrasound-guided percutaneous kidney biopsy complications at King Saud Medical City, a tertiary hospital in Riyadh, Saudi Arabia during the period from May 2014 to June 2021. Data were extracted using pre-structured data collection sheet. Data collected included children’s age, gender, primary disease, laboratory findings, and kidney complications with needed management. Results: The study identified 76 children who had undergone 86 ultrasound-guided percutaneous kidney biopsies in the study period and fulfil the inclusion criteria. Children’s ages ranged from 1 years to 15 years with a mean age of 7.3 ± 4.0 years old. Most of the study children had nephrotic syndrome (61.6%; 53), followed by glomerulonephritis (25.6%; 22). Thirty-five (40.7%) children developed at least one of the complications. The most-reported complication was microscopic haematuria (32.6%; 28), followed by gross haematuria (3.5%; 3), Flank pain was reported among 3 (3.5%) children also and hematoma (1 child), only 2 children (3.9%) among those who had no complications recorded Haemoglobin drop > 2 g/dl compared to 3 of those who had complications with no statistical significance (p = .365). Prothrombin time was significantly higher among children who had renal complications than others who had not (11.7 ± 1.8 vs. 10.8 ± 1.2 seconds; p = .022). Conclusion: Suggestive by the low need to intervene in complications, ultrasound-guided percutaneous kidney biopsy is a relatively safe procedure in children. Even in the most commonly observed complication, i.e. hemorrhagic ones, blood transfusion is rarely needed.

Risk of bleeding-related complications after kidney biopsy in patients with systemic lupus erythematosus.

Kidney biopsy is essential for the diagnosis and classification of lupus nephritis. Percutaneous biopsy has a risk of bleeding-related complications; however, data on the risk of percutaneous kidney biopsy in patients with systemic lupus erythematosus (SLE) are scarce. In this study, we aimed to investigate the rate of bleeding-related complications and to examine the risk factors for complications of kidney biopsy in patients with systemic lupus erythematosus (SLE). METHODS: We retrospectively reviewed the medical records of patients with SLE who underwent ultrasound-guided percutaneous kidney biopsy between 2002 and 2020 at a tertiary referral center. Minor complications were defined as hematoma and passing hematuria not requiring an intervention. Major complications included bleeding events that required interventions after the biopsy. Statistical analysis with a multivariate logistic regression model was performed. In a total of 277 patients with SLE, the rate of overall bleeding-related complications after kidney biopsy was 19.9% (minor 13.0%; major 6.9%). Among patients with major complications, 84.2% needed blood transfusion alone without embolization or surgery, whereas the remaining three patients needed embolization for bleeding control. Multivariate analysis revealed that thrombocytopenia (odds ratio [OR] 7.186, 95% confidence interval [CI] 2.315-22.300), and low eGFR (OR 3.478, 95% CI 1.094-11.056) were significantly associated with the risk of major bleeding-related complications after kidney biopsy. Percutaneous kidney biopsy is accompanied by the risk of bleeding-related complications; however, most events in our study did not require vascular intervention for bleeding control. Low platelet count and low estimated glomerular filtration rate (eGFR) significantly increase the risk of complications after kidney biopsy in patients with SLE. Key Points • The rate of overall bleeding-related complications after kidney biopsy was about 20% of patients with SLE. • The most commonly observed events were gross hematuria followed by blood transfusion. • Thrombocytopenia and poor kidney function areis an important risk of bleeding-related complications after kidney biopsy.

How useful is kidney biopsy for the management of glomerulopathies in the elderly?

