Department of Endocrinology, Peking Union Medical College Hospital, Peking, China.
Department of Nephrology, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Int Urol Nephrol. 2024 May;56(5):1713-1720. doi: 10.1007/s11255-023-03860-2. Epub 2023 Nov 22.
Ultrasound-guided percutaneous renal biopsy (PRB) has been considered as a golden standard for CKD diagnosis and is employed to identify potential therapeutic targets since 1950s. Post-biopsy hemorrhage is the most common complication, while severe bleeding complication might cause nephrectomy or death. Therefore, how to reduce the occurrence of complications while ensuring the success of PRB is always a clinical research topic.
This study retrospectively collected and established a renal biopsy database of each patient who underwent ultrasound-guided PRB at a tertiary teaching hospital from September 2017 to December 2020 through the Health Information System. All the data were statistically processed by SPSS software.
A total of 1146 patients underwent PRB for various reasons. The overall rate of post-biopsy hemorrhage was 37.70% (432/1146). Of those bleedings, minor bleeding after PRB was found in 337 (29.41%), middle bleeding 84 (7.33%), major bleeding 11 (0.96%). Besides that, there were 96 patients (8.38%) reported their discomfort symptoms. There was no death. Females were at significantly increased risk of hemorrhagic complication than males (OR = 2.017, CI = 1.531-2.658). While the risk for hemorrhagic complication significantly decreased as BMI and platelet before renal biopsy increased (OR = 0.956, CI = 0.924-0.989; OR = 0.998, CI = 0.996-1.000). As the APTT time prolonged, the risk for hemorrhagic complication significantly increased (OR = 1.072, CI = 1.023-1.123). Those patients whose albumin were higher, also had higher risk for hemorrhagic complication than other patients (OR = 1.020, CI = 1.000-1.041). Specifically, postoperative urination within 4 h increased the risk for hemorrhagic complication (OR = 1.741, CI = 1.176-2.576).
Our analysis finds that the incidence of post-biopsy bleeding complication is 37.70%, and its risk is associated with female, lower BMI, lower platelet before renal biopsy, prolonged APTT, higher albumin, and postoperative urination within 4 h. The findings highlighted the importance of perioperative management for renal biopsy, including adequate risk assessment, tailored careful observation after PRB. And medical staff should pay more attention to fluid management after ultrasound-guided PRB.
自 20 世纪 50 年代以来，超声引导经皮肾活检（PRB）已被认为是 CKD 诊断的金标准，并用于确定潜在的治疗靶点。活检后出血是最常见的并发症，而严重的出血并发症可能导致肾切除或死亡。因此，如何在确保 PRB 成功的同时降低并发症的发生一直是临床研究的课题。
本研究通过医院健康信息系统回顾性收集了 2017 年 9 月至 2020 年 12 月在一家三级教学医院接受超声引导 PRB 的每位患者的肾活检数据库。所有数据均采用 SPSS 软件进行统计学处理。
共有 1146 例患者因各种原因接受 PRB。活检后出血的总体发生率为 37.70%（432/1146）。其中，337 例（29.41%）为 PRB 后轻度出血，84 例（7.33%）为中度出血，11 例（0.96%）为重度出血。此外，有 96 例（8.38%）患者报告有不适症状。无死亡病例。女性出血并发症的风险明显高于男性（OR=2.017，CI=1.531-2.658）。而随着 BMI 和肾活检前血小板的增加，出血并发症的风险显著降低（OR=0.956，CI=0.924-0.989；OR=0.998，CI=0.996-1.000）。随着 APTT 时间的延长，出血并发症的风险显著增加（OR=1.072，CI=1.023-1.123）。那些白蛋白较高的患者出血并发症的风险也高于其他患者（OR=1.020，CI=1.000-1.041）。具体来说，术后 4 小时内排尿会增加出血并发症的风险（OR=1.741，CI=1.176-2.576）。
我们的分析发现，活检后出血并发症的发生率为 37.70%，其风险与女性、较低的 BMI、较低的肾活检前血小板、延长的 APTT、较高的白蛋白和术后 4 小时内排尿有关。这些发现强调了围手术期管理对肾活检的重要性，包括充分的风险评估、PRB 后精心的个体化观察。医务人员应更加注意超声引导 PRB 后的液体管理。
