Life-Threatening Complications Following Percutaneous Ultrasound-Guided Renal Biopsy: a Rare Case Report

Ultrasound-guided percutaneous renal biopsy has been a basic tool for the diagnosis of kidney disease, but minor and major complications cannot be completely avoided. Major complications including gross hematuria, renal hematoma and arteriovenous fistula, and usually develop within 24 hours after renal biopsy. We present an educational case of female having major bleeding complications after renal biopsy with unusual clinical courses. The patient developed hypovolemic shock at 48 hours after renal biopsy along with perirenal hematoma and hemothorax. The case highlight the need to remain the major complications in mind for physicians. Key words: Hemothorax, renal biopsy.

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The efficacy of blind versus real-time ultrasound-guided percutaneous renal biopsy in developing country

SAGE Open Medicine ◽

10.1177/2050312119849770 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984977 ◽

Cited By ~ 1

Author(s):

Wanjak Pongsittisak ◽

Naphat Wutilertcharoenwong ◽

Tanun Ngamvichchukorn ◽

Sathit Kurathong ◽

Chutima Chavanisakun ◽

...

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Resource Constraint ◽

Bleeding Complications ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Percutaneous Renal Biopsy ◽

Renal Biopsies ◽

Lower Egfr ◽

Adequate Tissue

Introduction: Renal biopsy is a useful diagnostic procedure. In developing countries, two techniques of renal biopsy, blind percutaneous renal biopsy and real-time ultrasound-guided percutaneous renal biopsy, have been performed. The majority of studies compared these using different types and sizes of biopsy needle. The aim of this study was to compare both techniques in resource constraint country. Method: We reviewed renal biopsy database, between 1 January 2014 to 30 June 2017. The primary outcome was the total number of glomeruli. The other outcomes were tissue adequacy and bleeding complications. We also analyzed multivariable logistic regression to find factors associated with tissue adequacy and bleeding complications. Result: Of the 204 renal biopsies, 100 were blind percutaneous renal biopsy and 104 real-time ultrasound-guided percutaneous renal biopsy. The number of native renal biopsies was 169 (82.8%). Baseline characteristics of two groups were comparable. The mean number of total glomeruli from real-time ultrasound-guided percutaneous renal biopsy was significantly more than blind percutaneous renal biopsy (20.8 ± 12.1 vs 16.0 ± 13.0, p = 0.001). The real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissues than blind percutaneous renal biopsy (45.2% vs 16%, p < 0.001) and was the only factor associated with adequate tissue. Moreover, 16 renal biopsies from blind percutaneous renal biopsy obtained inadequate tissue. The overall bleeding complications were not statistically different. We found being female, lower eGFR and lower hematocrit were associated with bleeding complications. Conclusion: In comparison with blind percutaneous renal biopsy, real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissue and number of glomeruli. While the complications of both were comparable. We encourage to practice and perform real-time ultrasound-guided percutaneous renal biopsy in resource constraint countries.

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Percutaneous Renal Biopsy: Comparison of Blind and Real-time Ultrasound Guided Technique

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i1.19369 ◽

2018 ◽

Vol 16 (1) ◽

pp. 66-72 ◽

Cited By ~ 2

Author(s):

Anil Pokhrel ◽

Rajendra Kumar Agrawal ◽

Anil Baral ◽

Ajaya Rajbhandari ◽

Rajani Hada

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Randomized Study ◽

Bleeding Complications ◽

Renal Diseases ◽

Ultrasound Guided ◽

Macroscopic Hematuria ◽

Percutaneous Renal Biopsy ◽

Significant Difference ◽

Perinephric Hematoma

Background: Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique.Methods: It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma.Results: Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours.Conclusions: Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.

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Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120923527 ◽

2020 ◽

Vol 7 ◽

pp. 205435812092352

Author(s):

Melissa Schorr ◽

Pavel S. Roshanov ◽

Matthew A. Weir ◽

Andrew A. House

Keyword(s):

Retrospective Study ◽

Blood Transfusion ◽

Renal Biopsy ◽

Major Bleeding ◽

Bleeding Complications ◽

Minor Bleeding ◽

Risk Calculator ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy ◽

C Statistic

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 ).

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Risk Factors Associated with Major Complications after Ultrasound-Guided Percutaneous Renal Biopsy of Native Kidneys

Kidney & Blood Pressure Research ◽

10.1159/000504544 ◽

2019 ◽

Vol 45 (1) ◽

pp. 122-130 ◽

Cited By ~ 4

Author(s):

Beatriz Pombas ◽

Eva Rodríguez ◽

Juan Sánchez ◽

Aleksandar Radosevic ◽

Javier Gimeno ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Blood Transfusion ◽

