Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Image-guided renal parenchymal biopsies- how we do it

This paper is a multi-institutional review of image-guided renal parenchymal biopsies. Among the topics covered are indications, preprocedural considerations, biopsy technique, complications, and postprocedural management. Both native kidney and transplant kidney biopsies are considered in this review.

Validation and modification of existing bleeding complications prediction models for percutaneous renal biopsy: a prospective study

Background

Bleeding complications following percutaneous renal biopsy (PRB) are a significant clinical concern. This study aimed to validate and refine existing prediction models for post-biopsy bleeding to support more accurate clinical decision-making.

Methods

Clinical data from 471 PRB patients were examined in this prospective analysis. Ultrasounds were performed immediately and 6 h post-biopsy to identify perinephric hematomas. Patients exhibiting severe pain, a hemoglobin drop of >10 g/L, symptomatic hypotension, hematuria within 7 days post-procedure underwent repeat ultrasound to assess for bleeding complications. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with bleeding risk. The predictive performance of three kidney biopsy risk calculators (KBRC) was evaluated using the area under the receiver operating characteristic (AUROC) curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) to determine clinical utility. Nomograms were developed for each model to facilitate clinical application.

Results

Univariate analysis identified body mass index (BMI), hemoglobin, and ultrasound findings as significant predictors of bleeding complications. In multivariable analysis, BMI, immediate ultrasound, and 6-h ultrasound data remained significant (p < 0.05). The three models compared included: KBRC-5 (age, body mass index (BMI), platelet count, hemoglobin, kidney size), KBRC-5 with immediate ultrasound data (IKBRC), and KBRC-5 with 6-h hematoma size (SKBRC). The AUROC values for these models were 0.683, 0.786, and 0.867, respectively (p < 0.001). NRI and IDI analyses demonstrated that adding immediate or 6-h ultrasound data significantly improved the risk reclassification ability of the KBRC-5 model (p < 0.05). DCA indicated that IKBRC provided the highest net benefit for risk thresholds between 25% and 77%, while SKBRC was superior for thresholds between 10% and 95%. Nomograms were constructed for each model, allowing clinicians to estimate the probability of bleeding complications by summing scores for each predictor. Calibration curves showed good agreement between predicted and observed probabilities.

Conclusion

Incorporating real-time ultrasound data post-PRB significantly enhances the predictive accuracy and risk reclassification capability of bleeding risk models. These findings provide critical insights for guiding clinical management decisions in patients undergoing renal biopsy.

Desmopressin as a hemostatic and blood sparing agent in bleeding disorders

Intranasal, subcutaneous, or intravenous desmopressin can be utilized to release von Willebrand Factor and Factor VIII into circulation, enhance platelet adhesion and shorten bleeding time. Due to these properties, desmopressin can be effective in controlling bleeding in mild hemophilia A, certain subtypes of von Willebrand disease and in acute bleeding from uremia, end stage renal disease, and liver disease. Its use, however, can be complicated by hyponatremia and rarely arterial thrombotic events. While desmopressin has also been used as a prophylactic blood sparing agent in orthopedic, renal, and hepatic procedures, clinical studies have shown limited benefit in these settings. The purpose of this article is to review the evidence for desmopressin in primary hematologic disorders, discuss its mechanism of action and evaluate its utility as a hemostatic and blood sparing product in various bleeding conditions.

Desmopressin Acetate Before Percutaneous Ultrasound-Guided Kidney Biopsy in Patients with Renal Failure - Is it Really Beneficial?

Introduction

The most common complication of percutaneous renal biopsy is bleeding, which can be seen in up to one-third of cases. The aim of this study was to evaluate the effect of prebiopsy administration of intranasal desmopressin acetate in reducing the incidence of biopsy-related bleeding complications in patients with significant renal dysfunction who underwent renal biopsy.

Methods

This was a retrospective, observational study of percutaneous native renal biopsies performed at our center from July 2014 to June 2018. Bleeding complication rates of patients with renal failure (estimated glomerular filtration rate [eGFR] <30 mL/minute/1.73 m²) who received desmopressin and those who did not receive desmopressin were compared.

Results

Desmopressin administration before renal biopsy in patients with eGFR <30 mL/minute/1.73 m² was associated with a significant reduction of bleeding complications (major and minor together; P = 0.025) and no significant reduction in major complications (P = 0.616) or intervention rates (P = 0.251) when compared with a group that did not receive desmopressin.

Conclusions

While prebiopsy intranasal desmopressin use was associated with a significant reduction of overall bleeding complications including major and minor complications, there was no reduction in the rate of other major complications and interventions.

Kidney Tissue Biopsy

Kidney tissue biopsy is a commonly performed procedure which is valuable in the work-up for patients with medical renal disease and renal transplant. This article will review indications, contraindications, technique and potential complications of kidney biopsy.

Bleeding Complications of Percutaneous Kidney Biopsy: Does Gender Matter?

The incidence of bleeding complications after percutaneous kidney biopsies is low.Female sex may be associated with a greater risk for bleeding complications after percutaneous kidney biopsies.This association and the plausible mechanisms require further evaluation in prospective study.

Blood Banking and Transfusion Medicine Challenges During the COVID-19 Pandemic

SARS-CoV-2 (also known as COVID-19) has been an unprecedented challenge in many parts of the medical field with blood banking being no exception. COVID-19 has had a distinctly negative effect on our blood collection nationwide forcing blood banks, blood centers, and the US government to adopt new policies to adapt to a decreased blood supply as well as to protect our donors from COVID-19. These policies can be seen distinctly in patient blood management and blood bank operations. We are also faced with developing policies and procedures for a nontraditional therapy, convalescent plasma; its efficacy and safety is still not completely elucidated as of yet.