Marwah DS, Korbet SM
Timing of complications in percutaneous renal biopsy:
What is the optimal period of observation?
Am J Kidney Dis
(Jul) 28:47-52 1996
Renal biopsies play a central role in establishing clinical renal
diagnoses. During a 12 year period this group performed 394 biopsies
with either Trucut needles or a 14 gauge biopsy gun needle. 52 patients
developed complications [13%] which is higher than one would expect.
26 patients developed major complications: defined as requiring a
transfusion, an invasive procedure, or resulting in septicemia.
The timing of the complications was most interesting. Only 46% of major
complications were identified within 4 hours post biopsy, 77% by 8 hours, and
100% by 12 hours. There were only 3 minor complications beyond 12 hours. The
authors conclude that observation of patients for 12 hours is the minimum
acceptable, with a 24 hour post biopsy observation period being optimal.
Comment: The authors' data does not appear to support
their own hypothesis that observation for 24 hours is required. In fact,
many insurance companies consider renal biopsy as an outpatient procedure.
In this study, 14 G needles were used, which is
probably a larger bore needle than most nephrologists employ nowadays.
Do smaller needles lead to fewer complications? Do more or fewer
passes lead to fewer or more complications? These two issues are
In an article by Fraser and Fairley in AJKD 25:876:,1995, it was
reported that biopsy could be performed safely as an outpatient
procedure. They also estimated that it saved about 880 Australian
dollars. This was the largest reported series. A small series of 44
patients was presented at the ASN in 1992 by Maddux et al; JASN
3:345,1992. They concluded also that outpatient renal biopsy was a
safe procedure. Outpatient biopsy appears to be safe, as long as it
is limited to an appropriate choice of patients.
(Lionel Mailloux, M.D., North Shore University Hospital,