门诊肾脏活检：单中心经验和文献回顾。

Outpatient Kidney Biopsy: A Single Center Experience and Review of Literature.

机构信息

Abdominal Center, Nephrology, Helsinki University and Helsinki University Hospital, Helsinki, Finland,

Abdominal Center, Nephrology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

出版信息

Nephron. 2020;144(1):14-20. doi: 10.1159/000503255. Epub 2019 Oct 2.

DOI:10.1159/000503255

PMID:31578024

Abstract

BACKGROUND

A kidney biopsy is an important tool in managing kidney diseases. Bleeding is the most significant complication. The biopsy can be performed as an inpatient or an outpatient procedure with a shorter post-biopsy bed rest and monitoring period. It is cost-effective, but raises some questions about patient safety. At Helsinki University Hospital, the majority of elective kidney biopsies have been performed as outpatient procedures since 2010. The aim of this study was to retrospectively evaluate the safety and risk factors of this protocol.

METHODS

We collected data from all patients undergoing an elective outpatient biopsy of a native or transplanted kidney following the outpatient protocol between January 2011 and February 2016. We recorded the data on the biopsy procedure and complications: bleeding (hematoma or macrohematuria), severe pain, death, or "other" (infection, accidental puncture of another organ). A complication was classified as major, if it required interventions such as transfusion or radiological or surgical intervention.

RESULTS

Over a 5-year period, 824 (448 native and 326 transplant kidney) patients were biopsied. In total, 94 (11.4%) had a complication, but only 4 patients (0.5%) had a major complication; no deaths were recorded. All major and 70 minor complications emerged during post-biopsy monitoring (4-6 h). Patients with complications were younger (p = 0.001), female (p < 0.001), and had lower hemoglobin (p = 0.001) than those without. Transplant biopsies were associated with fewer complications than native kidney biopsies (p= 0.002).

CONCLUSIONS

In selected patients, an outpatient kidney biopsy is a relatively safe procedure.

摘要

背景

肾活检是肾脏疾病诊治的重要手段，出血是最常见的并发症。肾活检可以在住院或门诊进行，住院时间和监测时间更短。该方法具有成本效益，但对患者安全存在一些疑问。自 2010 年以来，赫尔辛基大学医院的大多数择期肾活检都是在门诊进行的。本研究旨在回顾性评估该方案的安全性和危险因素。

方法

我们收集了 2011 年 1 月至 2016 年 2 月期间按照门诊方案对自身或移植肾脏进行择期门诊肾活检的所有患者的数据。我们记录了活检程序和并发症的数据：出血（血肿或肉眼血尿）、严重疼痛、死亡或“其他”（感染、意外穿刺其他器官）。如果需要输血或放射学或手术干预，则将并发症分类为主要并发症。

结果

在 5 年期间，共对 824 例（448 例为自身肾脏，326 例为移植肾脏）患者进行了活检。共有 94 例（11.4%）患者出现并发症，但只有 4 例（0.5%）患者出现主要并发症；无死亡病例。所有主要并发症和 70 例轻微并发症均在活检后监测期间（4-6 小时）出现。有并发症的患者年龄更小（p = 0.001），女性（p < 0.001），血红蛋白水平更低（p = 0.001）。与自身肾脏活检相比，移植肾脏活检的并发症更少（p = 0.002）。