Severe haemorrhage and retroperitoneal haematoma secondary to renal biopsy
... P ERCUTANEOUS RENAL BIOPSY is used to obtain a diagnosis of glomerular, vascular, and tubulointerstitial diseases of native [1][2][3][4] and transplanted kidneys. [5][6][7][8][9][10] Real-time ultrasound guidance has made percutaneous renal biopsy easier and safer. ...
... [5][6][7][8][9][10] Real-time ultrasound guidance has made percutaneous renal biopsy easier and safer. [2][3][4]7,8,10 Unfortunately, being invasive, one has to be aware of major and minor complications that can occur. Minor complications such as self-limiting micro-and macroscopic hematuria, and perirenal bleeding or hematoma are most common. ...
... Minor complications such as self-limiting micro-and macroscopic hematuria, and perirenal bleeding or hematoma are most common. [1][2][3][11][12][13][14][15][16][17] Major, clinically significant, complications are less common. Their frequency (1-18% in small animals) is patient, disease, and technique dependent. ...
Ultrasound-guided percutaneous renal biopsy may be associated with complications, especially when using larger needles. Contrast harmonic ultrasound increases blood pool echo intensity, enhancing parenchymal lesions. Therefore, contrast harmonic ultrasound is a potential alternative screening method for postbiopsy renal lesions. Renal biopsies were performed using 14 G needles in 11 healthy Beagles, at three occasions: 0 ("Baseline Biopsy"; BB), 4 ("Biopsy 2"; B2), and 6 months ("Biopsy 3"; B3). Ultrasound and contrast harmonic ultrasound of biopsied kidneys were performed approximately 30 min after biopsy (week 0) at BB and B2, and repeated once every week (weeks 1-3) until normal appearance. At B3, only contrast harmonic ultrasound was performed, both immediately and 30-min postbiopsy. Contrast harmonic ultrasound images were reviewed using subjective and semiquantitative methods to describe lesions including number, shape, size, sharpness, echogenicity, and evolution. More renal lesions were detected with contrast harmonic ultrasound (22/22) compared with conventional ultrasound (14/22). The majority appeared at week 0 as hypoechoic tract(s) (27/33), the other (6/ 33) as ill-defined areas or area/tract combination, all having variable size, shape, and echogenicity. Seven tracts had a small subcapsular hematoma. In most kidneys, similar or gradual decrease of size and sharpness, and increased echogenicity was observed until normal appearance occurred at week 1 (1/22), week 2 (18/22), or week 3 (22/22). Two Beagles developed complications. At B3, immediately postbiopsy, tracts were hyperechoic in 9/11 kidneys, becoming hypoechoic again 30 min later. Contrast harmonic ultrasound is a valuable method to evaluate postbiopsy renal lesions in dogs.
... The patients' ages ranged from 35 to 70 years, with serum creatinine ranging from 65 to 230 μmol/L, and they had a normal coagulation profile. Separately, there have been solitary reports of injury to the mesenteric artery, intercostal artery, and abdominal aorta after native renal biopsy [11][12][13]. ...
Injuries to extrarenal arteries caused by percutaneous biopsy needles are very rare but highly lethal due to delay in recognition. Here we report the case of an inadvertent lumbar artery puncture after native renal biopsy and provide a literature review and a proposed workflow for management of massive bleed after renal biopsy. This case highlights evidence-based management considerations regarding massive bleed after renal biopsy, including the first-line imaging modality and the need to consider extrarenal site bleed. While angiographic embolization is an effective method of control of haemorrhage, surgical exploration is required in a proportion of cases for control of bleeding. Centre-specific workflows should be adopted to minimize the mortality and morbidity associated with massive bleed after renal biopsy.
... Source of haemorrhage is often intra-renal arteries, however, rarely lumbar, intercostal, and capsular arteries can be the source of haemorrhage. [3][4][5][6] Abed et al. reported a case of large retroperitoneal haemorrhage due to dual artery injury, where CTA showed two separate sources of haemorrhage due to intra-renal and subcostal artery injuries. [5] Colic artery injury resulting in a large retroperitoneal haemorrhage after renal biopsy, is also reported. ...
