Kidney Week

Abstract: FR-PO0857

Safety of Acute Reduction of Blood Pressure to Enable Performance of a Kidney Biopsy

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Del Vecchio, Antonio, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Antonio Del Vecchio

• Aslam, Sadia, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Sadia Aslam, MD

• Asad, Maira, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Maira Asad, MBBS

• Liberto, Rosemary, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Rosemary Liberto, MPH

• Velez, Juan Carlos Q., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Juan Carlos Q. Velez, MD, FASN

Background

Percutaneous kidney biopsy (PKB) is often cancelled when arterial blood pressure (BP) is high because of bleeding risk, resulting in delay in diagnosis and logistical burden for patients. To overcome this barrier, acute reduction of BP (arBP) can be attempted prior to PKB. However, there is paucity of data reporting safety of this approach.

Methods

We retrospectively examined the effect of arBP in patients who underwent real-time US-guided PKB performed by a single operator. When BP was ≥150/90 mmHg pre-PKB, IV hydralazine 10 mg and/or IV labetalol 5-10 mg doses were given. Life-threatening complication (LTC) was defined as bleeding leading to hemorrhagic shock, embolization, nephrectomy or death. Clinically significant complication (CSC) was defined as radiological evidence of hematoma + either hemoglobin drop or gross hematuria that led to escalation of care. Hypotension intra- or post-PKB (H) was defined as a drop in systolic BP (SBP) ≥30 mmHg to a value <90 mmHg. Composite outcome (COMP) was: LTC + CSC + H (COMP). Rebound hypertension (RebHTN) was defined as BP ≥160/90 mmHg post-PKB.

Results

88 patients were included [medians: age 59 (44% women), serum creatinine (sCr) 1.9 mg/dL, platelets 230,000/µL, pre-PKB BP 138/76 mmHg]. arBP was done in 31 (35%). Median pre-PKB SBP was higher for those who required arBP compared to those who did not (163 vs 131 mmHg, p<0.001). Zero patients had LTC, 9 (10.2%) had CSC and 7 (7.9%) developed H. Four (12.9%) patients with arBP had a CSC compared to 5 (8.8%) of those without (p=0.54). Using Firth’s penalized logistic regression for low event rate and small sample size adjusted by sCr, the point estimates for CSC and COMP [OR: 1.39 (CI 0.30-5.67) and 1.91 (CI 0.59-5.98)] suggest a trend toward increased odds associated with arBP, though no significance was reached (p=0.65 and 0.27). RebHTN was not more common in the arBP group [6 (19.4%) vs. 8 (14%), p=0.51] and was not associated with CSC (0 cases).

Conclusion

Although no signal for a life-threatening risk was detected, the numerical trends for higher probability of CSC suggest that arBP should only be considered when the anticipated benefit of avoiding a delay in diagnosis outweighs the potential risks. A larger scale investigation is required to optimally assess the safety of arBP pre-PKB.