Salvage of bleeding renal allograft following biopsy, with suture technique: a case report

Percutaneous renal biopsy is a valuable procedure in the management of and prognostication for patients with renal disease. Complications, although rare, occur with renal biopsies. Arteriovenous fistulas and heavy bleeding are notable complications. In this report, we describe simple suturing of the biopsy tract for salvage of a graft destined for a nephrectomy due to a profusely bleeding arteriovenous fistula.

A 20-year-old Sri Lankan man with end-stage renal disease due to steroid-resistant nephrotic syndrome underwent a renal transplant. He had poor urine output following the surgery, and a renal biopsy was performed to diagnose his renal pathology. He experienced poorly controlled postprocedural hypertension, and he had four episodes of gross hematuria that required blood transfusion. Coil embolization was delayed due to technical issues, and a graft nephrectomy was planned following the fourth episode of hematuria, which was the most severe. A Doppler scan revealed a slender, iatrogenic arteriovenous fistula corresponding to the biopsy tract, with very high flow rates. With knowledge of the anatomy of the fistula, we performed suturing of the tract to obliterate the fistula as a last resort to salvage the graft. The surgical procedure stopped the bleeding, and the patient made a full recovery with an excellent quality of life.

In our patient, a renal transplant biopsy revealed acute tubular necrosis. The incidence and treatment of fistulas and differences in complication rates among native and graft kidney biopsies are discussed.