Monday, February 22, 2010

TOPIC DISCUSSION Risk factors for bleeding post kidney biopsy

Kidney biopsy done by Nephrologist world wide is not a benign procedure. Risks are real and significant retroperitoneal bleed is a major concern in most patients.  Although with US guidance or CT guidance, the risk has been much less in the current era.
What are the clinical risk factors associated which can predict bleeding post biopsy?
The article above lists a few from a retrospective trial done in Ohio State
In this article, the risk of post biopsy bleeding was higher in patients with high Systolic Blood Pressure, Diastolic Blood pressure and MAP. A history of hypertension and high serum creatinine are significant independent risk factors. What about Platelet values or coagulation parameters?
Another study in NDT, talks about if we should stop antiplatelet agents before biopsy and if that makes a difference?  Based on that one study, the risk was unchanged in major complications in both groups but minor complications were more in the antiplatelet group.
Perhaps another thing to keep in mind is patients with amyloidosis, chronic kidney disease and perhaps even antiphospholipid antibody syndrome are at higher risk of bleeding. There is evidence for amyloidosis both ways.  What about patients with SLE? are they at higher risk of bleeding? No one knows?
Any other thoughts on the other potential risk factors, feel free to add.
Other good references are listed below:
Image courtesy: MDCONSULT

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