Indications for Percutaneous Ultrasound-Guided Renal Biopsy and Complications Associated with it: An Observational Study
Abstract
Renal biopsy is performed for various reasons depending on the clinical manifestations presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications could occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Patients who underwent percutaneous ultrasound-guided renal biopsy at the institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in six (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. No procedure-related mortality was reported in the study. The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low.
Keywords
How to Cite
References
Young M, Leslie SW. Renal biopsy. In: StatPearls [Internet]. [Cited Jan 22, 2022]. Treasure Island, FL: StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK470275/. Accessed May 23, 2022.
Bickle I, Pianalto S, Foster T. Percutaneous renal biopsy. Reference article, Radiopaedia.org [Internet]. [Cited 2013]. Available at: https://radiopaedia.org/articles/21865. Accessed May 23, 2022.
Tang S, Li JH, Lui SL, Chan TM, Cheng IK, Lai KN. Free-hand, ultrasound-guided percutaneous renal biopsy: Experience from a single operator. Eur J Radiol. 2002;41(1):65–9. 10.1016/s0720-048x(01)00439-9
Ori, Y., Neuman, H., Chagnac, A., Siegal, A., Tobar, A., Itkin, M., et al. Using the automated biopsy gun with real-time ultrasound for native renal biopsy. ISR Med Assoc J. 2002;4(9):698–701.
Korbet SM. Percutaneous renal biopsy. Semin Nephrol. 2002;22(3):254–67. 10.1053/snep.2002.31713
Kim D, Kim H, Shin G, Ku S, Ma K, Shin S, et al. A randomized, prospective, comparative study of manual and automated renal biopsies. Am J Kidney Dis. 1998;32(3):426–31. 10.1053/ajkd.1998.v32.pm9740159
Xu D, Chen M, Zhou F, Zhao M. Risk factors for severe bleeding complications in percutaneous renal biopsy. Am J Med Sci. 2017;353(3):230–5. 10.1016/j.amjms.2016.12.019
Corapi K, Chen J, Balk E, Gordon C. Bleeding complications of native kidney biopsy: A systematic review and meta-analysis. Am J Kidney Dis. 2012;60(1):62–73. 10.1053/j.ajkd.2012.02.330
Al Turk A, Estiverne C, Agrawal P, Michaud J. Trends and outcomes of the use of percutaneous native kidney biopsy in the United States: 5-Year data analysis of the nationwide inpatient sample. Clin Kidney J. 2017;11(3):330–6. 10.1093/ckj/sfx102
Korbet S, Volpini K, Whittier W. Percutaneous renal biopsy of native kidneys: A single-center experience of 1,055 biopsies. Am J Nephrol. 2014;39(2):153–62. 10.1159/000358334
Zajjari Y, Aatif T, Bahadi A, Hassani K, El Kabbaj D, Benyahia M. Kidney biopsy in the military hospital of Morocco: Complications and histopathological findings. Saudi J Kidney Dis Transplant. 2015;26(5):1044. 10.4103/1319-2442.164604
Nalamati A, Bandi V, Kasinaboina B, Chundru S. Epidemiologic data of biopsy-proven renal diseases: Experience from a single center in South India. Saudi J Kidney Dis Transplant. 2019;30(2):478. 10.4103/1319-2442.256855
Das U, Prayaga A, Dakshinamurty K. Pattern of biopsy-proven renal disease in a single center of south India: 19 Years experience. Indian J Nephrol. 2011;21(4):250. 10.4103/0971-4065.85482
Abraham G, Koshy P, Parthsarathy R, Mathew M, Prabakaran R, Kuruvilla S. Interpretation of kidney biopsy in Indian patients older than 60 years: A tertiary care experience. Indian J Nephrol. 2018;28(3):198. 10.4103/ijn.ijn_158_17
Paripovic D, Kostic M, Kruscic D, et al. Indications and results of renal biopsy in children: A 10-year review from a single center in Serbia. J Nephrol. 2012;25(6):1054–9. 10.5301/jn.5000095
Ganesh K, Nair R, Seethalekshmy N, Kurian G, Mathew A, Sreedharan S, et al. A study of clinical presentation and correlative histopathological patterns in renal parenchymal disease. Indian J Nephrol. 2018;28(1):28. 10.4103/ijn.ijn_256_16
Imtiaz S, Nasir K, Drohlia M, Salman B, Ahmad A. Frequency of kidney diseases and clinical indications of pediatric renal biopsy: A single center experience. Indian J Nephrol. 2016;26(3):199. 10.4103/0971-4065.159304
Andrulli S, Rossini M, Gigliotti G, La Manna G, Feriozzi S, Aucella F, et al. The risks associated with percutaneous native kidney biopsies: A prospective study. Nephrol Dial Transplant. 2022. Epub ahead of print, May 19, 2022. 10.1093/ndt/gfac177
Manno C, Strippoli G, Arnesano L, Bonifati C, Campobasso N, Gesualdo L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004;66(4):1570–7. 10.1111/j.1523-1755.2004.00922.x
Korbet S, Volpini K, Whittier W. Percutaneous renal biopsy of native kidneys: A single-center experience of 1055 biopsies. Am J Nephrol. 2014;39(2):153–62. 10.1159/000358334
Waldo B, Korbet S, Freimanis M, Lewis E. The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys. Nephrol Dialy Transplant. 2009;24(8):2433–39. 10.1093/ndt/gfp073
Whittier W. Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol. 2004;15(1):142–7. 10.1097/01.asn.0000102472.37947.14
Lefaucheur C, Nochy D, Bariety J. Biopsierénale: techniques de prélèvement, contre-indications, complications (Renal biopsy: Procedures, contraindications, complications). Nephrol Ther. 2009;5(4):331–9. 10.1016/j.nephro.2009.02.005
Parrish AE. Complications of percutaneous renal biopsy: A review of 37 years’ experience. Clin Nephrol. 1992;38(3):135–41.
Korbet SM. Percutaneous renal biopsy. Semin Nephrol. 2002;22(3):254–67. 10.1053/snep.2002.31713
Peterson P, Hayes T, Arkin C, Bovill E, Fairweather R, Rock Jr, et al. The preoperative bleeding time test lacks clinical benefit. College of American Pathologists’ and American Society of Clinical Pathologists’ Position Article. J Urol. 1998;160(4):1599–600. 10.1016/s0022-5347(01)62659-4
Stiles KP, Hill C, LeBrun CJ, Reinmuth B, Yuan CM, Abbott KC. The impact of bleeding times on major complications rates after percutaneous real-time ultrasound-guided renal biopsies. J Nephrol. 2001;14:275–9.
Whittier WL, Korbet SM. Renal biopsy: Update. Curr Opin Nephrol Hypertens. 2004;13(6):661–5. 10.1097/00041552-200411000-00013
Gupta S. New techniques in image-guided percutaneous biopsy. Cardiovasc Intervent Radiol. 2004;27(2):91–104. 10.1007/s00270-003-0056-3
Kajawo S, Ekrikpo U, Moloi M, Noubiap J, Osman M, Okpechi-Samuel U, et al. A systematic review of complications associated with percutaneous native kidney biopsies in adults in low-and middle-income countries. Kidney Int Rep. 2021;6(1):78–90. 10.1016/j.ekir.2020.10.019
Copyright and licence
Copyright (c) 2022 Mohammad Ashraf Bhat, Shahid Sulayman, Manzoor Parry, Muzaffar Wani, Imtiyaz Wani
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
