Simard-Meilleur Marie-Christine, Troyanov Stéphan, Roy Louise, Dalaire Etienne, Brachemi Soumeya
Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada.
Division of Nephrology Division, Hôpital du Sacré-Cœur de Montréal, Montreal, Que., Canada.
Nephron Extra. 2014 Mar 22;4(1):42-9. doi: 10.1159/000360087. eCollection 2014 Jan.
The appropriate observation period, rate and risk factors of complications after a percutaneous renal biopsy remain debated.
We retrospectively studied native kidney biopsies performed in our institution between January 2007 and July 2011. Outpatients had either an 8- (67%) or a 24-hour (33%) observation period.
312 biopsies were reviewed (287 patients), 51% of patients were female and the mean age was 54 ± 15 years. Half of these biopsies were performed in outpatients. A total of 15% of patients developed a symptomatic hematoma, 9% received a red blood cell transfusion and 1% required an angio-intervention. Eighty-four percent of the complications manifested within the first 8 h, 86% at 12 h and 94% at 24 h. Outpatients experienced significantly less complications, all manifesting within the first 8 h, 14% required an observation period longer than planned. The risk of symptomatic hematoma increased to 11, 20, 35 and 40% in patients with >200, 140-200, 100-140 and <100 × 10(9)/l platelets, respectively (p = 0.002). It also increased in hemodialysis patients (29% compared to 14%, p = 0.02). We found no association of risk with the number of biopsy passes and only a trend with needle size.
Symptomatic hematomas occurred in 15% of kidney biopsies and were strongly associated with platelet count and hemodialysis. Outpatients experienced fewer complications; therefore, we can conclude that same-day discharge in selected patients is safe.
经皮肾活检术后的适当观察期、并发症发生率及危险因素仍存在争议。
我们回顾性研究了2007年1月至2011年7月在我院进行的自体肾活检。门诊患者的观察期为8小时（67%）或24小时（33%）。
共审查了312例活检病例（287例患者），51%为女性，平均年龄为54±15岁。其中一半的活检在门诊患者中进行。共有15%的患者出现有症状的血肿，9%接受了红细胞输血，1%需要进行血管介入治疗。84%的并发症在最初8小时内出现，86%在12小时内出现，94%在24小时内出现。门诊患者的并发症明显较少，均在最初8小时内出现，14%的患者需要比计划更长的观察期。血小板计数>200、140 - 200、100 - 140和<100×10⁹/L的患者出现有症状血肿的风险分别增加至11%、20%、35%和40%（p = 0.002）。血液透析患者的风险也增加（29%对比14%，p = 0.02）。我们发现风险与活检针穿刺次数无关，仅与针的大小有一定趋势关联。
15%的肾活检患者出现有症状的血肿，且与血小板计数和血液透析密切相关。门诊患者的并发症较少；因此，我们可以得出结论，在选定患者中当日出院是安全的。
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