The use of kidney biopsy in elderly individuals is still matter of discussion. The purpose of this study isto assess the utility of kidney biopsy for the management of glomerulopathies in an Eastern European cohort, targetingpatients older than 65years. This retrospective study included 875 adults (147 older than 65years), with biopsy-proven glomerulopathies, followed up for 71.1 (95% CI 68.2-73.9) months. The primary endpoint was chronic renal replacement therapy initiation.Statistical evaluation wasperformed with IBM SPSS software version 20, Analyse-it, and SAS Studio. The Kaplan-Meier method was used to estimate the time to death and the log-rank test was used for comparisons. The multivariate Cox proportional hazard analysis was used to evaluate the risk of death. Secondary glomerulopathies were more frequent in patients aged > 65years (52.4% vs. 41.9%, p = 0.004). Membranous nephropathy and amyloidosis were the most frequent primary and secondary glomerulopathies in this age group. Kidney biopsy complications were low (< 4%) in both age groups. In 42% of the elderly, the result of biopsy guided the immunosuppressive therapy. While the all-cause mortality rate was higher (OR 4.2; 95% CI 2.7-6.7; p < 0.0001) in elderly individuals, the rate of renal replacement therapy initiation was similar (31.3 vs 26%; p = 0.1) in both age groups. In the competitive risk analysis, kidney survival was similar irrespective of age [CIF 0.4 (95% CI 0.26-0.53) vs. 0.34 (95% CI 0.28-0.39), p = 0.08]. However, after adjusting for the confounding factors, younger age was associated with an increased risk of renal replacement therapy (HR = 1.57, p = 0.01), along with secondary glomerulopathies. The diagnosis of an underlying glomerulopathy guided the therapy in almost one-half of the elderlypatients who underwent a kidney biopsy, provided important prognostic information and had a low complications rate; kidney biopsy may therefore be considered a safe, reliable procedure in the management of glomerulopathies, even in patients over 65years of age.

Kidney Tissue Biopsy

Kidney tissue biopsy is a commonly performed procedure which is valuable in the work-up for patients with medical renal disease and renal transplant. This article will review indications, contraindications, technique and potential complications of kidney biopsy.

Kidney biopsy practice amongst Australasian nephrologists

BackgroundPercutaneous kidney biopsy is the gold standard investigation for the diagnosis of kidney diseases. The associated risks of the procedure depend on the skill and experience of the proceduralist as well as the characteristics of the patient. The Kidney Health Australia – Caring for Australasians with Renal Impairment (KHA-CARI) guidelines on kidney biopsies, published in 2019, are the only published national kidney biopsy guidelines. As such, this study surveys current kidney biopsy practices in Australasia and examines how they align with the Australian guidelines, as well as international biopsy practice.MethodsA cross-sectional, multiple-choice questionnaire was developed examining precautions prior to kidney biopsy; rationalisation of medications prior to kidney biopsy; technical aspects of kidney biopsy; complications of kidney biopsy; and indications for kidney biopsy. This was distributed to all members of the Australian and New Zealand Society of Nephrology (ANZSN).ResultsThe response rate for this survey is approximately 21.4 % (182/850). Respondents found agreement (> 75.0 %) in only six out of the twelve questions (50.0 %) which assessed their practice against the KHA-CARI guidelines.ConclusionsThis is the first study of its kind where kidney biopsy practices are examined against a clinical guideline. Furthermore, responses showed that practices were incongruent with guidelines and that there was a lack of consensus on many issues.

POS-751 AN UNUSUAL PRESENTATION OF ARTERI-VENOUS FISTULA AFTER RENAL BIOPSY: CASE REPORT

Renal biopsy is an important diagnostic procedure but is associated with a number of significant complications even when performed by a skilled operator. While most of these complications present with haemodynamic disturbance, pain or macroscopic haematuria, some – such as the development of a post-biopsy arteriovenous fistula may be occult. We present an unusual presentation of a post-biopsy arteriovenous fistula which was diagnosed after the patient reported an audible bruit. A 39-year-old woman with end stage renal disease of unknown etiology received her first kidney transplant in February 2020. The right kidney from a deceased after cardiac death donor was transplanted into her right iliac fossa. Before transplantation, she had been on hemodialysis via an arteriovenous fistula (AVF) for a year. There was delayed graft function and the patient was dialysed through her AVF on the 2nd day of transplantation. Graft function was slow to improve and a kidney biopsy was performed on the 6th day post-transplantation. The biopsy was performed under ultrasound (US)control with two passes of a 16 G needle. Post-procedure observations were unremarkable and the patient went home after 6 hours of bed rest.The biopsy showed borderline rejection and the patient was prescribedthree doses of intravenous methylprednisolone. On the second day post-biopsy, graft function remained poor and routine bloods showed a drop in haemoglobin from 107 to 78 g/L. Abdominal US did not show any abnormality. Patient received blood transfusion and was observed overnight. The patient was discharged home next day. On the 5th day post-biopsy, the patient presented with reports of hearing “buzzing” sounds. ENT review was unremarkable. Graft function was poor and the patient remained on dialysis. Abdominal US and Doppler studies showed a large AVF within the transplanted kidney at the site of the earlier biopsy (fig 1). Figure 1: Doppler ultrasound of renal transplant showing post biopsy AVF The fistula was large and, with evidence of recent bleeding, thus underwent coil embolisation in the interventional radiology department (fig 2). Figure 2: Coil embolisation of AVF. Left panel shows initial angiographic appearance; right panel shows appearance following coil embolisation At present, the patient is nine months post-transplantation and remains dialysis independent with stable graft function and an eGFR 25-30 mL/min/1.73m2. Most biopsy-associated AVFs close spontaneously, are asymptomatic, and do not require intervention. The indication for intervention is usually an increase in the size of fistula over time, the development of signs of heart failure, deterioration in kidney function, or a rise in blood pressure. Embolisation of biopsy-associated AVFs has been reported to result in good outcomes with minimal changes in serum creatinine and estimated glomerular filtration rate. The risks include proximal dissemination of the embolisation material and the resultant focal occlusion of the arterial system causing renal, gut and pulmonary ischaemia. Surgical procedures are reserved for large AVFs with high velocity flows. Complications of kidney biopsy can be asymptomatic, and missed because of late and atypical presentation. A possibility of kidney biopsy related complication should always be considered when a patient presents within few weeks of the kidney biopsy.

