Risk management of renal biopsy: 1387 cases over 30 years in a single centre

Eur J Clin Invest. 2007 Dec;37(12):954-63. doi: 10.1111/j.1365-2362.2007.01885.x.


Background: Although renal biopsy is largely employed, even in old patients with systemic diseases, few clinical studies have addressed its risk management. We aimed to obtain a comprehensive assessment of safety/utility ratio of percutaneous renal biopsy.

Patients and methods: Retrospective review of all the 1387 patients who consecutively underwent renal biopsy in a single centre over three decades (1973-2002) was made, with calculation of complications, multivariate logistical analyses to evaluate risk factors of complications, and rate of alteration of clinical hypotheses by pathological diagnosis.

Results: There were no deaths and five major complications, (0.36%). One nephrectomy (0.07%), two surgical revisions (0.1%) and two arterial-venous fistulae (0.1%). There were also 337 minor bleeding complications (24.2%) (16.4% gross haematuria and 7.8% clinically relevant haematomas needing at least prolonged bed rest). Multivariate analyses demonstrated that the risk for complications was significantly increased by systemic autoimmune diseases with odds ratio (OR) 2.06, 95% confidence interval (CI)=1.40-3.01, end-stage kidney/acute-tubular necrosis (OR 2.96, 95% CI=1.19-7.30), and prolonged bleeding time test (BTT) (OR 1.87, 95% CI=1.17-2.83). Among the 1288 cases in which a clinical hypothesis before renal biopsy was recorded, renal pathology changed previous diagnoses in 423/1,288 (32.8%) of cases.

Conclusions: Risk assessment demonstrates that renal biopsy is a useful procedure with a low incidence of serious complications. Platelet function is the only modifiable factor significantly related to bleeding complications, suggesting the need for a more standardized alternative to the BTT. Platelet function should be evaluated to select low-risk patients for renal biopsy as 'a day case procedure', in order to build adequate risk management strategies.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle
  • Child
  • Female
  • Humans
  • Italy
  • Kidney / pathology*
  • Kidney Diseases / pathology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Risk Management