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Varnell CD, Stone HK, Welge JA. Bleeding Complications after Pediatric Kidney Biopsy: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2019; 14:57-65. [PMID: 30522995 PMCID: PMC6364534 DOI: 10.2215/cjn.05890518] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney biopsy is an essential tool for the diagnosis and treatment of patients with kidney disease; however, because of its invasive nature, bleeding complications may arise. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a meta-analysis of prospective or retrospective observational studies and randomized, controlled trials in pediatric patients undergoing native or transplant kidney biopsy in an inpatient or outpatient setting in MEDLINE-indexed studies from January 1998 to November 1, 2017 to determine the proportion of patients who develop hematoma, need blood transfusion, or need an additional intervention due to a complication after kidney biopsy. RESULTS Twenty-three studies of 5504 biopsies met inclusion criteria. The proportion of patients developing hematoma after biopsy was between 11% (95% confidence interval, 7% to 17%) and 18% (95% confidence interval, 9% to 35%) using two analyses that included different time periods. The proportion needing blood transfusion was 0.9% (95% confidence interval, 0.5% to 1.4%). The proportion needing an additional intervention due to postbiopsy complication was 0.7% (95% confidence interval, 0.4% to 1.1%). Secondary analysis was not possible due to lack of data in the original manuscripts on laboratory values, needle gauges, number of needle passes, age of patient, or performer (attending versus trainee). Analysis with metaregression found that use of real-time ultrasound during biopsy did not modify the risk for hematoma, requirement of a blood products transfusion, or requirement of an additional procedure after biopsy. Analysis with metaregression comparing native biopsies with transplant biopsies did not reveal that biopsy type (native kidney biopsy versus transplant kidney biopsy) was associated with the need for a blood transfusion or requirement of an additional intervention after biopsy. CONCLUSIONS The development of perinephric hematoma after kidney biopsy is not an infrequent finding. The proportion of patients requiring blood transfusion or needing an additional intervention as a result of kidney biopsy in pediatric patients is significantly smaller.
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Affiliation(s)
- Charles D. Varnell
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of
- Pediatrics
| | - Hillarey K. Stone
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of
| | - Jeffrey A. Welge
- Psychiatry and Behavioral Neuroscience, and
- Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Prasanna A, Weerakkody RM, Wijewickrama ES, Cassim MRN, Wijeyarathne M. Salvage of bleeding renal allograft following biopsy, with suture technique: a case report. J Med Case Rep 2016; 10:82. [PMID: 27039173 PMCID: PMC4818873 DOI: 10.1186/s13256-016-0870-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Percutaneous renal biopsy is a valuable procedure in the management of and prognostication for patients with renal disease. Complications, although rare, occur with renal biopsies. Arteriovenous fistulas and heavy bleeding are notable complications. In this report, we describe simple suturing of the biopsy tract for salvage of a graft destined for a nephrectomy due to a profusely bleeding arteriovenous fistula. Case presentation A 20-year-old Sri Lankan man with end-stage renal disease due to steroid-resistant nephrotic syndrome underwent a renal transplant. He had poor urine output following the surgery, and a renal biopsy was performed to diagnose his renal pathology. He experienced poorly controlled postprocedural hypertension, and he had four episodes of gross hematuria that required blood transfusion. Coil embolization was delayed due to technical issues, and a graft nephrectomy was planned following the fourth episode of hematuria, which was the most severe. A Doppler scan revealed a slender, iatrogenic arteriovenous fistula corresponding to the biopsy tract, with very high flow rates. With knowledge of the anatomy of the fistula, we performed suturing of the tract to obliterate the fistula as a last resort to salvage the graft. The surgical procedure stopped the bleeding, and the patient made a full recovery with an excellent quality of life. Conclusions In our patient, a renal transplant biopsy revealed acute tubular necrosis. The incidence and treatment of fistulas and differences in complication rates among native and graft kidney biopsies are discussed.