Correction: Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications.

Emilio D. Poggio, Robyn L. McClelland, Kristina N. Blank, Spencer Hansen, Shweta Bansal, Andrew S. Bomback, Pietro A. Canetta, Pascale Khairallah, Krzysztof Kiryluk, Stewart H. Lecker, Gearoid M. McMahon, Paul M. Palevsky, Samir V. Parikh, Sylvia E. Rosas, Katherine R. Tuttle, Miguel A. Vazquez,

Safety of Kidney Biopsy when Performed as an Outpatient Procedure

Introduction: Kidney biopsy remains the gold standard for the diagnosis of most renal diseases. A major obstacle to performing a biopsy is safety concerns. However, many safety measures are not evidence based and therefore vary widely between centers. We sought to determine the rate and timing of kidney biopsy complications in our center, to compare the complication rate between native and transplant kidney biopsies, to evaluate the feasibility of performing kidney biopsies as an outpatient procedure and the value of a postbiopsy ultrasound before discharge, and to identify risk factors for complications. Methods: We performed a single-center, retrospective, observational study at the Division of Nephrology of the University Hospital Zurich including all patients who underwent renal biopsy between January 2005 and December 2017. Major bleeding (primary outcome) and any other bleeding or nonbleeding complications (secondary outcomes) were compared between native and transplant kidney biopsies and between inpatient and outpatient procedures and correlated with clinical factors possibly affecting bleeding risk. Results: Overall, 2,239 biopsies were performed in 1,468 patients, 732 as inpatient and 1,507 as outpatient procedures. Major bleeding was observed in 28 (3.8%) inpatient and in 15 (1.0%) outpatient procedures, totaling to 43 (1.9%) of all biopsies. Major bleeding requiring intervention amounted to 1.0% (0.5% of outpatient procedures). Rate of major bleeding was similar between native and transplant kidneys. 13/15 (87%) bleeding episodes in planned outpatient procedures were detected during the 4-h surveillance period. Risk factors for bleeding were aspirin use, low eGFR, anemia, cirrhosis, and amyloidosis. Routine postbiopsy ultrasound did not change management. Conclusions: Kidney biopsy is an overall safe procedure and can be performed as an outpatient procedure in most patients with an observation period as short as 4 h. The value of routine postbiopsy ultrasound is questionable.

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications.

Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.

