Sethi Imran, Brier Michael, Dwyer Amy
University of Louisville, Louisville, Kentucky Robley Rex VA Medical Center, Louisville, Kentucky.
Semin Dial. 2013 Sep-Oct;26(5):633-5. doi: 10.1111/sdi.12076. Epub 2013 Mar 12.
At our institution, kidney biopsies are performed by an interventional nephrologist with standardized guidelines using real-time ultrasound. We hypothesized that patient factors could predict post biopsy complications. We did a retrospective review of 100 patients who underwent renal biopsy. Prebiopsy data obtained included demographics, blood pressure, laboratory studies, and kidney size. Biopsy procedure information was also recorded. Complications and post biopsy imaging was noted. A minor complication was defined as one not requiring intervention while a major complication required interventions like readmission or blood transfusion. The average age was 47 years, 41 were men, 51 were black, 30 had diabetes, 42 were obese, and 81 had hypertension. Twenty-six patients had a complication; 14 minor and 12 major including 1 nephrectomy. Factors predictive of a complication were thrombocytopenia (p=0.002) and inpatient status (p=0.04). Drop in hemoglobin at 6 hours was moderately sensitive and specific for a bleeding complication with an ROC of 0.723. Thrombocytopenia and inpatient status are risk factors for complications after renal biopsy. Serum creatinine, obesity, blood pressure, kidney size, needle size, and number of passes were not predictive of a major complication in our study.
在我们机构,肾活检由介入肾脏病学家依据标准化指南并使用实时超声进行操作。我们假设患者因素可预测活检后并发症。我们对100例行肾活检的患者进行了回顾性研究。获取的活检前数据包括人口统计学资料、血压、实验室检查及肾脏大小。活检操作信息也予以记录。记录并发症及活检后影像学检查情况。轻微并发症定义为无需干预的并发症,而严重并发症则需要再次入院或输血等干预措施。平均年龄为47岁,41例为男性,51例为黑人,30例患有糖尿病,42例肥胖,81例患有高血压。26例患者出现并发症;14例为轻微并发症,12例为严重并发症,包括1例肾切除术。预测并发症的因素为血小板减少症(p = 0.002)和住院状态(p = 0.04)。6小时时血红蛋白下降对出血并发症具有中度敏感性和特异性,ROC为0.723。血小板减少症和住院状态是肾活检后并发症的危险因素。在我们的研究中,血清肌酐、肥胖、血压、肾脏大小、穿刺针大小及穿刺次数均不能预测严重并发症。