Dr Mitch Carroll1, Dr SUSHEEL SHARMA1, Dr LOUISE BLAKE2, Dr BAILEY VICKERS1
1Ballarat Health Services, Ballarat, Australia, 2Barwon Health, Geelong, Australia
Aim
To describe bleeding complications and practices of renal biopsies performed at a single centre regional hospital over a five-year period, and to discuss risk factors for bleeding as well as the use of desmopressin pre-procedure.
Background
Renal biopsies are conducted to aid in the diagnosis of renal pathologies and guide management. Whilst clearly beneficial, complications can be significant including haematuria and perinephric haematoma formation, at times requiring transfusion, embolization, or even nephrectomy. Use of desmopressin to reduce these complications remains controversial.
Methods
Retrospective medical record review.
Results
153 percutaneous native renal biopsies were reviewed with bleeding complications occurring in 16.9% (n=26). Minor complications (not requiring intervention) occurred in 13.7% (n=21). Major complications requiring intervention occurred in 3.3% (n=5), with 2.6% requiring transfusion. One patient required interventional embolization and subsequent nephrectomy. There was no discrepancy in complications when accounting for demographics, or inpatient vs outpatient procedures. Rates were higher in patients with reduced eGFR and elevated urea, and when performed under ultrasound (direct and indirect visualisation) compared with computer tomography (5.9%, n=1, vs 18.4%, n=25). Desmopressin use was associated with lower bleeding rates (13% vs 19.2%). The most common diagnosis obtained was IgA nephropathy (19,6%, n=30), followed by diabetic/hypertensive nephropathy (17.7%, n=27) and pauci-immune glomerulonephritis in (9.2%, n=14).
Conclusions
In a regional centre, native renal biopsy bleeding complications were higher when performed under ultrasound and in patients with impaired renal function. Demographics, presence of anaemia, thrombocytopaenia, or hypoalbuminaemia did not affect complication rates. Minor complications and major complications requiring intervention were comparable in reported studies, however transfusion rates were higher in this study. Bleeding complications rates were lower in those who received desmopressin.
Biography:
I am a first year General Medicine Advanced Trainee currently completing six months of Renal Medicine in Ballarat, working towards a career aspiration to dual train in General Medicine and Nephrology. I have completed my basic training with Barwon Health and live in Geelong with my wife and co-registrar Louise.