Complications of Kidney Biopsy in a Tertiary Hospital of Central Nepal, Chitwan

Background: Kidney biopsy is an important diagnostic tool in Nephrology and is said to berelatively a safe procedure.There are limited studies in the complications of kidney biopsy from this region. We therefore thought of looking into the complications of kidney biopsy and its risk factors.&#x0D; Methods: A hospital based analytical cross sectional study was carried out over a period of 3 years. Kidney biopsies were done under ultrasonography guidance. The complications and its risk factors were recorded and were analyzed using mean, standard deviation, ratio, percentage and chi square. &#x0D; Results: A total of 210 patients were analysed. The mean± standard deviation of 210 patients was 35.7±14.9 years. The commonest minor complication was biopsy site pain not requiring analgesics 136 (64.8%)and the commonest major complication was biopsy site pain requiring analgesics 18(8.6%) followed by perinephric hematoma 10 (4.8%).There was a significant association between low platelet count and the development of complications like pain requiring analgesic (p value 0.04), perinephric hematoma (p value 0.022) and gross hematuria (p value 0.011).&#x0D; Conclusions: Kidney biopsy is a safe procedure and low platelet count is a significant risk factor for complications (p value &lt;0.05).&#x0D; Keywords: complications; kidney biopsy; perinephric hematoma; platelet count.&#x0D;

Spectrum of pediatricbiopsy-proven renal diseases: A single center experience.

Glomerular diseases are considered to be a significant cause of chronic kidney disease. Kidney biopsy continues to be an essential diagnostic tool. We review the renal biopsies which were done on children below the age of 14 years in the past 10 years (from January 2008 to September 2018) in a single tertiary pediatric hospital in Saudi Arabia to determine the patterns of renal disease among Saudi children as well-correlating clinical presentation with histopathological diagnosis. A total of 203 pediatric kidney biopsies were performed. The mean age was 7.3 ± 3.9 years (3 months to 14 years). There were 105 males and 98 females. The most frequent indication for renal biopsy was nephrotic syndrome in 58.9% of patients, followed by acute glomerulo- nephritis in 20.8%. Other indications included significant proteinuria, persistent microscopic hematuria, acute kidney injury of uncertain etiology, in the remaining 20% of biopsies. Clinical diagnosis was consistent with histopathological diagnosis in 92% of the cases. Minimal change disease was the most common cause of primary glomerular diseases in 37.4%, followed by focal segmental glomerulosclerosis in 20.2%. Lupus nephritis represents the most common cause of the secondary renal disease (8.4%). Complications of kidney biopsy were observed in only 16.3% of patients, of whom 9.9% had perirenal hematomas and 6.4% of the patients developed either microscopic hematuria or macroscopic hematuria.

Risk Factors and Timing of Native Kidney Biopsy Complications

Background: The appropriate observation period, rate and risk factors of complications after a percutaneous renal biopsy remain debated. Methods: We retrospectively studied native kidney biopsies performed in our institution between January 2007 and July 2011. Outpatients had either an 8- (67%) or a 24-hour (33%) observation period. Results: 312 biopsies were reviewed (287 patients), 51% of patients were female and the mean age was 54 ± 15 years. Half of these biopsies were performed in outpatients. A total of 15% of patients developed a symptomatic hematoma, 9% received a red blood cell transfusion and 1% required an angio-intervention. Eighty-four percent of the complications manifested within the first 8 h, 86% at 12 h and 94% at 24 h. Outpatients experienced significantly less complications, all manifesting within the first 8 h, 14% required an observation period longer than planned. The risk of symptomatic hematoma increased to 11, 20, 35 and 40% in patients with >200, 140-200, 100-140 and <100 × 10⁹/l platelets, respectively (p = 0.002). It also increased in hemodialysis patients (29% compared to 14%, p = 0.02). We found no association of risk with the number of biopsy passes and only a trend with needle size. Conclusion: Symptomatic hematomas occurred in 15% of kidney biopsies and were strongly associated with platelet count and hemodialysis. Outpatients experienced fewer complications; therefore, we can conclude that same-day discharge in selected patients is safe.

Assessing the safety and quality of ward-based renal transplant biopsies

Assessing the safety and quality of ward-based renal transplant biopsies Kenneth Wu1, Bindhu Musunuru1, Chera Arunachalam1, Aung Sett1, Paul Musker21Renal Unit, St James&rsquo; University Hospital, Leeds, West Yorkshire, UK; 2Renal Unit, St Luke&rsquo;s Hospital, Bradford, West Yorkshire, UKAbstract: The aim of this pilot study was to compare renal transplant biopsies carried out by ward-based nephrology trainees and departmental based radiologists, primarily reviewing major complications and glomerular yield. There was only one patient who developed a single episode of major complication out of the 145 procedures recorded. We concluded there is no significant difference in complication rate and glomerular yield for renal allograft biopsies between nephrology trainees and radiologists, regardless of location.Keywords: renal transplant, kidney biopsy complications, renal hemorrhage, glomerular yield

