Department of Nephrology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Ir J Med Sci. 2024 Oct;193(5):2537-2544. doi: 10.1007/s11845-024-03753-y. Epub 2024 Jul 12.
Percutaneous renal biopsy, although essential for renal disease diagnosis, is associated with a number of post-biopsy complications ranging from gross haematuria to AV fistula to death. In this study, we carried out an active haematoma surveillance and attempted to correlate renal sonological parameters-kidney length, renal parenchymal changes, renal cortical and parenchymal thickness for their potential use in prediction of post-renal biopsy complications.
This was a prospective study done from April 2022 to April 2023 on all adult patients undergoing native or transplant kidney biopsy. Baseline clinical, laboratory and renal sonological parameters were noted prior to biopsy. USG-guided renal biopsy was done and any haematoma at 0 h, 12 h and 24 h post-biopsy noted. Biopsy complications including need for any interventions were noted.
Out of the 240 patients enrolled in the study, 58.3% experienced post-biopsy complications. Among these, 5% of patients encountered major complications, with 3.33% necessitating medical intervention following renal biopsy procedures. A high percentage, 98.89%, exhibited hematoma formation within 12 h post-biopsy. Furthermore, our analysis revealed that a hematoma size exceeding 1.2 cm at the 12-h mark exhibited a sensitivity of 100% and specificity of 71% in predicting the need for blood transfusion. Renal parenchymal changes were the most reliable sonological parameters for predicting post-biopsy complication on multivariate analysis.
The incidence of major complications requiring interventions following renal biopsy is notably low. Our study highlights the significance of renal sonological characteristics, including parenchymal thickness, cortical thickness and parenchymal changes, in predicting these complications. Furthermore, we emphasize the utility of hematoma surveillance immediately post-biopsy and at the 12 h, as a valuable tool for predicting the necessity of post-biopsy interventions. This approach can aid in efficiently triaging patients and determining the need for further observation post-renal biopsy.
经皮肾活检虽然对肾脏疾病的诊断至关重要，但与多种活检后并发症相关，范围从肉眼血尿到动静脉瘘到死亡。在本研究中，我们进行了主动血肿监测，并试图将肾脏超声参数-肾脏长度、肾实质变化、肾皮质和实质厚度相关联，以预测肾活检后的并发症。
这是一项前瞻性研究，于 2022 年 4 月至 2023 年 4 月在所有接受原生或移植肾活检的成年患者中进行。在活检前记录基线临床、实验室和肾脏超声参数。进行超声引导下的肾活检，并在活检后 0 小时、12 小时和 24 小时观察任何血肿。记录活检并发症，包括是否需要任何干预。
在纳入研究的 240 名患者中，58.3%发生了活检后并发症。其中，5%的患者出现了严重并发症，3.33%的患者在肾活检后需要医疗干预。大多数患者（98.89%）在活检后 12 小时内出现血肿形成。此外，我们的分析表明，在 12 小时时血肿大小超过 1.2 厘米预测输血需求的敏感性为 100%，特异性为 71%。在多变量分析中，肾实质变化是预测活检后并发症的最可靠的超声参数。
需要干预的严重并发症的发生率明显较低。我们的研究强调了肾脏超声特征，包括实质厚度、皮质厚度和实质变化，在预测这些并发症中的重要性。此外，我们强调了活检后立即和 12 小时进行血肿监测的作用，作为预测活检后干预必要性的有用工具。这种方法可以帮助有效地对患者进行分类，并确定肾活检后进一步观察的必要性。
