Percutaneous Native Kidney Biopsy Research Articles

Bleeding Complications and Insufficient Samples after Percutaneous Native Kidney Biopsy

Bleeding Complications and Insufficient Samples after Percutaneous Native Kidney Biopsy

#1289 The effect of desmopressin in reducing post-kidney biopsy bleeding complication in patients with reduced renal function: a randomised control trial

Abstract Background and Aims Percutaneous kidney biopsy remains the gold standard for diagnosis of kidney disease. The incidence of bleeding complications following kidney biopsy ranges from 13 to 34%. This study aimed to evaluate the effect of prebiopsy administration of intranasal desmopressin on the incidence of post-biopsy bleeding complications in patients undergoing ultrasound-guided percutaneous native kidney biopsy with an estimated GFR of 60 ml/min/1.73 m2. Method It was a single-centre, double-blind, randomized controlled trial. Patients undergoing percutaneous ultrasound-guided biopsy of the native kidney in the department with age >18 years, BP before biopsy ≤140/90 mm Hg, and eGFR < 60 mL/min/1.73 m2. The patients were divided into experimental (intranasal desmopressin) and control group (intranasal normal saline), and block randomization was done by a computer-generated random number list prepared by an investigator with no clinical involvement in the study into an experimental and control group. The experimental group was treated using intranasal desmopressin acetate (dosage of 3 mcg/kg, each puff delivering 10 mcg) 1 hour before the kidney biopsy. The control group was treated with a placebo (equivalent dose of intranasal saline)(CTRI/2023/01/048812) Results A total of 152 patients were included (78 male and 74 female), the experimental group had 74 patients, and the control group had 78 patients. The mean age was 39.08 ± 15.03 yrs and 38.83 ± 15.67 yrs., respectively (p = 0.921). The experimental group had significantly less hematoma formation at 24 hrs. post kidney biopsy compared to the control group (p = 0.019). The hematoma volume at six hrs. (p = 0.342) and 24 hrs. (p = 0.698); post-kidney biopsy was not different between the two groups. Conclusion Intranasal desmopressin administration effectively reduces post-biopsy native kidney peri-renal hematoma formation at 24 hrs post-procedure. However, other bleeding complications were not different in the two groups of our studies.

Diagnostic yield and safety of percutaneous native kidney biopsy in pregnancy: 20-years of single-center experience.

Percutaneous kidney biopsy is a fundamental procedure in nephrology. Although pregnancy is not a contraindication, a careful risk-benefit assessment is mandatory in pregnancy. We aimed to evaluate safety and diagnostic accuracy of percutaneous kidney biopsy in pregnancy in a single-center retrospective study. Percutaneous kidney biopsy was performed in 19 pregnantpatients. Demographics, estimated glomerular filtration rates, serum albumin levels, and proteinuria levels at the time of biopsy were evaluated. Biopsy-related complications, diagnoses, and treatments during the follow-up were analyzed. In addition, delivery success, preeclampsia, early delivery, low birth weight rates, and long-term outcomes of the patients were retrieved and analyzed. Mean patient age was 27 (range 16-41) years. Median gestational week at kidney biopsy was 20th. All but one biopsies were diagnostic. Median gestational week of delivery was 35 (range 23-39)gestational weeks. Preterm delivery (< 37 gestational weeks) and low birth weight (< 2500mg) occurred in 73.7% and 52.6% of cases, respectively. Median weight at birth was 2500mg. The incidence of preeclampsia was 57.9%.Overall 89.5% of the children survived. Median post-biopsy follow-up was 64months. Maternal mortality was not observed during the follow-up period. End stage kidney disease developed in one patient. The results of percutaneous kidney biopsy led to therapeutic decisions in 73.7% of cases. Although percutaneous kidney biopsy is not frequently performed during pregnancy, it is relativelysafe and usuallydiagnostic, and may guide further follow-up.

