Hemodynamic assessment and study of bleeding complications following percutaneous renal biopsy in a tertiary care hospital

Background: Percutaneous kidney biopsy is the primary diagnostic tool used in kidney diseases. In general, it is a low-risk procedure in a majority of the patients, however, complications do occur and the most common complications are pain abdomen and bleeding which may be microscopic or macroscopic hematuria or perirenal hematoma. We aim to assess all the biopsies performed by following the patients postprocedure. Materials and Methods: All patients were evaluated before renal biopsy with prebiopsy investigations like Hemoglobin percentage, platelet count, and other test for coagulation. Following which patients underwent ultrasound guided renal biopsy. post renal biopsy they were followed clinically for pulse rate , blood pressure and laboratory monitoring by repeat hemoglobin levels, and by ultrasound scan for any hematoma and visible hematuria. The results were compared to prebiopsy values and tabulated and difference in values were assessed. Results: We enrolled 88 patients in our study done over 3 years; out of 88 patients enrolled, we found that 58% of the patients were male and 42% were female; following biopsy, pain abdomen was the most common symptom reported in 50% of the patients, followed by hematuria in 33% of the patients. Out of 88 patients, 57 patients (64%) had a decrease in Hb from their prebiopsy levels, but the range was 0.1g/dl-3.4g/dl drop with a mean value of 0.932 ± 0.819 g%. Seventeen patients (19.3%) developed hematoma on day 1 following biopsy with a size ranging from 1 cc to 25 cc hematoma with a mean size of 3 cc, which decreased in size on follow-up scans to 3 (3.4%) patients on day 3 having persistent hematoma with a Median size of 4cc on day 3. The odds ratio (O.R) for developing hematoma following kidney biopsy was assessed in different groups. It was found that those patients who had their baseline serum creatinine >3mg/dl had O R of 1.66 95% C.I, [0.53-5.07]. And those patients whose systolic blood pressure was >160 mm of Hg had an Odds Ratio of developing hematoma of O.R 2.77 95% C.I [0.43-11.08]. Conclusion: Renal biopsy is a relatively safe procedure with some morbidity and occasional mortality if performed by screening of patients thoroughly for bleeding parameters, and patients may require monitoring postprocedure by repeated ultrasound scans if needed. Moreover, bleeding in many patients is clinically insignificant rarely requiring any transfusion postprocedure. Moreover, patients with high prebiopsy creatinine have some risk of bleeding than other patients with normal kidney function.