Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience
The aim was to evaluate the risk for major hemorrhage complications (MHC) prior to percutaneous renal biopsy and apply a specific procedure in high-risk patients to decrease their incidence. Hemorrhage complications that required blood transfusion or other interventions were diagnosed as MHC.
One retrospective (Group A, n = 1314) and two prospective cohorts (Group B, n = 249 and Group C, n = 422) were involved in the study. Group A was used to establish a risk equation for MHC, Group B to test its performance, and Group C to evaluate the efficacy of the proposed procedure to reduce MHC incidence. Group C was classified, based on the equation, into high-risk (C1) and low-risk (C2) patients, who received different interventions. The intervention in Group C1 consisted of use of 18-gauge needles, a 12-h rest period post-operation, and reptilase injection; in Group C2, 16-gauge needles were used, with a 6-h rest, and no reptilase injection. Group B was also divided into B1 (high-risk) and B2 (low-risk) using the same cut-off, for further comparison.
(1) In Group A, 4.8 % of patients experienced MHC and the equation: Logit (PMHC) = 0.022 × mean arterial pressure (mmHg) + 0.216 × bleeding time (min) − 0.011 × eGFR [ml/(min 1.73 m2)] − 0.894 × kidney length (cm) − 2.100 × renal cortical thickness (cm) + 6.225 (cutoff = −1.664) was established. (2) The area under the receiver operating characteristic curve was 0.848 (95 % CI 0.797–0.890) for Group B. (3) MHC occurred in 4.8 and 2.8 % of patients in Group B and C, respectively; Group B1 suffered significantly more frequent gross hematuria, hematoma and MHC than Group C1; however, no significant difference except for large hematoma was found between Groups B2 and C2 for all complications.
The equation is reliable to predict the risk for MHC; the interventions proposed can decrease the incidence of MHC in high-risk patients.
KeywordsBiopsy Complications Hemorrhage Risk adjustment Intervention
Conflict of interest
All authors declared no conflict of interest on this paper.
The study was approved by the Health Department Ethics Committee of Beijing Military Region (Code: BH20100125).
All patients needed sign the informed consent before the operation.
- 15.Guerrero-Ramos F, Villacampa-Auba F, Jimenez-Alcaide E, Garcia-Gonzalez L, Ospina-Galeano IA, de la Rosa-Kehrmann F, Rodriguez-Antolin A, Passas-Martinez J, Diaz-Gonzalez R (2014) Renal biopsy with 16 g needle: a safety study. Actas urologicas espanolasGoogle Scholar
- 21.Pasquariello A, Innocenti M, Batini V, Pasquariello G, Beati S, Rindi S, Paoletti S, Panichi V (2007) Theoretical calculation of optimal depth in the percutaneous native kidney biopsy to drastically reduce bleeding complications and sample inadequacy for histopathological diagnosis. Nephrol Dial Transplant 22:3516–3520CrossRefPubMedGoogle Scholar