Post-Percutaneous Renal Biopsy Observation Time; Single Center Experience

Background: Percutaneous Renal Biopsy (PRB) should be performed to diagnose renal damage, to assess response to treatment and to predict prognosis.PRB is a safer procedure and mostly free of complications. Assessing optimal time duration post-PRB is important to predict Post-PRB complication and to reduce the cost of PRB. Aim: To reduce the Post-PRB observation time for optimal outcome and patient's safety. Methods: All PRBs were performed at the Nephrology Unit, Tripoli Central Hospital, Libya between May 2008 to December 2015. One hundred eighteen ultrasound-guided PRBs were done. After explaining the procedure and its possible complications, an informed consent was signed by patients. Coagulation profile PT, PTT, INR, BT, CT and CBC were done before PRB. Each biopsy was performed with an automated biopsy gun with a 16 -gauge needle under real-time US. Two biopsy specimens from lower pole of left kidney were taken from native kidneys. All patients were kept under close medical supervision and on bed rest for 2-hours. All patients had IV 500 ml normal saline and Lasix during the first 30 minutes, and asked to pass urine to check for macroscopic hematuria. US were done before the patient discharge Patients were followed by ultrasound and urine examination a week later. Statistical analysis: Statistical analysis was done using statistical software IBM-SPSS 16.0 for post-PRB complications by multiple linear and multivariate logistic regression. Results: A total of 118 PRB were performed; 73 patients were rheumatology patients, 10 kidney transplant recipients and 35 patients referred by general physician clinics. There were 50 males aged 15-60 years, and 68 females aged 16-52 years. Indications for renal biopsy were an elevation in serum creatinine (>2 mg/dL), proteinuria, hypertension, hematuria and for assessment of kidney involvement in rheumatologic diseases. A mean of 9 glomeruli were present in each specimen. A specimen yielded less than five glomeruli was seen in four biopsies. The core sample was reported as “inadequate for diagnoses” in two patients, and “normal” in two patients. Post-PRB minor bleeding was higher in women and older patients with overall complication rate of 5.8%, small perinephric hematoma in two patients, arteriovenous fistula and large hematoma occurred in one patient causing graft loss. Severe bleeding caused patient death two days post-PRB in SLE female patient. Macroscopic hematuria was seen in two renal allograft patients, of which one developed urinary retention and required intervention urinary catheterization and bladder irrigation. All the three complications were observed within the first two hours after PRB. Pain at the site of PRB were seen more in elective native biopsies (P=0.02). There were not late complications reported by patients or detected by US a week after post-BRP. Conclusion: Experienced operator using real-time US and automated 16-gauge automatic biopsy gun with certain safety precautions make PRB complications free procedure. Two hours post-PRB observation is optimal time to assess the safety of PRBs and prediction of late complications. This makes PRBs safe and more cost effective.