Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, M5G 1H4, Canada.
Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Nephrol. 2017 Oct;32(10):1927-1934. doi: 10.1007/s00467-017-3680-x. Epub 2017 May 5.
We aimed to evaluate the role of post-procedural hemoglobin (hb), without pre-discharge ultrasound (US), after US-guided renal biopsy in children.
A retrospective review was conducted of consecutive outpatient native kidney biopsies over an 8-year period. Procedures were performed under real-time US guidance. Data collected included number of passes, presence and size of perinephric hematoma, age, body mass index (BMI), blood pressure (BP), fasting status, hb and platelets. Continuous variables were expressed as mean ± standard deviation, group differences were tested with Student's unpaired t test and analysis of variance and correlations were assessed using Pearson's r. Significance was defined as p < 0.05. Hb changes (g/L), percentage hb (%hb) change, hematoma size and positive and negative predictive values (PPV, NPV, respectively) were analyzed.
A total of 330 procedures in 300 children (141 females, mean age 11.2 ± 4.30 years) were analyzed. Post-procedural hematoma occurred in 63%. There was a significant (p = 0.0001) post-procedural hb decrease of 6.3 ± 5.5 g/L and %hb decrease of 4.56 ± 4.01%. Fasting during pre-procedural hb estimation and procedural hematoma was associated with a greater hb drop. A ≥10% hb drop had 73% PPV for repeat blood work and US and a 17% PPV for admission, whereas a <10% hb drop had a NPV of 84% and 98%, respectively. Hb change showed a weak correlation with age, and hematoma size showed a weak inverse correlation with platelet count, but no correlation with BMI, number of passes or BP.
Bleeding complications from US-guided native kidney biopsies in pediatric outpatients can be safely followed by a complete blood count at 6 h post procedure. A 10% hb decrease is strongly associated with requirement for further testing and/or admission.
我们旨在评估在超声引导下肾活检后，不进行出院前超声（US）检查时，术后血红蛋白（hb）的作用。
对 8 年内连续进行的门诊肾活检的患者进行回顾性分析。所有操作均在实时超声引导下进行。收集的数据包括穿刺针数、肾周血肿的存在和大小、年龄、体重指数（BMI）、血压（BP）、禁食状态、hb 和血小板。连续变量用平均值±标准差表示，组间差异用学生独立样本 t 检验和方差分析进行检验，用 Pearson 相关系数评估相关性。定义 p 值＜0.05 为差异有统计学意义。分析 Hb 变化（g/L）、%hb 变化、血肿大小和阳性预测值（PPV）、阴性预测值（NPV）。
共分析了 300 名儿童（141 名女性，平均年龄 11.2±4.30 岁）的 330 次操作。术后血肿发生率为 63%。术后 hb 显著下降（p=0.0001），平均下降 6.3±5.5g/L，%hb 下降 4.56±4.01%。术前 hb 评估和操作时的禁食与更大的 hb 下降有关。Hb 下降≥10%时，再次查血和 US 的 PPV 为 73%，住院的 PPV 为 17%；而 Hb 下降＜10%时，NPV 分别为 84%和 98%。Hb 变化与年龄呈弱相关，血肿大小与血小板计数呈弱负相关，但与 BMI、穿刺针数或 BP 均无相关性。
在儿科门诊患者中，超声引导下的肾活检后，可在术后 6 小时通过全血细胞计数安全地进行随访。Hb 下降 10%与进一步检查和/或住院的需求密切相关。
