title: Development of an outpatient native kidney biopsy service in low-risk patients: a multidisciplinary approach.
abstract: BACKGROUND
  In the US, native kidney biopsies are usually inpatient procedures. We developed an outpatient biopsy protocol for low-risk patients and assessed its safety and efficacy.
  
  
  METHODS
  Patients with an SBP <140 mm Hg and a BMI ≤35 who were not taking anticoagulants, ASA and NSAIDS in the preceding week were included. Biopsies were performed under ultrasound guidance using a 15-gauge needle that changed to a 14-gauge needle during the study. Patients were discharged after 5 h of observation if there were no signs of bleeding. Complications were carefully recorded.
  
  
  RESULTS
  Between November 2008 and April 2011, 105 patients underwent outpatient renal biopsies. A 15-gauge needle was used in 43 patients (group A) while a 14-gauge needle was used in 62 (group B). A median of 25 (range 4-64) glomeruli were obtained in group A versus 39 (range 0-107) in group B (p < 0.001). Complications requiring admission for observation occurred in 7 patients (16%) in group A versus 5 patients (8%) in group B (p = 0.22). One patient in group B had bleeding requiring intervention, while all other complications were minor. Nine complications occurred during the observation period, while 3 patients presented >48 h after biopsy. The mean cost per patient for each outpatient biopsy was USD 976 versus USD 5,489 for inpatients.
  
  
  CONCLUSIONS
  In a selected low-risk population, outpatient renal biopsy is safe with low complication rates and results in significant cost savings relative to elective inpatient biopsies. The use of a 14-gauge biopsy needle resulted in a greater yield of glomeruli without increased complications.
authors.affiliation: Renal Division, Brigham and Women's Hospital, Boston, Mass., USA. gearoidmm@gmail.com
authors.forename: Gearoid M
authors.initials: GM
authors.lastname: McMahon
authors.forename: Molly E
authors.initials: ME
authors.lastname: McGovern
authors.forename: Vanesa
authors.initials: V
authors.lastname: Bijol
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
authors.forename: Richard
authors.initials: R
authors.lastname: Foley
authors.forename: Karen
authors.initials: K
authors.lastname: Munkley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schnipper
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.forename: Julie
authors.initials: J
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D001706:Biopsy / Q000009:adverse effects* / Q000191:economics; D005260:Female; D006417:Hematuria / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D033183:Interdisciplinary Communication; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D018084:Ultrasonography, Interventional