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Kidney Week

Abstract: TH-PO1120

Reassessment of Native and Transplant Renal Biopsy Complications and Risk Factors as Performed by Nephrologists from a Large Australian Renal Unit

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Cheong, Jamie X., The Royal Melbourne Hospital, Parkville, Victoria, Australia
  • Champion de Crespigny, Paul J., The Royal Melbourne Hospital, Parkville, Victoria, Australia
Background

Renal biopsies are the gold standard for diagnosis for many renal conditions. Approximately 250 renal biopsies per million population are performed in Australia per annum, 75 per million in the USA. In Australia biopsies are performed percutaneously under ultrasound guidance with spring loaded needles predominantly by nephrologists. Worldwide minor complications (5-30%) and major complications (1-7%) have been reported. Risk factors include hypertension, acute kidney injury, aspirin use, gender, BMI. There remains limited high quality data on biopsy complications and risk factors. We conducted a single centre audit of percutaneous renal biopsies with the aim to clarify complication rates and identify risk factors.

Methods

We retrospectively reviewed 997 native and transplant renal biopsies performed by nephrologists or trainees at our large tertiary renal and transplant centre between October 2015 to April 2018. Risk factors were recorded on a regulated form and review of the medical records. Major bleeding was defined as transfusion, embolisation or surgical management. Minor complications included macroscopic haematuria, urinary retention, non-diagnostic sample and pain.

Results

We report a total of 58 (5.8%) complications with 12 (1.1%) major complications and 46 (4.7%) minor complications. No nephrectomies or deaths were recorded. Macroscopic haematuria and pain were the most common. We found a significant increase in complications with systolic blood pressure >160 mmHg but no difference with diastolic blood pressure >90 mmHg. Of the 197 patients on aspirin, 17 (29.3%) had complications compared to those not on aspirin (5.1%, p=0.06). Urea ≥ 20 mmol/L had increased complications compared to Urea < 20 mmol/L(7.9% vs 5.3%, p=0.232). Males were more likely to have complications than females (10.2% v 3.2%, p<0.001). There were no increase in complications from BMI or gauge. 38(3.4%) patients recorded an incidental decrease in haemoglobin of > 10g/L but only 2 of these had documented complications.

Conclusion

Complication rates following percutaneous renal biopsies have markedly improved. Ongoing collection of prospective data and increase size of study is required. Detailed data will help provide further insight into the risks of renal biopsies and potential modifiable risk factors.