Kidney Week

Abstract: TH-PO0634

Renal Arteriovenous Fistulas After Percutaneous Kidney Biopsy: The Role of Doppler Ultrasonography

Session Information

• CKD: Clinical - Guidelines, Biomarkers, Progression, Procedures, Outcomes, and More
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Alvarez Velazquez, Luis Rafael Rafael, Instituto Mexicano del Seguro Social, Mexico City, Mexico

Luis Rafael Rafael Alvarez Velazquez, MD

• Moguel, Bernardo, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Bernardo Moguel, MD

• Cortez, Brenda, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Brenda Cortez, MD

• Roldan, Ruben Garrido, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Ruben Garrido Roldan, MD

• Flores Fonseca, Milagros Melissa, Instituto Mexicano del Seguro Social, Mexico City, Mexico

Milagros Melissa Flores Fonseca, MD, MSc

Background

Renal arteriovenous fistula(rAVF)is a vascular complication of percutaneous kidney biopsy (PKB), with a reported incidence of 1–18%.Doppler ultrasound(DUS)enables detection of symptomatic and silent lesions and guides surveillance or intervention.We aimed to determine the incidence and outcomes of Doppler-detected rAVF after PKB

Methods

Retrospective observational study including all PKB performed by interventional nephrologist (IN) between 2019 and 2025.rAVFs were diagnosed by DUS based on arterialized venous flow, turbulent high-velocity flow, and low-resistance arterial waveforms (Fig. 1).Major complications included hematoma > 40mL or gross hematuria with hemoglobin decrease ≥1 g/dL, and/or blood transfusion (BT),nephrectomy, embolization or death; minor complications required no intervention

Results

Among 1,132 kidney biopsies, 28 patients developed rAVF(incidence 2.47%),equally distributed between native and allograft.Women represented 60.7% of cases.Mean serum creatinine was 2.2 mg/dL and eGFR 52.1 mL/min. Mean kidney length was 10.3 cm,renal volume 218.2 cc. Baseline mean resistive index was 0.68 and mean peak systolic velocity (PSV) 39.1 cm/s at the PKB site.
17 patients (60.7%) presented with isolated rAVF without additional compolications. Minor complications beyond rAVF occurred in 5 patients (39.3)%,more frequently after native PKB(50%vs28.6%).Hematoma was the most common in 25%, followed by hematuria in 14%.
Major complications occurred in 5 patients (18%),predominantly after native PKB(28.6% vs 7%).Hemoglobin decrease >1 g/dL occurred in 14.3% and BT in one patient.Conservatively management occurred in 89.3% and endovascular intervention was required in 10.7% of cases (all native PKB), with success in all cases.This group had higher rates of active pregnancy, greater skin to kidney depth, higher Doppler PSV (p<0.05). No nephrectomy or deaths occurred (Fig.1).

Conclusion

rAVF was an infrequent complication requiring expertise for diagnosis and follow-up, intervention was reserved for progressive DUS abnormalities or hemodynamic compromise. Highlighting the relevance of IN assessment for early recognition of high-risk DUS patterns and timely endovascular or surgical management.