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Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience

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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 m2)] − 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.

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Conflict of interest

All authors declared no conflict of interest on this paper.

Ethical approval

The study was approved by the Health Department Ethics Committee of Beijing Military Region (Code: BH20100125).

Informed consent

All patients needed sign the informed consent before the operation.

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Author notes

    Authors and Affiliations

    1. 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

      Chao Wang, Yang Yang, Liping Jin, Ying Zhang, Guanglei Chen, Zhuliang Zhou, Minghui Song, Qingman Gao, Changchun Li, Tao Pan, Fagui He & Lu Ma

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    1. Chao Wang
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    2. Yang Yang
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    3. Liping Jin
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    7. Minghui Song
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    Corresponding author

    Correspondence to Lu Ma.

    Additional information

    C. Wang and Y. Yang contributed equally to the work.

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    Wang, C., Yang, Y., Jin, L. et al. Evaluating renal biopsy-associated hemorrhage complications by the equation and providing an early intervention: a single-center experience. J Nephrol 28, 691–700 (2015). https://doi.org/10.1007/s40620-015-0197-x

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    • DOI: https://doi.org/10.1007/s40620-015-0197-x

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