Lees Jennifer S, McQuarrie Emily P, Mordi Natalie, Geddes Colin C, Fox Jonathan G, Mackinnon Bruce
Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Renal Unit, Ninewells Hospital, James Arnott Drive, Dundee, UK.
Clin Kidney J. 2017 Aug;10(4):573-577. doi: 10.1093/ckj/sfx012. Epub 2017 Mar 15.
Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding.
We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding.
There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P < 0.001). Aspirin was being taken at the time of biopsy in 327 of 1509 patients, with no significant increase in the risk of major bleeding (P = 0.93). Body mass index (BMI) data were available for 546 patients, with no increased risk of major bleeding in 207 patients classified as obese (BMI >30).
The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.
出血是经皮肾穿刺活检公认的并发症。本研究旨在描述一个中心15年间肾穿刺活检后严重出血的发生率，并探讨与严重出血相关的因素。
我们确定了2000年至2014年在格拉斯哥肾脏与移植科接受超声引导下经皮肾穿刺活检的成年连续患者。从电子病历中，我们收集了与活检指征、活检前后实验室检查、处方药物和诊断相关的数据。阿司匹林常规继续服用。我们将活检后严重出血定义为需要输血、手术或放射介入治疗或死亡。采用二元逻辑回归分析评估与严重出血风险增加相关的因素。
共有2563例患者接受了经皮肾穿刺活检（1499例择期，1064例急诊）。患者的平均年龄为57岁（标准差17），57.4%为男性。总体而言，严重出血率为2.2%。共有46例患者需要输血（1.8%），9例患者接受了栓塞治疗（0.4%），无患者需要肾切除术，1例患者因严重的晚期腹膜后出血死亡。与择期肾穿刺活检相比，急诊肾穿刺活检患者的严重出血更为常见（3.4%对1.1%；P＜0.001）。1509例患者中有327例在活检时正在服用阿司匹林，严重出血风险无显著增加（P = 0.93）。546例患者有体重指数（BMI）数据，207例肥胖患者（BMI＞30）严重出血风险未增加。
现代经皮肾穿刺活检后严重出血的风险较低。急诊进行活检时并发症更常见，这对获得知情同意有影响。我们的数据支持肾穿刺活检前不停用阿司匹林的策略。
