HDCN Article Review/Hyperlink

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 unresolved.

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, Manhasset, NY)