#4706 THERAPEUTIC AND PROGNOSTIC IMPACT OF KIDNEY BIOPSY FINDINGS IN PATIENTS AGED 80 YEARS AND OLDER: A MULTICENTER RETROSPECTIVE COHORT STUDY (KB-OLD)

Abstract Background and Aims The great phenotypic heterogeneity in the presentation of kidney diseases makes the diagnostic strategy all the more complex in the elderly. While kidney biopsy should play a pivotal role, its non-negligible risk of bleeding complications (2-5% in the general population) justifies a certain reluctance to its application in the elderly. To date, however, there is little data on the benefit-risk ratio of kidney biopsy in the elderly. Most of these studies have focused on a relatively young population (60-70 years old) and on a limited number of patients. Concerning patients aged 80 years and older, very few studies have described the real therapeutic influence of kidney biopsy findings with regard to the rate of complications. Moreover, none of these studies have evaluated the long-term prognostic impact of therapeutic changes induced by the results of the kidney biopsy. The main objectives of this study are to describe the indications, diagnoses, complication rate, therapeutic influence and the prognostic impact of a change in therapeutic management after native kidney biopsies performed in patients aged 80 years and older. Method The KB-Old study (Kidney Biopsy for Old) is a retrospective multicenter cohort that consecutively included all patients aged 80 years and older who underwent percutaneous native kidney biopsy in 17 centers in the northern region of France, between 2010 and 2020. Clinical, biological and anatomopathological data as well as post-biopsy follow-up (therapeutic strategy, occurrence of complications) were collected from medical records. All pathology examinations were analyzed centrally by a team of experienced nephropathologists. Events of death or kidney failure were identified by specific registry cross-linking. To analyze the prognostic impact of therapeutic management following kidney biopsy (either initiation of a specific treatment or simple nephroprotection) on the risk of kidney failure and death, we performed Cox models weighted by propensity score (Inverse Probability of Treatment Weighting -IPTW-) in the population potentially eligible for treatment (exclusion of diseases without specific treatment). The areas under Kaplan Meier curves were calculated up to 6 years of follow-up (Restricted Mean Survival Time - RMST) and compared according to the initiation of a specific treatment after the kidney biopsy. This study was approved by Institutional Review Board (#AUG-20-707). Results Overall, the cohort included 453 patients (54% men, median age 83 years), half of whom underwent biopsy in the context of acute kidney injury (median serum creatinine level 3.0 mg/dl). The main diagnoses were nephroangiosclerosis (15%), renal involvement of hematological malignancies (13%), acute tubulointerstitial nephritis (12%) and vasculitis (10%). The complication rate was approximately 10%, with only 2.8% of serious complications requiring therapeutic intervention (mostly transfusion). The kidney biopsy identified a disease potentially accessible to a specific treatment in 73% of cases. After exclusion of patients with ineligible diseases, a specific treatment was initiated in about one out of two cases (163/332, 49%). After weighting on propensity score, the two treatment groups were globally balanced. A beneficial effect of treatment on dialysis-free survival was observed (HR = 0.51 [0.28-0.92], p = 0.02), without any major influence on mortality (Figure 1). Over a 6-year follow-up period, there was a gain in dialysis-free survival in the treated group estimated by the delta RMST at +10.46 months [3.39 - 17.54] compared with the untreated group (p = 0.004), with no difference in overall life expectancy. Conclusion To the best of our knowledge, this is the largest multicenter cohort of patients aged 80 years and over who have undergone kidney biopsy. It seems to confirm the interest and safety of this examination for specific indications, and a potentially important benefit on the prognosis when it leads to an adapted therapeutic management.

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 &gt; 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.

Histopathological patterns in kidney biopsies in Zimbabwe: a 12-year retrospective study