Renal Biopsy ◽

Categorical Variables ◽

Ultrasound Guided ◽

Factors Associated ◽

Percutaneous Renal Biopsy ◽

Major Complications ◽

Increased Risk

Introduction: Percutaneous renal biopsy (PRB) of native kidneys is an important tool for diagnosis and management of renal disease. In this study, we analyzed the success, safety, and risk complications of PRB in our center. Methods: A retrospective review of ultrasound-guided PRB done at our institution from January 1998 to December 2017 was performed. Clinical and laboratory data were collected for 661 PRBs. Statistical analysis was performed using the Mann-Whitney U test for continuous variable and chi-square test for categorical variables. Multivariate analysis using logistic regression was performed to assess factors associated with increased risk of complications after PRB. Results: The median age was 56 (42–68) years old, the majority were male (64%) and white (82%). Ten glomeruli were present in 63.5% of PRBs. Overall, the rate of complications was 16.6%, where 15.1% of them were minor complications and 1.5% were major complications. Perinephritic hematoma accounted for the minor complication that occurred most frequently, whereas the need of a blood transfusion was the prevalent for major complications. By multivariate analysis, increased activated partial thromboplastin time (aPTT; OR 1.11, 95% CI 1.035–1.180) and prebiopsy lower hemoglobin (Hgb; OR 1.61, 95% CI 1.086–2.304) were identified as independent risk factors for major complications. In addition, older patients (OR 1.057, 95% CI 1.001–1.117) were identified as an independent risk factor for blood transfusion requirement. Conclusion: The current risk of complications after native PRB is low. Major complications are most common in case of increased aPTT and decreased Hgb baseline level.

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Percutaneous renal biopsy of native kidneys: efficiency, safety and risk factors associated with major complications

Archives of Medical Science ◽

10.5114/aoms.2011.25557 ◽

2011 ◽

Vol 5 ◽

pp. 823-831 ◽

Cited By ~ 35

Author(s):

Abel Torres Muňoz ◽

Rafael Valdez-Ortiz ◽

Carlos González-Parra ◽

Elvy Espinoza-Dávila ◽

Luis E. Morales-Buenrostro ◽

...

Keyword(s):

Risk Factors ◽

Renal Biopsy ◽

Factors Associated ◽

Percutaneous Renal Biopsy ◽

Major Complications

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An improved technique for ultrasound guided percutaneous renal biopsy

Kidney International ◽

10.1038/ki.1985.13 ◽

1985 ◽

Vol 27 (1) ◽

pp. 80-82 ◽

Cited By ~ 32

Author(s):

Jason C. Birnholz ◽

Balakuntalam S. Kasinath ◽

Howard L. Corwin

Keyword(s):

Renal Biopsy ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy ◽

Improved Technique

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Ultrasound-Guided Renal Biopsy with Biopsy Gun Technique — Efficacy and Complications

Acta Radiologica ◽

10.1177/028418519503600313 ◽

1995 ◽

Vol 36 (3) ◽

pp. 276-279 ◽

Cited By ~ 22

Author(s):

J. Christensen ◽

S. Lindequist ◽

D. Ulrik Knudsen ◽

R. Smith Pedersen

Keyword(s):

Renal Biopsy ◽

Severe Hypertension ◽

Ultrasound Guided ◽

Histologic Diagnosis ◽

Biopsy Technique ◽

Major Complications ◽

Renal Biopsies ◽

The Mean ◽

Adequate Tissue

One hundred and thirty-one ultrasound-guided renal biopsies performed in 127 patients with automated spring-loaded biopsy technique were evaluated. Adequate tissue for histologic diagnosis was obtained in 92% of the procedures (94% of the patients). The mean glomerular yield was 16.8 glomeruli. Complications were seen in 21% of the patients, 18% having minor and 3% having major complications. Patients with severe hypertension had significantly more complications than the rest of the patients. The rate of complications in patients who had 3 or 4 biopsy passes was not increased compared to patients who had one or 2 biopsy passes. Thus, this study indicates that the risk of complications and the safety of the procedure is not influenced by increasing the number of biopsy passes in order to obtain representative specimens.

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The complications of ultrasound-guided percutaneous renal biopsy

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.202784 ◽

2017 ◽

Vol 28 (2) ◽

pp. 430

Author(s):

Gioacchino Li Cavoli ◽

Luisa Bono ◽

Calogera Tortorici ◽

TancrediVincenzo Li Cavoli ◽

Carlo Giammarresi ◽

...

Keyword(s):

Renal Biopsy ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy

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Complications of Percutaneous Renal Biopsy

Seminars in Interventional Radiology ◽

10.1055/s-0039-1688422 ◽

2019 ◽

Vol 36 (02) ◽

pp. 097-103

Author(s):

Kenaz Bakdash ◽

Kristofer M. Schramm ◽

Aparna Annam ◽

Matthew Brown ◽

Kimi Kondo ◽

...

Keyword(s):

Risk Factors ◽

Renal Biopsy ◽

Bleeding Complications ◽

Modifiable Risk Factors ◽

Delayed Presentation ◽

Histologic Diagnosis ◽

Poor Renal Function ◽

Percutaneous Renal Biopsy ◽

Risk Patients

AbstractPercutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.

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