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Analysis of hemorrhage upon ultrasound-guided percutaneous renal biopsy in China: a retrospective study
Fang-Fang Li1, Yu-Xia Guan2, Tong-Xin Li3
1Department of Endocrinology, Peking Union Medical College Hospital, Peking, China.
Insights
Ultrasound-guided renal biopsy has a 37.70% hemorrhage risk, influenced by patient factors like sex, BMI, and pre-biopsy platelets. Careful perioperative management and fluid monitoring are crucial for reducing complications.
Area of Science:
- Nephrology
- Radiology
- Clinical Medicine
Background:
- Ultrasound-guided percutaneous renal biopsy (PRB) is a gold standard for chronic kidney disease (CKD) diagnosis.
- Post-biopsy hemorrhage is a common complication, with severe cases potentially leading to nephrectomy or death.
- Minimizing complications while ensuring biopsy success remains a key clinical research area.
Purpose of the Study:
- To identify risk factors associated with post-biopsy hemorrhage after ultrasound-guided PRB.
- To analyze the incidence of hemorrhagic complications and related patient characteristics.
- To inform improved perioperative management strategies for renal biopsy procedures.
Main Methods:
- Retrospective analysis of a renal biopsy database.
- Inclusion of 1146 patients undergoing ultrasound-guided PRB from September 2017 to December 2020.
- Statistical analysis using SPSS software to evaluate complication risk factors.
Main Results:
- The overall post-biopsy hemorrhage rate was 37.70%.
- Risk factors for hemorrhage included female sex, lower BMI, lower pre-biopsy platelet count, prolonged APTT, higher albumin levels, and postoperative urination within 4 hours.
- No deaths were reported; minor bleeding occurred in 29.41% and major bleeding in 0.96% of patients.
Conclusions:
- The incidence of post-biopsy bleeding is significant and linked to specific patient and procedural factors.
- Highlights the importance of comprehensive risk assessment and tailored perioperative care.
- Emphasizes the need for vigilant fluid management post-ultrasound-guided PRB to mitigate bleeding risks.
Purpose:
Ultrasound-guided percutaneous renal biopsy (PRB) has been considered as a golden standard for CKD diagnosis and is employed to identify potential therapeutic targets since 1950s. Post-biopsy hemorrhage is the most common complication, while severe bleeding complication might cause nephrectomy or death. Therefore, how to reduce the occurrence of complications while ensuring the success of PRB is always a clinical research topic.
Methods:
This study retrospectively collected and established a renal biopsy database of each patient who underwent ultrasound-guided PRB at a tertiary teaching hospital from September 2017 to December 2020 through the Health Information System. All the data were statistically processed by SPSS software.
Results:
A total of 1146 patients underwent PRB for various reasons. The overall rate of post-biopsy hemorrhage was 37.70% (432/1146). Of those bleedings, minor bleeding after PRB was found in 337 (29.41%), middle bleeding 84 (7.33%), major bleeding 11 (0.96%). Besides that, there were 96 patients (8.38%) reported their discomfort symptoms. There was no death. Females were at significantly increased risk of hemorrhagic complication than males (OR = 2.017, CI = 1.531-2.658). While the risk for hemorrhagic complication significantly decreased as BMI and platelet before renal biopsy increased (OR = 0.956, CI = 0.924-0.989; OR = 0.998, CI = 0.996-1.000). As the APTT time prolonged, the risk for hemorrhagic complication significantly increased (OR = 1.072, CI = 1.023-1.123). Those patients whose albumin were higher, also had higher risk for hemorrhagic complication than other patients (OR = 1.020, CI = 1.000-1.041). Specifically, postoperative urination within 4 h increased the risk for hemorrhagic complication (OR = 1.741, CI = 1.176-2.576).
Conclusion:
Our analysis finds that the incidence of post-biopsy bleeding complication is 37.70%, and its risk is associated with female, lower BMI, lower platelet before renal biopsy, prolonged APTT, higher albumin, and postoperative urination within 4 h. The findings highlighted the importance of perioperative management for renal biopsy, including adequate risk assessment, tailored careful observation after PRB. And medical staff should pay more attention to fluid management after ultrasound-guided PRB.
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