Background: Hemorrhage is the most serious potential complication of percutaneous kidney biopsy. Patients are typically observed for at least 6-8 hours after a kidney biopsy, with serial measurements of vital signs and hemoglobin to monitor for major hemorrhage. This study assessed whether an immediate postbiopsy ultrasound can reliably exclude delayed major hemorrhage.
Methods: We retrospectively evaluated the clinical outcomes in 147 patients undergoing an outpatient native kidney biopsy with an 18-gauge needle at a large medical center during a 2.5-year period (January 2017 to June 2019). All patients underwent a standardized postbiopsy ultrasound to assess for active extravasation of blood. We extracted from the medical records vital signs and hemoglobin values obtained before the biopsy and at 2, 4, and 6 hours after the procedure. We ascertained whether any patients with a negative postbiopsy ultrasound developed a delayed major hemorrhage.
Results: Each patient underwent two or three biopsy passes. The mean patient age was 48±17 years, 49% were female, 37% were black, 53% had hypertension, and 16% had diabetes. Of the 142 patients without evidence of active extravasation on ultrasound, the BP, heart rate, and hemoglobin remained stable during 6 hours of observation. All were discharged after 6 hours, and none had a late bleeding complication.
Conclusions: If the immediate postkidney biopsy ultrasound does not show active bleeding, the patient is extremely unlikely to develop a late major hemorrhagic complication (negative predictive value, 100%). Such patients can be discharged home safely after a 2-hour observation, thereby simplifying their management.
Keywords: biopsy; glomerular and tubulointerstitial diseases; hemoglobins; hemorrhage; kidney; outpatients; retrospective studies.
Copyright © 2020 by the American Society of Nephrology.