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Bleeding complications of native kidney biopsy: a systematic review and meta-analysis
Kristin M Corapi1, Joline L T Chen, Ethan M Balk
1Department of Medicine, Boston University Medical Center, MA 02118, USA.
Insights
Native kidney biopsy using automated devices and ultrasound guidance has low complication rates, including macroscopic hematuria and transfusion needs. Smaller needles may reduce risks, while patient factors like kidney function influence outcomes.
Area of Science:
- Nephrology
- Medical Procedures
- Patient Safety
Background:
- Kidney biopsy is crucial for diagnosis but complication risks require systematic evaluation.
- Understanding complication rates is essential for nephrologists to optimize patient care.
Purpose of the Study:
- To systematically describe the risk of complications associated with native kidney biopsy.
- To identify factors influencing complication rates in kidney biopsy procedures.
Main Methods:
- Meta-analysis of 34 studies (9,474 biopsies) including randomized controlled trials and observational studies.
- Included studies focused on adults undergoing native kidney biopsy with automated devices and ultrasonographic guidance.
- Data were extracted from MEDLINE-indexed studies published from January 1980 to June 2011, with a minimum sample size of 50.
Main Results:
- The overall rate of macroscopic hematuria was 3.5%, and erythrocyte transfusion was 0.9%.
- Higher transfusion rates were associated with larger gauge needles (14-gauge), higher mean serum creatinine (≥2.0 mg/dL), a higher proportion of women (≥50%), and a higher rate of biopsies for acute kidney injury (≥10%).
- Similar trends were observed for macroscopic hematuria, though not statistically significant.
Conclusions:
- Native kidney biopsy with automated devices and ultrasonography has a low risk of significant complications.
- Utilizing smaller gauge needles may decrease complication rates.
- Patient selection factors, including kidney function and biopsy indication, appear to influence outcomes, warranting further investigation.
Background:
Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described.
Study Design:
Meta-analysis of randomized controlled trials and prospective or retrospective observational studies.
Setting & Population:
Adults undergoing native kidney biopsy in an inpatient or outpatient setting.
Selection Criteria For Studies:
MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more.
Intervention:
Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance.
Outcomes:
Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes.
Results:
34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant.
Limitations:
Publication bias, few randomized controlled trials, and missing data.
Conclusions:
Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications.
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