In this section : Renal
Kidney Biopsy Complications
Parenteral Iron for Non-HD CKD Patients
Management of uncomplicated Henoch-Schonlein Purpura (HSP) in under 16s
Prescribing Advice on Admission – Insulin
Sodium Glucose Transporter 2 Inhibitors (SGLT2i)
Gentamicin in Renal Replacement Therapy
Vancomycin in Renal Replacement Therapy
Haemodialysis Medication Prescribing
Contrast Associated AKI
Acute Kidney Injury – Introduction
Low Molecular Weight Heparin
Fluid Replacement in AKI
Management of Urinary Symptoms
Management of Acute Kidney Injury
Urinary Tract Infection
Urethral Catheterisation
Renal Transplants
Ureteric Colic & Renal Stones
Intravascular Catheter Related Blood Stream Infection
Care of Vascular Access
Urinary Incontinence
Peritoneal Dialysis Related Peritonitis
Kidney Biopsy Complications
Last updated 14th March 2024
Introduction
- 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.
- 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.
- In a Scottish cohort of 5095 native kidney biopsies 2014-2023 complication rates were as follows:
- 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
- Radiologist d/w on call renal consultant (32177), arrange imaging & observations.
- If haemodynamically unstable – resuscitation on site via 2222 / Critical care if required. Aim is to stabilize for CT angiogram.
- 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
- Patient with falling BP, rising HR, falling Hb or unexpected pain following procedure:
- N/S inform Nephrologist on ward / 32177.
- 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:
- 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).
- D/W QEUH interventional radiologist on call. Complete Transfer Documentation.
- If urology input needed QEUH team will liaise once in Glasgow.
- If haemodynamically unstable: Escalate to DGRI CCU team for assistance with resuscitation and consideration of assisted transfer to QEUH ICU.
- Unstable patients should also be discussed with renal consultant directly.
Key Contacts
- Nephrologist on call 32177
- Dr Lastik / Dr Hrobar 33433 / 33626
- DGRI Angio Nurses 32164 / 32089
- DGRI CCU charge nurse 33181
- QEUH renal SpR 0141 452 2417
- QEUH switchboard 0141 201 1100
Complications After Discharge
- 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.
- 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.
- 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
- 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.
- 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.
- 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