Objectives: Data on histological patterns in native kidney biopsies in Zimbabwe is sparse. We sought to describe these histological patterns over a 12 year period.&#x0D; Study Design: We retrospectively evaluated the histological patterns on kidney biopsies at the largest private pathology laboratory in Zimbabwe from 1 January 2008 to 31 January 2020.&#x0D; Setting: Histopathological data on all percutaneous native kidney biopsy specimens received at the pathology lab was recovered from electronic records. Indications for the kidney biopsy were then reviewed and patient demographics collected.&#x0D; Subjects: All patients who had a histopathological report identified from the electronic records and who had had a kidney biopsy for nephrological indications were included.&#x0D; Results: Sixty four 64 reports in total were identified and 18 were excluded (17biopsies done to evaluate renal masses and 1 kidney transplant biopsy). Thus 46 percutaneous native kidney biopsies were evaluated in the final analysis. Ninety six percent of the patients biopsied were of African descent. Primary FSGS was the commonest primary glomerular disease (26%) and lupus nephritis the commonest secondary glomerular disease (24%). The commonest indication for kidney biopsy was nephrotic syndrome (61%).&#x0D; Conclusions: FSGS was the commonest primary GN in this study of adult patients and the commonest indication for kidney biopsy was nephrotic syndrome. This finding is useful for guiding clinicians on managing patients presenting with nephrotic syndrome in low resource settings as often patients lack access to kidney biopsy services and empiric use of steroids may be considered in appropriate individual cases.

Risk of bleeding after percutaneous native kidney biopsy in patients receiving low-dose aspirin: a single-center retrospective study.

Although discontinuation of antiplatelet agents at least 5days before kidney biopsy is commonly recommended, the evidence behind this practice is of low level. Indeed, few non-randomized studies previously showed an equivalent risk of bleeding in patients receiving aspirin therapy. We conducted a single center retrospective study comparing the risk of complications after percutaneous native kidney biopsy in patients who received low-dose aspirin (ASA) within 5days from biopsy and those who did not. The main outcome was the difference in the incidence of major complications (red blood cell transfusion, need for selective arterial embolization, surgery, nephrectomy). Secondary outcomes included difference in minor complications, comparison between patients who received ASA within 48h or within 3-5days, identification of independent factors predictive of major complications. We analyzed data on 750 patients, of whom 94 received ASA within 5days from biopsy. There were no significant differences in the proportion of major complications in patients receiving or not receiving ASA (2.59% and 3.19%, respectively, percentage point difference 1%, 95% CI - 3 to 4%, p = 0.74). Groups were also comparable for minor complications; among patients receiving ASA, there were no differences in major bleeding between those who received ASA within 48h or 3-5days from biopsy. Significant baseline predictors of major bleeding in our cohort were platelet count lower than 120*103/microliter, higher diastolic blood pressure and higher blood urea. Treatment with low-dose ASA within 5days from kidney biopsy did not increase the risk of complicationsafter the procedure.

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

BackgroundPercutaneous 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.MethodsFrom 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.ResultsOf 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.ConclusionsPercutaneous 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.

Ultrasound Versus Computed Tomography-Guided Native Parenchymal Kidney Biopsies for Hospitalized Patients: Comparison of Clinical Outcomes and Complications.

Percutaneous native kidney biopsies performed with ultrasound (US) or computed tomography (CT) guidance are important in the workup of medical renal disease, with modality choice often dependent on the performing institution, with various complication rates reported. We compared the complication rates and types of complication of US- versus CT-guided native parenchymal renal biopsy among hospitalized patients. One hundred five consecutive inpatient US- and CT-guided native parenchymal renal biopsies performed by radiologists at a tertiary care academic center between 2006 and 2020 were reviewed retrospectively. Complication rates of biopsy were calculated and compared between the 2 modalities. Comparisons with regard to types of complications were made using the Society of Interventional Radiology grading scale, American Society of Anesthesiologists score, and other clinical data. One hundred five hospitalized adult patients (58 women and 47 men; average age, 53 years) underwent native parenchymal kidney biopsy during the study period. Sixty-three (60%) were CT-guided and 42 (40%) were US-guided. Complication rates between CT- versus US-guided biopsies were 40% versus 19% ( P = 0.03), respectively. There were 7 major and 18 minor complications for CT-guided biopsies and 3 major and 5 minor complications for US-guided biopsies. No statistically significant difference was found in preprocedural American Society of Anesthesiologists Classification score, international normalized ratio, platelet count, or body mass index. Computed tomography-guided native parenchymal kidney biopsy was associated with a higher overall complication rate compared with US-guided biopsy for hospitalized patients. Most complications were minor, which required no treatment or additional follow-up.

