Published online Dec 25, 2023. doi: 10.5527/wjn.v12.i5.147
Peer-review started: July 20, 2023
First decision: September 4, 2023
Revised: September 11, 2023
Accepted: September 27, 2023
Article in press: September 27, 2023
Published online: December 25, 2023
Processing time: 155 Days and 8.5 Hours
Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions. Various studies have identified several risk factors associated with bleeding complications following the procedure, but these findings have shown inconsistency and variation.
To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam. We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context.
We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020. The outcomes of interest were post-biopsy bleeding and the need for blood transfusions. Demographics, clinical, laboratory and procedural-related data were collected. Logistic regression analysis was used to identify predictors of outcomes.
A total of 255 kidney biopsies were included, with 11% being performed on transplanted kidneys. The majority of biopsies were done under ultrasound guidance (83.1%), with the rest under computer tomography guidance (16.9%). The most common indications for biopsy were chronic kidney disease of undefined cause (36.1%), nephrotic syndrome (24.3%) and acute kidney injury (11%). Rate of bleeding complication was 6.3% – 2% frank hematuria and 4.3% perinephric hematoma. Blood transfusion was required in 2.8% of patients. No patient lost a kidney or died because of the biopsy. Multivariate logistic regression identified baseline hemoglobin [odds ratio (OR): 4.11; 95% confidence interval (95%CI): 1.12-15.1; P = 0.03 for hemoglobin ≤ 11 g/dL vs. > 11 g/dL) and the presence of microscopic hematuria (OR: 5.24; 95%CI: 1.43-19.1; P = 0.01) as independent risk factors for post-biopsy bleeding. Furthermore, low baseline platelet count was identified as the dominant risk factor for requiring post-biopsy transfusions. Specifically, each 10 109/L decrease in baseline platelet count was associated with an 12% increase risk of needing transfusion (OR: 0.88; 95%CI: 0.79-0.98; P = 0.02).
Kidney biopsies were generally well-tolerated. The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.
Core Tip: This retrospective study in Brunei Darussalam examined kidney biopsies from 2013 to 2020 and identified key risk factors for post-biopsy bleeding complications. Notably, it revealed that the presence of microscopic hematuria is a significant, previously unrecognized risk factor for such complications. Other findings included the impact of low baseline hemoglobin levels and platelet counts on bleeding and transfusion risk. These insights can assist clinicians in identifying high-risk patients and improving post-biopsy monitoring and care. Overall, the study enhances our understanding of kidney biopsy outcomes and patient safety.