Blake D. Niederhauser MD, Presenter: Nothing to Disclose

Thomas Duncan Atwell MD, Abstract Co-Author: Nothing to Disclose

Jaywant N. Mandrekar PhD, Abstract Co-Author: Nothing to Disclose

Dana L Williams RN, Abstract Co-Author: Nothing to Disclose

Gina Kay Hesley MD, Abstract Co-Author: Nothing to Disclose

Timothy Welch, Abstract Co-Author: Nothing to Disclose

To identify risk factors for serious bleeding complications following percutaneous core needle biopsy of the kidney.

A total of 7160 renal parenchymal biopsies were performed in 3617 patients from September, 2002 to December, 2009, of which, 6509 have been analyzed. Biopsies were performed under ultrasound-guidance using an 18 gauge biopsy device. Combined prospective and retrospective data collection included patient demographic information, medications, vital signs, and common lab values. Serious complications were determined as defined by the NCI’s Common Terminology Criteria for Adverse Events.  Associations between bleeding complication and risk factors of interest was assessed univariately using Chi-square (Fisher's exact) test or two sample t-test as appropriate.

Of 6509 biopsies analyzed, a total of 40 bleeding complications met or exceeded a grade 3 event, including bleeding requiring transfusion, angiography, embolization, or surgery for an overall complication rate of 0.61%. No deaths were determined to be a result of renal biopsy. Significant risk factors identified for bleeding complications include increased patient age (56.8 vs 51.1 years, p=0.028), serum blood urea nitrogen (BUN) (47.7 mg/dL vs 34.2 mg/dL , p<0.001), serum creatinine (3.00 mg/dL vs 1.89 mg/dL, p<0.001), and having a maximum systolic blood pressure (SBP) >160 mmHg vs SBP <160 mmHg (1.06% vs 0.49%, p=0.015).  Bleeding was more common following biopsy of a native kidney vs transplanted kidney (1.42% vs 0.36%, p<0.001).  No significant difference in complication rate was seen in respect to gender, race, body mass index (BMI), or international normalized ratio (INR) with screening threshold of 1.5.  Patient age was not significant when only biopsy of transplanted kidneys was analyzed.

Our reported complication rate is similar to previously reported studies, however our results suggest a significantly higher risk in biopsy of native kidneys. Patients with increased age, renal insufficiency, and SBP >160 mmHg are also at higher risk for complications.

A better understanding of risk factors for significant bleeding following biopsy allows physicians to tailor screening protocols to make the procedure as safe as possible.

Niederhauser, B, Atwell, T, Mandrekar, J, Williams, D, Hesley, G, Welch, T, Risk Factors for Complications of Percutaneous Kidney Biopsy: A Single Institution Review of 6,509 Cases.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9004970.html