Lower eGFR is independently associated with embolization‑requiring severe bleeding after percutaneous renal biopsy: a...

Reduced estimated glomerular filtration rate (eGFR) is a suspected risk factor for bleeding after percutaneous renal biopsy, but its association with hemorrhage requiring embolization is unclear. We evaluated this association using a matched case‑control study.

This single‑center, retrospective, matched case‑control study included patients who underwent ultrasound‑guided native renal biopsy between 2012 and 2025 at a Chinese tertiary hospital. Cases (n = 16) were patients with severe bleeding requiring selective renal artery embolization; controls (n = 64) had no post‑biopsy bleeding, matched 1:4 by sex and age. eGFR was calculated using the CKD‑EPI equation, analyzed as a continuous variable and categorized according to KDIGO criteria (<30, 30-60, ≥60 mL/min/1.73 m²). Multivariable logistic regression, restricted cubic spline analysis, subgroup analyses, LASSO regression, and sensitivity analyses (ROC curve, dichotomized eGFR, complete‑case analysis) were performed.

In fully adjusted models, each 1 mL/min/1.73m² increase in eGFR was associated with 4% lower bleeding risk (OR 0.96, 95% CI 0.93-0.98, p = 0.007). eGFR ≥60 versus <30 mL/min/1.73 m² gave OR 0.09 (95% CI 0.01-0.75, p = 0.03), with a significant dose‑response trend (P for trend = 0.02). Restricted cubic spline analysis revealed a linear inverse association. Results were consistent across subgroups and sensitivity analyses.

Lower eGFR may be independently associated with increased risk of embolization-requiring bleeding after renal biopsy in a linear dose-response manner. Given the limited sample size, these exploratory findings require validation in larger, prospective cohorts. eGFR may aid in preoperative risk stratification.