Chao Wang1, Yang Yang1, Liping Jin1, Ying Zhang1, Guanglei Chen1, Zhuliang Zhou1, Minghui Song1, Qingman Gao1, Changchun Li1, Tao Pan1, Fagui He1, Lu Ma2. 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. 2. 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. malu281@163.com.
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 m(2))] - 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.
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 m(2))] - 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.
Authors: Jun Mai; Jim Yong; Hugh Dixson; Angela Makris; Ananthakrishnapuram Aravindan; Michael G Suranyi; Jeffrey Wong Journal: Nephrology (Carlton) Date: 2013-07 Impact factor: 2.506
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Shepherd Kajawo; Udeme Ekrikpo; Mothusi Walter Moloi; Jean Jacques Noubiap; Mohamed A Osman; Ugochi S Okpechi-Samuel; Andre Pascal Kengne; Aminu K Bello; Ikechi G Okpechi Journal: Kidney Int Rep Date: 2020-11-03