Emilio D Poggio1, Robyn L McClelland2, Kristina N Blank2, Spencer Hansen2, Shweta Bansal3, Andrew S Bomback4, Pietro A Canetta4, Pascale Khairallah4, Krzysztof Kiryluk4, Stewart H Lecker5, Gearoid M McMahon6, Paul M Palevsky7,8, Samir Parikh9, Sylvia E Rosas10,11,12, Katherine Tuttle13, Miguel A Vazquez14, Anitha Vijayan15, Brad H Rovin16. 1. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. 2. Department of Biostatistics, University of Washington, Seattle, Washington. 3. Division of Nephrology, Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas. 4. Division of Nephrology, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, New York. 5. Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 6. Division of Nephrology, Brigham and Women's Hospital, Boston, Massachusetts. 7. Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 8. Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. 9. Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio. 10. Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, Massachusetts. 11. Nephrology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 12. Harvard Medical School, Boston, Massachusetts. 13. Division of Nephrology, Providence Medical Research Center, Sacred Heart Medical Center, Spokane, Washington. 14. Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas. 15. Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri. 16. Division of Nephrology, Ohio State University Wexner Medical Center, Columbus, Ohio Rovin.1@osu.edu.
Abstract
BACKGROUND AND OBJECTIVES: Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS: A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS: Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
BACKGROUND AND OBJECTIVES: Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. RESULTS: A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. CONCLUSIONS: Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
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