A GRAVER1, J LING1, Y FOONG1, S KUO1, G KIRKLAND1, MD JOSE1,2
1Royal Hobart Hospital, Tasmania, 2School of Medicine, University of Tasmania
Aim: To identify patient, procedural and equipment-related factors affecting complications in percutaneous renal biopsies (PRBs) performed in southern Tasmania, and to assess the impact of a change in biopsy needle gauge on outcomes.
Background: PRBs are an essential diagnostic intervention in Nephrology, and are currently performed under real-time radiological guidance with spring-loaded needles. However, despite improvements in equipment and technique, the procedure carries a significant risk of complications.
Methods: We conducted a retrospective review of medical records of patients undergoing PRB in southern Tasmania between 1st July 2012 and 1st July 2015. Clinical records were reviewed for procedural and complication details; histopathology reports were reviewed for sample adequacy.
Results: 225 biopsies were identified in 169 patients (87 female, median age 54.4). 95.6% (215/225) were ultrasound-guided; 54.2% were of native kidneys; all utilised 14-gauge needles. Median number of passes was 2; median number of glomeruli was 19 (range 0-66). There were 21 (9.3%) complications in total, 13 (61.9%) of which were minor and included pain / altered sensation (5), macroscopic haematuria (4) and inconsequential perinephric haematoma (4). There were 2 deaths within 7 days of biopsy; both underwent coroner review. Other major complications included urinary clot obstruction (2), pseudoaneurysm formation (1), syncope (1), and retroperitoneal bleeding (2). Complications were associated with younger age (beta coefficient 1.04), but not gender, number of passes or hospital site.
Conclusions: The complication rate for PRBs in southern Tasmania is significantly higher than expected; the association with younger age needs further study. With this data we implemented a unit-wide change to 16-gauge biopsy needles in 2016, and will review all PRBs over the ensuing 12-month period to compare PRB outcomes.