Iatrogenic Rupture of the Ureter During Kidney Biopsy

Perirenal hematoma, hematuria, and abdominal pain are common complications of kidney biopsy, but ureter rupture is relatively less frequent. Here we report a patient who experienced severe abdominal pain and gross hematuria following a non-smooth procedure of ultrasound-guided kidney biopsy. Computed tomography showed rupture of the left upper third of the ureter. We implanted a curled double-J catheter between the renal pelvis and urinary bladder. Abdominal pain and gross hematuria improved. After 2 months, the double-J catheter was removed and the patient had no further clinical symptoms. The possibility of ureter rupture, although rare, should be considered in the presence of abdominal pain and gross hematuria in patients after receiving a kidney biopsy.

Prolonged fever following kidney biopsy: a case report

This case report describes a patient with prolonged fever following a kidney biopsy. Workup disclosed a large perirenal and retroperitoneal hematoma. Neither imaging nor blood cultures supported an infective cause of his fever. Although the patient was initially treated with antibiotics, fever eventually resolved spontaneously. A review of the literature is provided addressing the association of fever with resorption of hematoma. Fever should be added to the list of potential complications of kidney biopsy. A conservative management is advocated.

Kidney biopsy and power Doppler imaging

Practically, all complications of kidney biopsy are connected with hemorrhage. In the last years, the use of color Doppler sonography in monitoring kidney biopsies was being described, later the possibility of using power Doppler (PD) in performing kidney biopsies was presented. PD depicts the amplitude, or power, of Doppler signals rather than the frequency shift. This allows detection of a larger range of Doppler shifts and thus better visualization of small vessels, but at the expense of directional and velocity information. Biopsy of native kidneys was performed in 144 patients. We performed real-time ultrasound-guided biopsy with an automatic biopsy device, 2-4 MHz convex probe and modified 18 G tru-cut needles were used. The vessels in the region of the biopsy were imaged with color Doppler sonography and with PD immediately before, after and the day following biopsy. Adequate tissue for histologic diagnosis was obtained in all patients with average 3.28 attempts at biopsy (range from 2-5). Average 24.15 (range from 7-58) glomeruli were obtained during each session. We observed complications in 6 (4.2%) patients, macrohematuria was presented in 4, and small hematoma with no need for intervention in 2 patients. In 138 (95.8%) patients, no complications were observed, microhematuria was present in 116 (80.6%) patients. In our study, complication rate of kidney biopsy was low and no complication requiring intervention was observed. Number of glomeruli obtained during each session was high. For better visualization of kidney vessels in biopsy path, PD was used. This additional kidney investigation itself does not essentially prolong the duration of the biopsy.

Discontinuation of the Bleeding Time Test without Detectable Adverse Clinical Impact

The bleeding time (BT) test predicts a higher bleeding complication rate in populations at risk for inherited or acquired platelet dysfunction, but it is of limited assistance in evaluating individual patients. There are no reports of clinical outcomes after discontinuation of the BT test. Interviews with a subset of the physicians who had ordered the BT test before discontinuation of the test were conducted. The total number of platelet-aggregation tests, the mean number of monthly, unmodified platelet units transfused, the incidence of kidney biopsy complications, and the number of doses of 1-deamino-8-D-arginine vasopressin (DDAVP) administered 5 months before and after discontinuation of the BT test were compared. We recorded the rates of bleeding complications in the Major Surgery Risk Pool during the 12 months before and the 5 months after the discontinuation of the BT test. Clinicians reported they did not significantly change their preprocedural work-ups, postpone an invasive procedure, experience an increase in bleeding complications, or increase their use of blood products after discontinuation of the BT test. Platelet-aggregation tests (n = 9, before and after), platelet transfusions (P = 0.958), and DDAVP administration (before = 24; after = 10) did not increase after discontinuation of the BT test. The rate of postprocedural bleeding complications did not increase significantly in either Major Surgery Risk Pool cases (<3final sigma deviation from the mean rate) or in patients undergoing renal biopsies (P = 0.225 for decrease in hematocrit; P = 1.000 for the percentage of patients transfused) after discontinuation of the BT test. Our study failed to identify a clinically significant, negative impact of discontinuing the BT test.