MO200: Risk of Complications after Percutaneous Native Kidney Biopsy in Patients Receiving Anti-Platelet Agents

Abstract BACKGROUND AND AIMS Although discontinuation of antiplatelet agents at least 5 days before kidney biopsy is recommended by most guidelines and commonly advised by nephrologists, the evidence behind this practice is very low. Indeed, few non-randomized studies previously showed a similar rate of bleeding after kidney biopsy in patients who received aspirin and those who did not. Withdrawal of antiplatelet agents has been associated with an immediate and substantial increase in cardiovascular events, especially in patients at risk for coronary heart disease. METHOD We conducted a single centre retrospective cross-sectional study comparing the risk of complications after percutaneous ultrasound-assisted native kidney biopsy in patients who received antiplatelet agents within 5 days from biopsy and those who did not; the study was approved by local Ethical Committee (protocol 1321/2020/OSS*/AOUMO). The main outcome was the difference in the proportion of major complications (any of the following: red blood cells transfusion, need for selective arterial embolization, surgical revision, nephrectomy). Secondary outcomes were: difference in the proportion of minor complications (drop in haemoglobin &amp;gt;2 g/dL, bladder tamponade, macrohematuria, need for angio-CT scan, hematoma &amp;gt;3 cm), difference in the proportion of complications between patients who received antiplatelet agents within 48 h and those who received them within 3–5 days from biopsy, identification of independent factors predictive of major complication. RESULTS We analszed 769 percutaneous native kidney biopsies performed by nephrologists from 1 January 2010 to 31 December 2020 in 741 patients; 113 procedures (14.69%) were conducted under antiplatelet therapy (within 5 days from biopsy). Demographical, clinical and laboratory characteristics of the whole cohort and dividing patients according to antiplatelet therapy status (absent or within 5 days from biopsy) are reported in Table 1; most patients (83.17%) on antiplatelet were receiving low-dose aspirin. A single (or a combination of more) major complication occurred in 17/656 (2.59%) of patients without and in 4/113 (3.54%) patients with antiplatelet therapy, with non-significant difference between groups (percentage point difference 1%, 95% CI –2% to 4%, P = .57); no deaths were attributable to the biopsy procedure. There were 103/656 (15.7%) minor complications in patients without and 14/113 (12.39%) in patients with antiplatelet therapy, with non-significant difference between groups (percentage point difference 3%, 95% CI –10% to 4%, P = .37). In patients treated with antiplatelet within 5 days from biopsy, we encountered no significant difference in the proportion of major or minor complications in those who received therapy in the last 48 h or 3–5 days before the procedure. The final multivariate stepwise logistic regression model for the prediction of major complication included two variables (platelets &amp;lt;120*10^3, eGFR); the model was logit(p) = –2668 + 2383*(platelets &amp;lt; 120*10^3)-0036*eGFR, where P is the probability of having a major complication after kidney biopsy (see Table 2 for univariate and multivariate analysis). This model produced an AUC of 0808 (95% CI 0.724–0.89). CONCLUSION Receiving anti-platelet therapy (in particular, low-dose aspirin) within 5 days from percutaneous native kidney biopsy did not increase the risk of major or minor complications in our cohort. Platelet count &amp;lt; 120*10^3/µL and lower eGFR were significantly associated with an increased risk for major complication.

Late Presentation for Kidney Biopsy: Clinical Presentations and Laboratory Findings.