Percutaneous renal biopsy is a minimally invasive procedure in the work up of a chronic kidney disease patient. However, it is not free from the complications. Hematuria and abdominal haemorrhage due to intra-renal artery injury are the common complications. We report and discuss the management of a rare case of retroperitoneal haemorrhage resulting from dual arterial injury involving left testicular artery and intra-renal artery. © 2018 Indian Journal of Radiology and Imaging | Published by Wolters Kluwer - Medknow.
... Complications that can occur include local infection, abdominal wall hematomas, intraperitoneal haemorrhage, and intestinal perforation [1]. Despite the increased coagulopathy in patients with hepatic dysfunction, severe bleeding is rare, occurring in less than 1% of cases [2]. The most common etiologies of major bleeding are abdominal wall hematoma and hemoperitoneum [3]. ...
Paracentesis is a safe procedure with severe bleeding occurring in less than 1% of cases. Paracentesis is often times performed as an outpatient procedure. Hemorrhagic complications can be rapidly fatal if not diagnosed and treated in a timely fashion. We present the case of a 55-year-old female with decompensated cirrhosis who developed hemodynamically significant bleeding post paracentesis. This case brings up the question whether certain patients who undergo paracentesis should be admitted for close observation for at least 24 hours after the procedure. It also identifies the need for more research into pre-operative risk factors in cirrhotics that predisposes them to severe bleeding.
... We found only four cases of lumbar artery injury following renal biopsy that have been reported in literature [4][5][6][7]. Injury to mesenteric artery, [8] intercostal artery [9] and abdominal aorta [10] are the other solitary case reports of biopsy related complications. Lumbar artery injury has also been described with percutaneous nephrostomy [11]. ...
... The prevalence has significantly reduced recently mainly due to the widespread use of ultrasound guidance and automated-gun biopsy devices [7]. These complications are less common in transplanted than in native kidneys biopsies [8]. ...
Background: Renal biopsy is a fundamental technique in the study of renal allograft pathology. It is essential to know its complications since it is the more aggressive procedure morbidity and mortality. Objectives: The main objective of our study is to analyze and identify clinical complications resulting from percutaneous renal biopsy in renal transplant patients. To assess whether a patient clinical factor influencing the onset of these complications. Patients and Methods: An observational, retrospective study of all patients who underwent percutaneous renal biopsy renal graft between January 2009 and January 2012. Were analyzed: age, sex, hypertension, serum creatinine, proteinuria and hemoglobin before and after the biopsy. We defined minor complications (hemoglobin drop greater than 1 g/dl) and major complications (requiring transfusion, surgery, nephrectomy, arteriography, embolization or death). The biopsy was performed by the nephrology team with ultrasound guidance and withdrawing the antiplatelet therapy. Results: The number of biopsies performed was 92. The mean age of patients was 47.9 ± 13.2 years and 70.7% were men. There were 2 major complications (2.2%) and both patients had urological bleeding and sepsis, one need a transfusion. Minor complications were 14.1%. The graft loss or patient death was not observed. Conclusion: Percutaneous renal graft biopsy performed by physicians experienced nephrologists under ultrasound guidance in real time, is a low risk procedure, similar to that observed in native kidney. The careful completion of our protocol renal biopsy, optimize the risk benefit ratio of this technique.
The differential-diagnostic strategy and the order of precedence of most diverse radiologic diagnostic procedures are discussed based on a case of retroperitoneal bleeding. Apart from iatrogen-caused bleedings, the therapeutic anticoagulant therapy in the context of the patient's disease, haemodialysis or a rare, spontaneously-occurring retroperitoneal bleeding play a substantial role. In the order of precedence of radiologic diagnostic procedures for fast diagnosis of a retroperitoneal haematoma, the abdomen CT-scan is the preferred method.
To evaluate the diagnostic impact of multislice computed tomography (MSCT) in treatment planning prior to transarterial coil embolization of iatrogenic renal injuries.
