title: Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience.
abstract: BACKGROUND
  The aim was to evaluate the risk for major hemorrhage complications (MHC) prior to percutaneous renal biopsy and apply a specific procedure in high-risk patients to decrease their incidence. Hemorrhage complications that required blood transfusion or other interventions were diagnosed as MHC.
  
  
  METHODS
  One retrospective (Group A, n = 1314) and two prospective cohorts (Group B, n = 249 and Group C, n = 422) were involved in the study. Group A was used to establish a risk equation for MHC, Group B to test its performance, and Group C to evaluate the efficacy of the proposed procedure to reduce MHC incidence. Group C was classified, based on the equation, into high-risk (C1) and low-risk (C2) patients, who received different interventions. The intervention in Group C1 consisted of use of 18-gauge needles, a 12-h rest period post-operation, and reptilase injection; in Group C2, 16-gauge needles were used, with a 6-h rest, and no reptilase injection. Group B was also divided into B1 (high-risk) and B2 (low-risk) using the same cut-off, for further comparison.
  
  
  RESULTS
  (1) In Group A, 4.8% of patients experienced MHC and the equation: Logit (PMHC) = 0.022 × mean arterial pressure (mmHg) + 0.216 × bleeding time (min) - 0.011 × eGFR [ml/(min 1.73 m(2))] - 0.894 × kidney length (cm) - 2.100 × renal cortical thickness (cm) + 6.225 (cutoff = -1.664) was established. (2) The area under the receiver operating characteristic curve was 0.848 (95 % CI 0.797-0.890) for Group B. (3) MHC occurred in 4.8 and 2.8% of patients in Group B and C, respectively; Group B1 suffered significantly more frequent gross hematuria, hematoma and MHC than Group C1; however, no significant difference except for large hematoma was found between Groups B2 and C2 for all complications.
  
  
  CONCLUSIONS
  The equation is reliable to predict the risk for MHC; the interventions proposed can decrease the incidence of MHC in high-risk patients.
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Chao
authors: C
authors: Wang
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Yang
authors: Y
authors: Yang
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Liping
authors: L
authors: Jin
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Ying
authors: Y
authors: Zhang
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Guanglei
authors: G
authors: Chen
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Zhuliang
authors: Z
authors: Zhou
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Minghui
authors: M
authors: Song
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Qingman
authors: Q
authors: Gao
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Changchun
authors: C
authors: Li
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Tao
authors: T
authors: Pan
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China.
authors: Fagui
authors: F
authors: He
authors: Kidney Therapy Center of Traditional Chinese and Western Medicine of Chinese Army, Beidaihe Sanatorium of Beijing Military Region, No. 4, Xihaitan Road, Beidaihe District, Qinhuangdao, Hebei Province, China. malu281@163.com.
authors: Lu
authors: L
authors: Ma
mesh_terms: D000328:Adult; D019540:Area Under Curve; D062186:Arterial Pressure; D012103:Batroxobin / Q000008:administration & dosage; D001706:Biopsy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D001803:Blood Transfusion; D005260:Female; D005919:Glomerular Filtration Rate; D006406:Hematoma / Q000209:etiology; D006417:Hematuria / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006490:Hemostatics / Q000008:administration & dosage; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D055641:Mathematical Concepts; D008875:Middle Aged; D009339:Needles; D009929:Organ Size; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D006490:Hemostatics; D012103:Batroxobin
keywords: Biopsy; Complications; Hemorrhage; Intervention; Risk adjustment