Ultrasonography as a predictor of overt bleeding after renal biopsy.
BACKGROUND
Renal biopsy is essential for the diagnosis of kidney diseases, but complications, particularly bleeding incidents, remain problematic.


METHODS
To evaluate the frequency of renal biopsy complications, and to reveal clinical and laboratory factors associated with overt bleeding complications, focusing on those available at hospital ward, we conducted a retrospective observational study for the period between 2001 and 2005 at Mie University Hospital in patients who underwent percutaneous renal biopsy of a native kidney. Of a total of 323 patients, 317 met the inclusion criteria.


RESULTS
Only one patient (0.3%) required blood transfusion or intervention to stop bleeding. The mean decrease in hemoglobin (Hb) after biopsy was 0.43 +/- 0.7 g/dL. Hb decreased > or =1.0 g/dL in 66 patients (20.8%) and > or =10% in 32 patients (10.1%). On ultrasonography, perirenal hematoma was detected immediately after biopsy in 273 patients (86.1%), and 41 patients (12.9%) showed hematoma > or =2 cm in width. Analgesics were required for back pain in 67 patients (21.1%). Vasovagal response developed in 31 patients (9.8%). Macrohematuria occurred in 12 patients (3.8%). Urinary catheter was used in 161 patients (50.8%). For Hb decrease > or =10% after biopsy, multivariate analysis revealed perirenal hematoma (> or =2 cm) as a significant factor. Other significant factors were prolonged international normalized ratio of prothrombin time, elevated blood pressure on hospital admission, older age, increased serum creatinine level, and steroid use.


CONCLUSIONS
Perirenal hematoma > or =2 cm on ultrasonography immediately after biopsy might well represent a predictive factor for bleeding complications.
Ishikawa
Eiji
E
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan. ishijin@clin.medic.mie-u.ac.jp.
Nomura
Shinsuke
S
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Hamaguchi
Tomiya
T
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Obe
Toshihide
T
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Inoue-Kiyohara
Michiyo
M
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Oosugi
Kazuki
K
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Katayama
Kan
K
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
Ito
Masaaki
M
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edo-Bashi, Tsu, Mie, 514-8507, Japan.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle / Q000009:adverse effects*; D001803:Blood Transfusion; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000209:etiology; D014463:Ultrasonography; D055815:Young Adult
D000700:Analgesics; D015415:Biomarkers; D006454:Hemoglobins