Although the number of patients reaching end-stage kidney disease without a biopsy- proven diagnosis is increasing, kidney biopsies play a key role in diagnosing kidney disease. We analyzed prospective data from patients with kidney disease who underwent percutaneous native kidney biopsies from January 2006 to December 2017. Demographic data, clinical presentations, and the laboratory and radiological findings at the time of biopsy were analyzed. Of 530 patients, 42.8% were male. The mean age was 33.9 (32.8-34.9.2) years; 66.3% were aged 25-64 years. Edema was the main clinical presentation (61.9%), with clinical urine changes seen in 66.7%. Most (89.6%) were nondiabetic; 46.8% had high blood pressure or were on antihypertensive therapy. Most patients (77.5%) were in Stages I, II, and III, and 12.3% underwent hemodialysis at the time of admission. Most (54.4%) were obese. Low hemoglobin (31.8%), high triglycerides (30%), high total cholesterol (58.2%), low serum albumin (73.9%), nephrotic proteinuria (61.8.6%), and microscopic hematuria (79.8%) were the main laboratory findings. The immunological investigations showed that antinuclear antibodies, positive anti-double-stranded DNA (anti-dsDNA), and extractable nuclear antigens were positive in 29.6%, 20.7%, and 19.7%, respectively. Perinuclear antineutrophil cytoplasmic antibodies (ANCA) were positive in 9.6% and cytoplasmic ANCA were positive in 5.4%, whereas immunoglobulin A was detected in 4.6%. More than one- third of the patients had reached advanced chronic kidney disease (CKD) Stages IIIB, IV, and V. This indicates the need to increase awareness about CKD, greater utilization of kidney biopsies, and earlier investigations to enable accurate diagnoses, and proper and timely management.

Correction: Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study.

Halimi J-M, Gatault P, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Grammatico-Guillon L, and Fauchier L: Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study. Clin J Am Soc Nephrol 15: 1587–1594, 2020; doi: <https://doi.

Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

IntroductionThe risk of bleeding associated with transjugular kidney biopsies is unclear, and which patients are the best candidates for this route is unknown.MethodsThis was a retrospective cohort study comparing proportion of bleeding associated with transjugular versus percutaneous native kidney biopsies in all patients in France in the 2010–2019 period. Major bleeding at day 8 (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, nephrectomy) and risk of death at day 30 were assessed, and we used a bleeding risk score initially developed for the percutaneous route.ResultsOur analysis included 60,331 patients (transjugular route: 5305; percutaneous route: 55,026 patients). The observed proportion of major bleeding varied widely (transjugular vs. percutaneous): 0.4% versus 0.5% for the lowest risk scores (0–4) to 19.1% versus 30.8% for the highest risk scores (≥35). Transjugular was more frequently used than percutaneous route (39% vs. 24%) when the risk score was ≥20 (15,133/60,331; 25% of all patients). Transjugular was associated with a lower risk of major bleeding than percutaneous route in multivariate analyses (odds ratio [OR]: 0.88 [0.78–0.99]), especially for scores ≥20 (OR: 0.83 [0.72–0.96], (i.e., 25% of patients). Major bleeding was associated with an increased risk of death both for transjugular (OR: 1.77 [1.00–3.14]) and percutaneous (OR: 1.80 [1.43–2.28]) routes.ConclusionsThe transjugular route is independently associated with a lower risk of bleeding than the percutaneous route, especially in high-risk patients identified by a preprocedure risk score ≥20 (i.e., 25% of patients). Major bleeding is associated with an increased risk of death for both routes.

Estimation of risk for major bleeding in native kidney biopsies in patients with multiple risk factors.

Individuals undergoing kidney biopsy are increasingly older and may have concurrent illnesses that cause deranged hematological and renal parameters that are associated with post-biopsy bleeding. We aimed to develop a clinical risk model to quantify bleeding risks in high-risk individuals with multiple risk factors. Single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 2mg/dL (176µmol/L) and had ultrasound-guided percutaneous native kidney biopsies between June 2011 and July 2015 in our tertiary referral center. The primary outcome was major bleeding, defined as need for red cell transfusion, radiological or surgical intervention, or if bleeding led to death within 7days after kidney biopsy. Among 184 native kidney biopsies with serum creatinine ≥ 2mg/dL, median age was 54.1years and eGFR was 18.8ml/min/1.73 m2. Major bleeding occurred in 19 biopsies (10.3%). Multivariate analysis accounting for age, weight, hemoglobin, platelet, prothrombin time and urea found that higher hemoglobin (adjusted OR 0.51, 95% CI 0.33-0.79, p = 0.003) and platelet (adjusted OR 0.99, 95% CI 0.98-0.99, p = 0.01) were independently associated with reduced major bleeding. A risk model that included (1) age ≥ 62years old, (2) hemoglobin < 10g/dL and (3) platelets ≤ 216 × 109/L as categorical variables predicted major bleeding post-biopsy. We developed a risk model that included multiple risk factors to quantify bleeding risks in native kidney biopsies with renal impairment.

