Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Abdom Radiol (NY). 2019 Jun;44(6):2316-2322. doi: 10.1007/s00261-019-01962-z.
To review the incidence of significant bleeding complications after ultrasound-guided percutaneous core native renal biopsies at a single center using a standardized technique.
A retrospective review of ultrasound (US)-guided percutaneous native renal core biopsies done at our institution from September 2005 to December 2015 was performed. Demographic and clinical data were collected at the time of biopsy, with additional clinical information recorded 24 h and 3 months after the biopsy. Bleeding complications were defined using the Common Terminology Criteria for Adverse Events (CTCAE, version 4.0) created by the National Institutes of Health.
2204 US-guided native renal core biopsies were performed during the study period, with 37 hemorrhages (1.64%) that were CTCAE grade 3 or higher. The rate of inadequate sampling as reported by pathology was extremely low (1.1%). Factors demonstrating a significant association with bleeding risk included estimated glomerular filtration rate (eGFR), specifically when the eGFR was less than 60 (p = 0.025), platelet count (p = 0.002), including a statistically significant decreased risk of bleeding with a platelet count greater than 100 (10/L) (p = <0.001), and performing four or more needle passes (p = 0.012). While female gender was also associated with an increased bleeding risk (p = 0.05), there was a significant association between females with a BMI ≥ 25 and a decreased bleeding risk (0.034). No statistically significant association between post-biopsy hemorrhage and aspirin use within 10 days prior to biopsy or a prior diagnosis of amyloidosis was demonstrated.
US-guided native renal biopsy is a safe procedure with a low rate of significant bleeding complications and a high tissue adequacy rate using an 18-gage spring-loaded biopsy device. Factors associated with increased bleeding risk include female gender, lower platelet counts, decreased eGFR and performing four or more needle passes, which has not been reported previously. Interestingly, females with a BMI ≥ to 25 demonstrated a decreased bleeding risk, and aspirin (81 mg or 325 mg) within 10 days of the procedure did not demonstrate a significant effect. While not shown in this current study, the relationship of very recent aspirin therapy with bleeding is yet to be defined. Similarly, the statistically significant decreased risk of bleeding complications in overweight or obese females requires further investigation.
回顾单中心应用标准化技术行超声引导下经皮核心肾活检后严重出血并发症的发生率。
对 2005 年 9 月至 2015 年 12 月在我院行超声引导下经皮肾活检的患者进行回顾性分析。在活检时收集患者的人口统计学和临床资料，并在活检后 24 小时和 3 个月记录额外的临床信息。出血并发症采用美国国立卫生研究院制定的不良事件常用术语标准（CTCAE，版本 4.0）进行定义。
研究期间共进行了 2204 例超声引导下经皮肾活检，其中 37 例（1.64%）发生 CTCAE 分级 3 级或更高级别的出血。病理报告显示，标本取材不足的发生率极低（1.1%）。与出血风险显著相关的因素包括估计肾小球滤过率（eGFR），特别是当 eGFR 低于 60 时（p=0.025）、血小板计数（p=0.002），血小板计数大于 100（10/L）（p<0.001）与出血风险降低相关，血小板计数小于 100（10/L）与出血风险升高相关，并且行 4 针或以上活检（p=0.012）。女性患者出血风险增加（p=0.05），但 BMI≥25 的女性患者出血风险降低（p=0.034）。未发现活检前 10 天内使用阿司匹林或既往诊断为淀粉样变性与活检后出血之间存在统计学显著关联。
使用 18 号弹簧加载活检装置行超声引导下经皮肾活检是一种安全的操作，严重出血并发症发生率低，组织学标本充足率高。与出血风险增加相关的因素包括女性、血小板计数较低、eGFR 降低和行 4 针或以上活检，这在之前的研究中尚未报道过。有趣的是，BMI≥25 的女性出血风险降低，而在操作前 10 天内使用阿司匹林（81mg 或 325mg）并未显示出显著影响。虽然本研究未显示，但近期使用阿司匹林与出血的关系尚待确定。同样，超重或肥胖女性严重出血并发症风险降低也需要进一步研究。
