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Percutaneous renal biopsy (PRB) is essential for diagnosing and managing kidney diseases, providing crucial insights into disease progression and treatment efficacy. As committed nephrologists, ensuring the safe execution of PRBs is paramount, directly impacting patient care decisions.
Suitability of the procedure hinges on obtaining a tissue sample sufficient for histological techniques, with a complication rate below 2%. Advancements in imaging and biopsy needles now enable obtaining ample renal tissue for diagnosis in most cases.
Despite its importance, recent years have seen a decline in nephrologist participation due to complications and waning educational emphasis. Bleeding issues, ranging from mild hematuria to serious hemorrhages, pose significant concerns, particularly in patients with coagulation disorders, hypertension, or kidney failure.
In 2012, we introduced a protocol to address bleeding risk factors before performing ultrasound-guided PRB on native kidneys. By tackling these risk factors, our goal was to minimize bleeding complications and enhance patient outcomes
The study included all consecutive and/or eligible patients during From June 2012 to May 2021, a total of 722 adult patients underwent 795 real-time ultrasound guided PRBs using semiautomatic 16-gauge biopsy needles at the University of Buenos Aires Hospital. The PRBs were performed by nephrology fellows who were supervised by experienced in PRB and ultrasound nephrologists. All fellows received prior instruction about the PRB procedure and the protocol.
Exclusion criteria comprised patients under 18, kidney transplant recipients, pregnant individuals, those with a solitary kidney, and those lacking control of bleeding risk factors. We implemented a rigorous protocol to correct bleeding risk factors, including managing coagulation disorders, hypertension, anemia, and prescribing desmopressin in renal failure cases. High-risk patients were admitted before biopsy.
We documented minor and major complications during the medical observation period after the biopsy. Complications categorized as minor (hematuria, hematoma) or major (transfusion, invasive procedure). Post-PRB hematuria or pain led to lab tests and CT scans. Number of glomeruli and final diagnosis recorded.
We observed complications in 13 patients (1.66%), with almost all occurring within the initial 8 hours post-PRB. The primary complication was macroscopic hematuria in 8 patients (1%), followed by left flank and back pain with confirmed retroperitoneal hematoma via CT in 5 patients (0.6%). Major complications affected 2 patients (0.25%), necessitating transfusions. In 0.12% of cases, a selective embolization of an inferior posterior branch of the left renal artery was performed to address persistent macroscopic hematuria. Notably, there were no instances of nephrectomy or mortality attributable to PRB.
Implementing a bleeding risk factor protocol for renal biopsies effectively minimizes complications, providing benefits like enhanced learning for fellows and improved capabilities for medical centers with limited percutaneous renal biopsy experience. This approach creates a safer procedural environment and promotes proficiency in PRBs across diverse medical settings.