Fontana Céline, Diebold Matthias, Amico Patrizia, Hirt-Minkowski Patricia, Wehmeier Caroline, Hopfer Helmut, Menter Thomas, Schaub Stefan, Steiger Juerg, Dickenmann Michael
Clinic for Transplantation Immunology and Nephrology, University Hospital, Basel, Switzerland.
Institute for Clinical Pathology, University Hospital Basel, Basel, Switzerland.
Swiss Med Wkly. 2025 Jun 5;155:4409. doi: 10.57187/s.4409.
Renal biopsies provide important and decisive information for diagnosis and therapy. Although biopsies are considered safe, bleeding complications remain a concern. We analysed the complication rate after kidney biopsies in native and transplant kidneys and their association with platelet function analyser bleeding time (PFA BT) and estimated glomerular filtration rate (eGFR).
This single-centre observational study included all patients who underwent an ultrasound-guided kidney biopsy at the University Hospital Basel from 2015 to August 2019. The main objective was to investigate the association of PFA BT with significant bleeding complications in kidney biopsies. Significant bleeding was defined as a haemoglobin decrease of >10 g/l within 48 hours or the need for transfusion after bleeding, according to the discretion of the treating physician. The pre-biopsy assessment included bleeding time using PFA BT, INR, thrombocyte count, and eGFR.
A total of 819 kidney biopsies-285 native and 534 transplant-were analysed. Complications occurred in 32 biopsies (3.9%): 18 (6.3%) in native and 14 (2.6%) in transplant kidneys. Bleeding was the most frequent complication in both groups. Overall, low eGFR (p = 0.01) and prolonged PFA BT (p = 0.02) were associated with bleeding complications. In native kidney biopsies, inpatient biopsy was associated with bleeding complications (p = 0.005), while in transplant kidney biopsies, bleeding complications were associated with time after transplantation (p <0.001), prolonged PFA BT (p <0.001), and diagnostic biopsies (p = 0.01). In the multivariable model, low eGFR was the only significant factor associated with bleeding complications (odds ratio 3.57, 95% confidence interval 1.76-7.23, p <0.001).
A low eGFR, especially below 30 ml/min, is associated with increased bleeding risk in native and transplant kidney biopsies.
肾活检为诊断和治疗提供重要且决定性的信息。尽管活检被认为是安全的，但出血并发症仍是一个令人担忧的问题。我们分析了自体肾和移植肾活检后的并发症发生率及其与血小板功能分析仪出血时间（PFA BT）和估计肾小球滤过率（eGFR）的关系。
这项单中心观察性研究纳入了2015年至2019年8月期间在巴塞尔大学医院接受超声引导下肾活检的所有患者。主要目的是研究PFA BT与肾活检中严重出血并发症的关系。严重出血根据主治医生的判断定义为48小时内血红蛋白下降>10 g/l或出血后需要输血。活检前评估包括使用PFA BT测量出血时间、国际标准化比值（INR）、血小板计数和eGFR。
共分析了819例肾活检病例，其中285例为自体肾，534例为移植肾。32例活检（3.9%）出现并发症：自体肾18例（6.3%），移植肾14例（2.6%）。出血是两组中最常见的并发症。总体而言，低eGFR（p = 0.01）和延长的PFA BT（p = 0.02）与出血并发症相关。在自体肾活检中，住院活检与出血并发症相关（p = 0.005），而在移植肾活检中，出血并发症与移植后时间（p <0.001）、延长的PFA BT（p <0.001）和诊断性活检（p = 0.01）相关。在多变量模型中，低eGFR是与出血并发症相关的唯一显著因素（比值比3.57，95%置信区间1.76 - 7.23，p <0.001）。
低eGFR，尤其是低于30 ml/min，与自体肾和移植肾活检出血风险增加相关。