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Affiliation(s)
- Aruna Prasanna
- Vascular and Transplant Division, University Surgical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 10, Sri Lanka
| | - Ranga Migara Weerakkody
- Renal Services, University Medical Unit, National Hospital of Sri Lanka, Regent Street, Colombo 10, Sri Lanka.
| | | | - Mohammed Rezni Nizam Cassim
- Vascular and Transplant Division, Department of Surgery, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka
| | - Mandika Wijeyarathne
- Vascular and Transplant Division, Department of Surgery, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 8, Sri Lanka
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Prasad N, Kumar S, Manjunath R, Bhadauria D, Kaul A, Sharma RK, Gupta A, Lal H, Jain M, Agrawal V. Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications. Clin Kidney J 2015; 8:151-6. [PMID: 25815170 PMCID: PMC4370312 DOI: 10.1093/ckj/sfv012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/03/2015] [Indexed: 01/12/2023] Open
Abstract
Background Percutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compare the biopsy yield and complications rate of the real-time ultrasonagram (USG)-guided PRB and needle tracking with and without needle guide in two different study periods. Methods We compared the yield and complications of 2138 kidney biopsies performed in two different periods, 1510 biopsies during the first period from April 2004–December 2010 and 628 biopsies during second period from January 2011–March 2013. All biopsies in both periods were performed by nephrologists. Radiologists provided the real-time image without needle guide during the first period while nephrologists performed both imaging and biopsy with needle guide during the second period. Results Of all the 2138 patients, 226 (10.5%) patients developed 118 minor and 108 major complications. Only 13 (2.1%) major complications occurred in the second period and 95 (6.7%) in the first period (P < 0.001). The relative risk of developing a major complication without guide was 3.04 times greater than that of the biopsies performed with use of the guide. The mean number of glomeruli per biopsy obtained during the second period (17.98 ± 6.75) was significantly greater than that of the first period (14.14 ± 6.01) (P = 0.004). The number of passes to acquire adequate tissue (P = 0.001) and percentage of cortex on biopsy (P = 0.001) were also significantly better in the second period. The optimal observation period post biopsy is 24 h. Conclusions Real-time USG imaging supported by needle guide device is associated with better biopsy yield and fewer complications.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Shashi Kumar
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Revanasiddappa Manjunath
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Anupama Kaul
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Raj K Sharma
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Amit Gupta
- Department of Nephrology and Renal Transplantation , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Hira Lal
- Department of Radiology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Manoj Jain
- Department of Pathology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
| | - Vinita Agrawal
- Department of Pathology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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Cakmakci E, Caliskan KC, Turkoglu OK, Cakmakci S, Ozcelik G, Yilmaz E, Turk S, Ozagari A, Ucan B. A modified technique for real time ultrasound guided pediatric percutaneous renal biopsy: the angled tangential approach. Quant Imaging Med Surg 2014; 4:190-4. [PMID: 24914420 DOI: 10.3978/j.issn.2223-4292.2014.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/09/2014] [Indexed: 11/14/2022]
Abstract
AIM Pediatric renal biopsy may result in serious hemorrhagic complications, requiring additional diagnostic procedures, blood transfusion, vascular interventions, and prolongation of hospitalization. The aim of the present study was to propose the angled tangential approach technique for real-time ultrasound-guided pediatric percutaneous renal biopsy. METHODS A retrospective analysis of 166 percutaneous biopsies from June 2004 to May 2009 was performed. Patients' medical records, pathology results, and complications were reviewed. RESULTS No major complications were seen in the study group. The most frequently occurring minor complication was macroscopic hematuria, which occurred at the rate of 9.6%. Hematoma was detected in three cases and regressed spontaneously in all cases. CONCLUSIONS The angled tangential approach is a safe technique and an alternative option in pediatric percutaneous renal biopsies.
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Affiliation(s)
- Emin Cakmakci
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Kosti Can Caliskan
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Ozlem Kolcak Turkoglu
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Selma Cakmakci
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Gul Ozcelik
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Engin Yilmaz
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Sebnem Turk
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Aysim Ozagari
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
| | - Berna Ucan
- 1 Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 2 Department of Radiology, Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey ; 3 Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey ; 4 Department of Pediatrics, Division of Pediatric Nephrology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 5 Department of Pediatric Surgery, Dr. Sami Ulus Children's Hospital, Ankara, Turkey ; 6 Department of Anesthesia and Reanimation, 7 Department of Pathology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey ; 8 Department of Radiology, Dr. Sami Ulus Children's Hospital, Ankara, Turkey
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