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Home | Articles | Renal | Kidney Biopsy Complications

Kidney Biopsy Complications

Last updated 14th March 2024

Introduction

  1. This protocol is for patients who undergo biopsy of their kidney under care of the nephrologists.  It does not apply for patients who have a renal-mass biopsy under care of urology.
  2. Complications can occur on the table, on the ward or after discharge.  Bleeding is the most common complication, with 1:10 having visible haematuria. Discomfort after LA wears off is expected but not severe pain.
  3. In a Scottish cohort of 5095 native kidney biopsies 2014-2023 complication rates were as follows:
  4. 6.1:1000 need angiography with embolization, 5.9:1000 needed angiography but no embolization, 3.5 in 1000 did not need angiography but needed blood transfusion (overall about 1:200 need a blood transfusion), 2:1000 suffered clot obstruction, 1.6:1000 died and none required nephrectomy.

Bleeding in XR

  1. Radiologist d/w on call renal consultant (32177), arrange imaging & observations.
  2. If haemodynamically unstable – resuscitation on site via 2222 / Critical care if required. Aim is to stabilize for CT angiogram.
  3. If haemodynamically stable, radiologist will assess bleeding with US post-procedure and advise whether / if repeat scan required. See Bleed on ward for subsequent actions.

Suspected Bleeding on Ward / ATU

  1. Patient with falling BP, rising HR, falling Hb or unexpected pain following procedure:
  2. N/S inform Nephrologist on ward / 32177.
  3. NEPHROLOGIST review the patient, NEWS, Stabilise haemodynamically ± escalate to level2/3 as needed.  Consider X-match for 4 units RBC. Arrange imaging: US / CTA depending on concern.

Significant Bleeding confirmed on imaging:

  1. D/W QEUH on-call Renal registrar (0141)4522417 / consultant regarding transfer including destination Renal ward / Medical / surgical HDU / ICU (ICU must be d/w consultant).
  2. D/W QEUH interventional radiologist on call. Complete Transfer Documentation.
  3. If urology input needed QEUH team will liaise once in Glasgow.
  4. If haemodynamically unstable: Escalate to DGRI CCU team for assistance with resuscitation and consideration of assisted transfer to QEUH ICU.
  5. Unstable patients should also be discussed with renal consultant directly.

Key Contacts

  1. Nephrologist on call 32177
  2. Dr Lastik / Dr Hrobar 33433 / 33626
  3. DGRI Angio Nurses 32164 / 32089
  4. DGRI CCU charge nurse 33181
  5. QEUH renal SpR 0141 452 2417
  6. QEUH switchboard 0141 201 1100

Complications After Discharge

  1. Patients admitted within 2 weeks of their kidney biopsy with pain, unexpected anaemia and / or haemodynamic compromise should be given appropriate resuscitation, analgesia, and prompt imaging usually CT renal angiogram.
  2. Blood tests for any patient admitted with suspected post kidney biopsy bleeding should include Usual CAU admission blood tests and cross-match for 4 units RBCs.
  3. Any concern of the admitting team should be discussed with the on call nephrologist via switchboard if out of hours or 32177 9-5 Monday to Friday.

Patients Going To / Returning From QEUH

  1. DGRI do not use SERPR for prescribing.  For day cases / outpatients the most recent drug list may be the letter on clinical portal or via ECS.  For inpatients an HEPMA printout and IDL transfer letter should accompany the patients.
  2. DGRI patients sent to QEUH for investigation / treatment of post biopsy bleeds are expected to return to DGRI as soon as possible once their bleeding has stabilized for further renal disease management, analgesia, or social issues.
  3. Patients fit for discharge home directly from QEUH will be discussed with DGRI on call consultant so that a Dumfries renal follow up plan is agreed.  QEUH can contact us via renal secretary on 01387 241657, or via DGRI switchboard on 01387 246246.

Content by Michael Kelly