Incidence and Risk Factors for Hemorrhagic Complications after Percutaneous Renal Biopsy using a 16-Gauge Needle Followed by 6 Hours of Bed Rest

Background: The procedures and management protocols forpercutaneous renal biopsy (PRB) are different among institutions. Herewe present the outcomes of our protocol and identify risk factors forhemorrhagic complications (HCs). Methods: Thirty From 2007 through 2016, 175 patients received PRB usinga 16-gauge biopsy needle with real-time ultrasound guidance. In asingle session, three specimen cores were obtained. Post operatively,all patients were monitored with strict bed rest without sandbagcompression for six hours. Adverse events were graded according tothe Clavien-Dindo classification.. Results: Ninety-seven patients (55.4%) were female and themedian age was 48.0 years (IQR 37.0-64.0). The median estimatedglomerular filtration rate based on serum creatinine (eGFRcreat) was57.8 mL/min/1.73 m2 (IQR 28.1-87.8). The median number of glomeruliassessable in each specimen was 19 (IQR 12-29). Symptomatic HCsdeveloped in 9 patients (5.1%). All the events occurred within 6 hoursafter PRB. Selective transcatheter arterial embolization and bloodtransfusion were required in 1 and 7 patients, respectively, but therewas no grade IIIb to V event. In univariate analysis, predictive factorsfor symptomatic HCs were being female (OR 1.102, p = 0.006), aplatelet count < 15.0 x 104/μl (OR 7.405, p = 0.004) and eGFRcreat < 30mL/min/1.73 m2 (OR 6.300, p = 0.005). Conclusion: PRB using a 16-gauge needle followed by 6 hours ofstrict bed rest secures sufficient samples for histological diagnosis witha low incidence of severe HCs. Furthermore, monitoring with six hoursof bed rest contributes to early detection and management of severeHCs.