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Summary
Renal needle biopsy can cause serious kidney arteriovenous fistulas, even in patients with high blood pressure. A patient required bilateral nephrectomy due to severe complications from kidney biopsies.
Area of Science:
- Nephrology
- Interventional Radiology
- Vascular Surgery
Background:
- Percutaneous kidney biopsy is a common diagnostic procedure.
- Arteriovenous fistulas are a known complication of kidney biopsy.
- Malignant hypertension and chronic kidney failure are significant comorbidities.
Observation:
- A patient with malignant hypertension and chronic kidney failure developed bilateral arteriovenous fistulas after percutaneous needle biopsies.
- The fistulas were associated with aneurysmal formation and significant hematuria.
- Repeat biopsies, including an open renal biopsy, preceded the severe complications.
Findings:
- The patient presented with gross hematuria requiring blood transfusions.
- The severity of the arteriovenous fistulas necessitated bilateral nephrectomy for control.
- Post-nephrectomy, the patient is normotensive and requires hemodialysis.
Implications:
- The case questions the advisability of renal needle biopsy in patients with uncontrolled hypertension.
- Intrarenal arteriovenous fistulas are reported with increasing frequency following kidney biopsies.
- While many fistulas resolve spontaneously, a significant percentage persist, posing risks of hemorrhage and organ damage.