Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Biostatistics, University of Washington, Seattle, Washington.
Clin J Am Soc Nephrol. 2020 Nov 6;15(11):1595-1602. doi: 10.2215/CJN.04710420. Epub 2020 Oct 15.
Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare.
A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.
Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
在急性肾疾病和慢性肾脏病的诊断中，通常会进行原生肾脏活检。由于该操作具有侵袭性，因此并不罕见与出血相关的并发症。美国国立卫生研究院、国家糖尿病与消化和肾脏疾病研究所赞助的肾脏精准医学项目要求所有参与者进行肾脏活检；因此，本分析的目的是研究在肾脏成像下使用自动化设备进行原生肾脏活检的并发症发生率。
设计、设置、参与者和测量：这是一项系统评价和文献荟萃分析，分析对象为 1983 年 1 月至 2018 年 3 月期间发表的文献。最初的 PubMed 搜索共产生了 1139 篇手稿。使用预定的选择标准，最终有 87 篇手稿被纳入最终分析。使用比例的随机效应荟萃分析来获得并发症发生率的综合估计值。使用 Freeman-Tukey 双弧形变换来稳定方差，因为并发症很少见。
本研究共纳入了 118064 例活检。患者年龄在 30 至 79 岁之间，45%的患者为女性。根据我们的荟萃分析，活检部位疼痛估计发生在 4.3%的活检患者中，血肿估计发生在 11%，肉眼血尿估计发生在 3.5%，需要输血的出血估计发生在 1.6%，仅 0.3%的患者需要干预以止血。归因于原生肾脏活检的死亡是一种罕见事件，仅估计在所有活检中发生 0.06%，但仅在门诊活检中发生 0.03%。并发症发生率在住院患者和急性肾疾病患者中更高。报告的并发症因研究类型和地理位置而异。
尽管原生肾脏活检是一种有创的诊断性操作，但出血并发症的发生率较低。虽然罕见，但活检后仍可能发生死亡。在因急性肾损伤住院的患者中，肾脏活检后更常出现并发症。