A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

IntroductionKidney biopsy is an important tool for making diagnoses and for assessing the drug treatment requirements and disease prognosis in the management of kidney diseases. There are variations in the rate of complications associated with kidney biopsies across countries, and this depends on various clinical and technical factors. The aim of this study is to report on complications associated with kidney biopsy performed in low- and middle-income countries.MethodsTwo reviewers searched studies in MEDLINE, Embase, Cochrane Reviews, and African Journals Online. A random effects meta-analysis method was used to pool estimates of complications.ResultsWe identified 39 studies reporting on 19,500 kidney biopsies with overall complications (major + minor) rate of 14.9% (95% confidence interval = 11.4%–18.7%). Fewer complications were reported in biopsies performed with real-time ultrasound scans compared to those pre-marked using ultrasound or blind procedures (12.4% vs. 14.9% vs. 24.5%; P = 0.037), respectively. Complications, albeit lower for procedures performed with automated needles (13.3%), were not significantly different from those performed with nonautomated needles (17.3%; P = 0.588). Major complications included macroscopic hematuria (1.48%), nephrectomy (0.04%), blood loss requiring red cell transfusion (0.24%), angiographic intervention (0.22%), and death (0.01%).ConclusionComplications associated with kidney biopsy in low- and middle-income countries are low, are comparable to those in other settings, and occur more sparingly when real-time ultrasound techniques or automated kidney biopsy needles are used. This suggests the need to expand the use of this procedure to improve diagnosis of kidney pathologies and choice of therapy when indicated.

Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study.

The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of major bleeding and to build a preprocedure bleeding risk score. Our study was a retrospective cohort study in all 52,138 patients who had a percutaneous native kidney biopsy in France in the 2010-2018 period. Measurements included major bleeding (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, or nephrectomy) at day 8 after biopsy and risk of death at day 30. Exposures and outcomes were defined by diagnosis codes. Major bleeding occurred in 2765 of 52,138 (5%) patients (blood transfusions: 5%; angiographic intervention: 0.4%; and nephrectomy: 0.1%). Nineteen diagnoses were associated with major bleeding. A bleeding risk score was calculated (Charlson index [2-4: +1; 5 and 6: +2; >6: +3]; frailty index [1.5-4.4: +1; 4.5-9.5: +2; >9.5: +3]; women: +1; dyslipidemia: -1; obesity: -1; anemia: +8; thrombocytopenia: +2; cancer: +2; abnormal kidney function: +4; glomerular disease: -1; vascular kidney disease: -1; diabetic kidney disease: -1; autoimmune disease: +2; vasculitis: +5; hematologic disease: +2; thrombotic microangiopathy: +4; amyloidosis: -2; other kidney diagnosis: -1) + a constant of 5. The risk of bleeding went from 0.4% (lowest score group =0-4 points) to 33% (highest score group ≥35 points). Major bleeding was an independent risk of death (500 of 52,138 deaths: bleeding: 81 of 2765 [3%]; no bleeding: 419 of 49,373 [0.9%]; odds ratio, 1.95; 95% confidence interval, 1.50 to 2.54; P<0.001). The risk of major bleeding after percutaneous native kidney biopsy may be higher than generally thought and is associated with a twofold higher risk of death. It varies widely but can be estimated with a score useful for shared decision making and procedure choice.

Correction to: A nationwide survey on clinical practice patterns and bleeding complications of percutaneous native kidney biopsy in Japan.

In the original publication, some errors have been found in the alignment of Table 9. The corrected table is given below.

Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort

BackgroundThe major risk of kidney biopsy is severe bleeding. Numerous risk factors for bleeding after biopsy have been reported, but findings have been inconsistent.MethodsWe retrospectively reviewed medical records of adult patients enrolled in a native kidney biopsy cohort study to identify major bleeding events (red blood cell [RBC] transfusions, invasive procedures, kidney loss, or death). We used logistic and linear regression models to identify characteristics associated with postbiopsy RBC transfusions and decline in hemoglobin within a week after the procedure.ResultsMajor bleeding events occurred in 28 of 644 (4.3%) patients (28 required an RBC transfusion, 4 underwent angiographic intervention, and 1 had open surgery to control bleeding). No patient lost a kidney or died because of the biopsy. Postbiopsy RBC transfusion risk was driven by the baseline hemoglobin level (odds ratio [OR] 13.6; 95% confidence interval [CI] 5.4–34.1 for hemoglobin <10 vs. ≥10 g/dl). After adjusting for hemoglobin, no other patient characteristics were independently associated with RBC transfusions. Female sex (β = 0.18; 95% CI: 0.04–0.32), estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (β = 0.32; 95% CI: 0.14–0.49), and baseline hemoglobin (β = 0.09; 95% CI: 0.05–0.13, per g/dl increase) were independently associated with a larger drop in hemoglobin. Histopathologic lesions were not independently associated with major bleeding after biopsy.ConclusionBiopsies were generally well tolerated. Baseline hemoglobin was the dominant risk factor for RBC transfusions, but female sex and eGFR <30 ml/min per 1.73 m2 were also associated with a larger decline in hemoglobin after the procedure.

Acute Kidney Disease Increases the Risk of Post-Kidney Biopsy Bleeding Complications

Introduction: Kidney biopsy, providing the insightful information for most kidney diseases, is an invasive diagnostic tool with certain risks ranging from the least severe macroscopic hematuria to the most severe life-threatening bleeding necessitating renal artery embolization. We aimed to compare the postbiopsy bleeding complications between 2 common methods and to further explore the risk factors of bleeding complications in patients using the negative pressure suction puncture (NPS) method. Methods: We retrospectively collected the data from percutaneous native kidney biopsies in 2016. The clinical, laboratory tests, pathological findings, and the occurrence of bleeding complications following kidney biopsy were analyzed. The kidney biopsy was performed in our center by experienced nephrologists with 2 different methods, namely, NPS method and real-time ultrasound-guided needle (RTU) method. We compared rates of complications between 2 methods and evaluated univariate and multivariate association of risk factors with bleeding complications in the NPS group. Results: 626 kidney biopsies were performed between January 2016 and December 2016. There were 83.2% (521/626) participants in the NPS group and 16.8% (105/626) in the RTU group. There were more participants in the RTU group needing >1 needle pass during biopsy than those in the NPS group (61.0 vs. 14.7%, p < 0.001). Acute kidney disease (AKD) occurred before the procedure of kidney biopsy accounted for 13.8% (72/521) in the NPS group and 1.9% (2/105) in the RTU group. The renal pathological findings revealed higher number of glomeruli in the NPS group than in the RTU group (26.8 ± 13.0 vs. 17.2 ± 8.6, p < 0.001). The incidence of bleeding complications in the NPS group was lower than that in the RTU group (9.2 vs. 21.9%, p < 0.01). Logistic multivariate regression showed that AKD was independently associated with bleeding complications after kidney biopsy in the NPS group. Conclusion: Regarding the bleeding risk, there was noninferiority of NPS over RTU. AKD contributes to higher risks of bleeding complications after kidney biopsy.

MON-031 OLDER INDIVIDUALS UNDERGOING NATIVE KIDNEY BIOPSIES: TREND OVER 10 YEARS IN AN URBAN SOUTHEAST ASIAN CENTER

Kidney biopsy remains the definitive diagnostic tool for glomerulonephritis, a frequent cause for end-stage renal disease. There is a recent trend towards older age among those biopsied in developed countries but older age may increase risk of post-biopsy complications. Hence there is a need to ascertain the patient profile in our local practice and increase awareness among physicians. This study aims to examine changes in patient characteristics for individuals who underwent percutaneous native kidney biopsy in our Southeast Asian city-state over the past 10 years and characterise indications for native kidney biopsies among elderly.