Day Case Renal Biospy, 3 Year Experience of Adequacy, Complications and Diagnostic Spectrum

M.Bairy, K.Beleed,S.Bhandari,A.T.Webb

Hull Royal Infirmary

Purpose: Percutaneous renal biopsy historically has been performed as an inpatient service with a potential high complication rate. However it is necessary for evaluation & monitoring of renal parenchymal disorders. We evaluated the safety and sample adequacy in a prospective study of 148 consecutive day case biopsies performed over 3years.

Design: 148 consecutive day case renal biopsies (real-time Ultrasound guided using a spring-loaded biopty gun with a 16 or 18-gauge needle) over a 3 year period were reviewed. Clotting profiles & platelet counts were normal in all patients. Aspirin or non steroidal anti-inflammatory drugs were discontinued where present at least one week prior to biopsy. The occurrence of major complications, readmission rate, the need for overnight stay and therapeutic interventions,sample adequacy and re-biopsy rates were examined.

Results: There were 148 biopsies (133 native and 15 transplants) in 144 patients. The median age of patients was 48 (range 16-81). Hypertension was present in 45.2% of patients. Proteinuria was the commonest indication for biopsy (105 patients) and 15 patients (10.1%) had nephrotic range proteinuria. Haematuria alone was the indication in 10 (6.6%). Renal impairment was present in 45.2% of the patientsAdequacy of tissue for diagnostic purposes was assessed by the number of glomeruli present and was sufficient in 93.25% of the biopsies. IgA Nephropathy was the commonest (18.2%).The overall complication rate was 12.7%. 2 patients stayed overnight due to hematuria (clots). Four patients (2.7%) were readmitted within the next week due to loin pain and gross haematuria.15 patients (10.1%) had haematoma on sonography perfomed directly after the biopsy, but none required blood transfusion or therapeutic interventions. Four patients were re-biopsied as day cases. No significant differences were noticed in the complication rate or tissue adequacy when an 18G needle was used as opposed to 16G. Bleeding complications were no more frequent in those with renal impairment.

Conclusion: Day case real time ultrasound guided renal biopsy using a spring-loaded biopty gun is a safe and reliable method of renal biopsy. Asymptomatic post biopsy haematoma remains the commonest complication, although no complications required medical intervention and overnight stay and readmission rates low. Tissue adequacy rate was satisfactory.

Relevance: Renal Biopsies performed in the Day case setting are safe and efficient and more convenient for patients and perhaps cost effective.