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Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications
Emilio D Poggio1, Robyn L McClelland2, Kristina N Blank2
1Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Insights
Native kidney biopsies using automated devices have low bleeding complication rates, though rare deaths can occur. Complications are more common in hospitalized patients with acute kidney injury (AKI).
Area of Science:
- Nephrology
- Medical Imaging
- Interventional Procedures
Background:
- Native kidney biopsies are crucial for diagnosing kidney diseases but carry risks of bleeding complications.
- The Kidney Precision Medicine Project mandates kidney biopsies, necessitating an analysis of complication rates.
- Automated biopsy devices under imaging guidance are increasingly used.
Purpose of the Study:
- To systematically review and meta-analyze complication rates of native kidney biopsies performed with automated devices under imaging guidance.
- To provide updated estimates of complication frequencies, including pain, hematoma, hematuria, and bleeding requiring intervention or transfusion.
Main Methods:
- Systematic review and meta-analysis of literature from January 1983 to March 2018.
- Inclusion of 87 manuscripts from an initial search of 1139.
- Random effects meta-analysis for proportions with Freeman-Tukey transformations.
Main Results:
- Analysis of 118,064 biopsies revealed low complication rates: pain (4.3%), hematomas (11%), macroscopic hematuria (3.5%), bleeding requiring transfusion (1.6%), and intervention (0.3%).
- Death post-biopsy was rare (0.06% overall, 0.03% outpatient).
- Higher complication rates were observed in hospitalized patients and those with acute kidney disease (AKI).
Conclusions:
- Native kidney biopsies, despite being invasive, demonstrate low rates of bleeding complications.
- While rare, mortality associated with kidney biopsy can occur.
- Hospitalized patients with AKI experience more frequent complications following kidney biopsy.
Background And Objectives:
Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.
Design, Setting, Participants, & Measurements:
This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare.
Results:
A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.
Conclusions:
Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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