INDICATIONS FOR AND COMPLICATIONS OF PERCUTANEOUS ULTRASOUND GUIDED RENAL BIOPSY

Résumé

Background: Percutaneous renal biopsy is a gold standard diagnostic procedure for patients with renal disease. It is performed in native and transplanted kidneys and is generally considered a safe procedure. The use of ultrasound guidance and automated biopsy gun provide a low risk of complications.

Objective: The purpose of this study was to analyse the indications and the consequent complications in patients who underwent renal biopsy.

Study Design: Prospective hospital based study done over a period of 1 year & 9 months.

Participants: 229 patients (136 males & 93 females , mean age ±  SD : 39.86 ±  15.22 ) with any of the indication for renal biopsy participated in the study. Out of 229 , 7 patients were post renal transplant.

Methods: Percutaneous renal biopsy was performed under real time ultrasound guidance. After the procedure patients were observed with hemodynamic monitoring for 24 hours for any complication. Before  discharge from the hospital , all patients were subjected to ultrasonography for any collection. Patients were followed for new onset hypertension on OPD basis. Complications and their association with azotemia, hypertension  was assessed by using pearson chi square, fischers exact test & likelihood ratio.

Results: Nephrotic  Syndrome ( 33.20%) was the most common indication followed by Subnephrotic proteinuria with azotemia (14.0%); unexplained azotemia, proteinuria & hematuria (13.50%); subnephrotic proteinuria (9.60%); proteinuria with hematuria (7.90%). Complications were seen in 89 patients (38.86%). Pain (38.86%)  was the most common complication followed by  hematoma (5.67%), gross hematuria (4.80%), hypotension (2.20%), urinary bladder clot (1.75%), need for blood transfusion (1.31%), urinary retention (0.44%), Pseudoaneurysm (0.44%). 6 patients (2.62%) developed major complications. Among them 2 patients (0.87%) underwent invasive procedure for the same .One required embolisation and the other cystoscopic removal of bladder clot. Rest 4 patients developed hemodynamic instability; 2 requiring  one unit of blood transfusion each  and the other two intravenous normal saline. The risk of hematoma was related to azotemia  with p value 0.03.

Conclusion: Renal biopsy in modern era remains a safe procedure. However major complications do happen. Patients with azotemia have increased risk of post procedure hematoma

Implication: It is advisable to perform renal biopsy  when required, given that the benefit will be greater than the risk to which the patient is subjected.