Safety and predictors of complications of renal biopsy in the outpatient setting

ArticleinClinical nephrology 76(6):464-9 · December 2011with13 Reads
DOI: 10.5414/CN107128 · Source: PubMed
Abstract
It has been recommended that patients should be admitted for 24 h of observation after percutaneous renal biopsy. This may be performed in the ambulatory outpatient setting, though its safety in this setting is an area of debate. We aim to demonstrate the safety of biopsy in the ambulatory outpatient setting. We performed a retrospective cohort study of 475 biopsies performed in the ambulatory outpatient setting to examine safety and risk factors for complications. Transplant and native kidney biopsies performed at the Canberra Hospital, a tertiary referral university hospital, from 2006 until 2010 were included. Patients were observed for 6 h before discharge. Study outcomes were minor complications, defined as pain, hemorrhage or postural hypotension; or major complications, defined as complications requiring therapeutic intervention including blood product transfusion. The overall complication rate was 8.2%. There were 33 minor complications (6.9%) and 6 major complications (1.3%). All complications occurring outside the period of observation were safely managed. Significant predictors of any complication was hemoglobin (OR 1.03, 95% CI 1.01 - 1.06), kidney size (OR 0.93, 95% CI 0.89 - 0.98), and proceduralist. Percutaneous renal biopsy is safe in the ambulatory outpatient setting. Establishing ongoing quality assurance programs may be helpful in early identification of operator-dependent factors.
    • "So detection of the renal allograft function accurately, safely, and early is particularly important. Renal biopsy is the gold standard for assessment of renal allograft function, but it is invasive, painful and prone to sampling errors [3,4]. Although glomerular filtration rate (GFR), estimated by renal scintigraphy, is considered as the best indicator for renal function, it requires exogenous contrast agents which has relatively high radiation exposure, and it is restricted for morphological evaluation [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Methods: This prospective study was approved by the local ethics committee, and written informed consent was obtained from all participants. A total of 82 participants with 62 renal allograft recipients (2-4weeks after kidney transplantation) and 20 volunteers were enrolled to be scanned using IVIM and ASL MRI on a 3.0T MR scanner. Recipients were divided into two groups with either normal or impaired function according to the estimated glomerular filtration rate (eGFR) with a threshold of 60ml/min/1.73m(2). The apparent diffusion coefficient (ADC) of pure diffusion (ADCslow), the ADC of pseudodiffusion (ADCfast), perfusion fraction (PF), and renal blood flow (RBF) of cortex were compared among three groups. The correlation of ADCslow, ADCfast, PF and RBF with eGFR was evaluated. The receiver operating characteristic (ROC) curve and binary logistic regression analyses were performed to assess the diagnostic efficiency of using IVIM and ASL parameters to discriminate allografts with impaired function from normal function. P<0.05 was considered statistically significant. Results: In allografts with normal function, no significant difference of mean cortical ADCslow, ADCfast, PF were found compared with healthy controls (P>0.05). Cortical RBF in allografts with normal function was statistically lower than that of healthy controls (P<0.001). Mean cortical ADCslow, ADCfast, PF and RBF were lower for allografts with impaired function than that with normal function (P<0.05). Mean cortical ADCslow, ADCfast, PF and RBF showed a positive correlation with eGFR (all P<0.01) for recipients. The combination of IVIM and ASL MRI showed a higher area under the ROC curve (AUC) (0.865) than that of ASL MRI alone (P=0.02). Conclusion: Combined IVIM and ASL MRI can better evaluate the diffusion and perfusion properties for allografts early after kidney transplantation.
    Full-text · Article · Apr 2016
    • "Similarly, Paik et al. [11] noted a poorer prognosis in ASP children with primary FSGS over a duration of 98 months than in those with nephrotic syndrome. Although isolated ASP is a matter of concern, nephrologists occasionally have difficulty deciding whether to perform PRB in patients with this condition , as the rate of biopsy-related morbidity is 8 – 10% [19]. This is particularly true given that there are no simple and commonly accepted criteria for the identification of those at the highest risk. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: This retrospective case series aimed at exploring the optimal urinary protein-to-creatinine ratio (uP/uCr) cut-off value to determine the need for renal biopsy in pediatric patients with isolated asymptomatic proteinuria (ASP). Methods: Data from 32 patients (16 boys, 16 girls) with persistent isolated ASP treated between January 2001 and September 2010 were analyzed. The uP/uCr cut-off value at which a renal biopsy is indicated was determined using the minimum p-value approach. An "optimal" cut-off value was selected to distinguish significant and non-significant glomerular changes. Results: The minimum p-value approach using the χ2-test resulted in a peak uP/uCr of 0.5 g/g x Cr, which was then used to divide the patients into a low-proteinuria group and a high-proteinuria group. The proportion of significant glomerular changes was marginally higher (p = 0.097) in the high-proteinuria group than in the low-proteinuria group after adjustment for multiple tests. In addition, the number of patients with severe proteinuria at the most recent followup was higher in the high-proteinuria group than in the low-proteinuria group. Conclusion: The use of a uP/uCr >= 0.5 g/g x Cr may be a reasonable criterion for renal biopsy aimed at distinguishing renal outcomes in patients with persistent isolated ASP.
    Full-text · Article · Jul 2014
    • "Renal biopsy, therefore, is necessary for a diagnosis, and scintigraphy is often performed to assess the residual renal function. A biopsy is an invasive, time-consuming and painful procedure with the risk of complications [2] . Therefore , a new diagnostic, non-invasive tool, capable of revealing early alterations of the renal parenchyma and reaching a diagnosis, would be very useful. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective To assess renal dysfunction in chronic kidney diseases using diffusion tensor imaging (DTI). Methods Forty-seven patients with impaired renal function (study group) and 17 patients without renal diseases (control group) were examined using DTI sequences. Cortical and medullary regions of interest (ROIs) were located to obtain the corresponding values of the apparent diffusion coefficient (ADC) and the fractional anisotropy (FA). The mean values of the ADC and FA, for each ROI site, were obtained in each group and were compared. Furthermore, the correlations between the diffusion parameters and the estimated glomerular filtration rate (eGFR) were determined. Results In both the normal and affected kidneys, we obtained the cortico-medullary difference of the ADC and the FA values. The FA value in the medulla was significantly lower (P = 0.0149) in patients with renal function impairment as compared to patients with normal renal function. A direct correlation between DTI parameters and the eGFR was not found. Tractography visualised disruption of the regular arrangement of the tracts in patient with renal function alteration. Conclusion DTI could be a useful tool in the evaluation of chronic kidney disease and, in particular, the medullary FA value seems to be the main parameter for assessing renal damage. Key Points • Magnetic resonance diffusion tensor imaging (MRDTI) provides new information about renal problems. • DTI allows non-invasive repeatable evaluation of the renal parenchyma, without contrast media. • DTI could become useful in the management of chronic parenchymal disease. • DTI seems more appropriate for renal evaluation than diffusion-weighted imaging.
    Full-text · Article · Jan 2013
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