title: Subclinical growth of an arteriovenous fistula associated with renal biopsy: a case report.
abstract: Renal biopsy is not free from complications and patients who undergo this procedure are usually hospitalized to receive intensive care for several days after biopsy. In contrast, after this period, routine follow-up to detect biopsy-associated complications is rarely scheduled, unless the patient develops a clinical manifestation. We describe a case of marked enlargement of arteriovenous fistula in the kidney that occurred many years after renal biopsy. In contrast to the previous cases requiring interventional radiology, our patient showed subclinical growth of fistula over about nine years.
  
  
  
  A 24-year-old man with a history of percutaneous renal biopsy was hospitalized for interventional radiology. Gross hematuria emerged shortly after biopsy, but completely disappeared with administration of hemostatic agents and bed rest. Subsequently, the patient had few symptoms for many years. A giant fistula (a gourd-shaped mass, size 26 × 22 and 12 × 11 mm) was unexpectedly detected by ultrasonography performed for examination of an unrelated disorder (slight elevation of serum transaminase) at 9 years after the original biopsy. The fistula was successfully treated with radiological intervention. Thus, subclinical development of complications associated with renal biopsy should be considered, even in an uneventful course.
  
  
  
  This case provides a platform to discuss the importance of long-term follow-up of patients after renal biopsy despite of its difficulty.
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan. takeshin@jichi.ac.jp.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Takeda
authors.affiliation: Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kanazawa
authors.affiliation: Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ugajin
authors.affiliation: Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Shigeyoshi
authors.initials: S
authors.lastname: Kijima
authors.affiliation: Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Imai
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Sugase
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Horikoshi
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Tetsu
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.affiliation: Division of Nephrology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nagata
mesh_terms: D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000209:etiology*; D001707:Biopsy, Needle / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000473:pathology*; D008297:Male; D012077:Renal Artery / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Interventional radiology; Renal arteriovenous fistula; Renal biopsy