Nine patients (median age 54 years, range 36-66) with iatrogenic renal vascular injury were treated with superselective coil embolization. Prior to therapy, a dual-phase (40 and 120 seconds) contrast-enhanced MSCT was applied in 6 patients. Seven patients underwent renal ultrasonography. Multiplanar reconstructions of the MSCT scans were used to affirm ongoing bleeding and to localize the bleeding site at the level of the segmental or interlobar artery. MSCT and angiographic findings were compared to evaluate the accuracy of MSCT in the detection of the bleeding source prior to therapy.
Multiplanar reconstructions of early-phase MSCT scans allowed precise identification of the bleeding interlobar or segmental artery in all 6 cases prior to angiography. In one case, MSCT was even able to detect a source of bleeding that was not revealed by selective renal angiography.
Multiplanar reconstructions of MSCT data demonstrate not only the presence of hematoma but also confirm ongoing bleeding and the location of the feeder artery prior to minimally invasive therapy.
Over a period of 37 years we performed renal biopsies 1812 times in 1638 subjects. Tissue adequate for interpretation was obtained in 1593 subjects (88%). Complications occurred in 7% of the total biopsies performed, consisting of gross hematuria lasting for more than 12 hours (3%), pain lasting for more than 12 hours (4%), a palpable hematoma (1%), infection (0.2%), and death (0.2%). Complications were higher when the biopsy yielded unsatisfactory samples (9.5%), although there were no deaths. Complications were not related to age but an elevated BUN appeared to be associated with a higher rate of complications, although this was not statistically significant. Deaths appeared to occur at unpredictable intervals and in retrospect could not have been foreseen.
We studied 142 consecutive percutaneous renal biopsies (puncturing on 73 allografts and 69 native kidneys) which were performed under continuous ultrasonic guidance, on 133 adult patients. The patients were monitored, at least, during the next 24 hours. We compared the complication rate for biopsies recording clinical and biochemical data and, the day after the biopsy, the kidney was examined with a color-coded Doppler sonography (CCDS): in real-time survey of the kidney and with spectral wave form analysis. The diagnosis of arteriovenous (AV) fistula was achieved detecting increased color saturation toward white, high peak systolic flow velocity and low resistive index in the supplying artery. Three procedures were excluded of the analyses because of incomplete data recorded, although none of them showed any remarkable complication. There was a 94.3% rate of successful biopsies. The mean +/- SEM number of glomeruli under light microscopic examination was 8.5 +/- 0.6. Complications occurred 64 times in relation to 55 patients with a higher incidence in allografts (61%) than in native kidneys (31%). Renal transplant patients showed higher serum creatinine values (5.8 +/- 0.8 vs. 3.2 +/- 0.4; p > 0.0001) and lower hematocrit (31.3 +/- 1.1 vs. 34.4 +/- 0.9; p = 0.025) than the native-kidney patients at the time of biopsy. De novo hematuria occurred in 30% of the procedures. In transplant patients, the gross hematuria incidence (9.9%) more than doubled that showed by native-kidney patients. The incidence of serious complications (hematoma, hemoperitoneum and AV fistula) was 16.5% and these were more frequent in transplant than in native kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)
We describe our experience with the use of the automatic core biopsy system for percutaneous renal biopsy and compare this with our experience with a standard biopsy needle. Three hundred twenty-three biopsies were performed between June 1983 and January 1993. From June 1983 through October 1990, 232 biopsies were performed with the use of a standard biopsy needle (Tru-cut needle; Travenol Laboratories, Deerfield, IL) and from November 1990 through January 1993, 91 biopsies were conducted with the use of the automatic core biopsy system (Biopty gun and needle; C.R. Bard, Inc, Covington, GA). Biopsies performed prior to January 1990 were reviewed retrospectively, while those performed after January 1990 were reviewed in a prospective manner. The primary indications for renal biopsy were to evaluate proteinuria (48.9%) and renal manifestations of systemic lupus erythematosus (26.0%). The two groups of patients were similar with respect to sex, age, serum creatinine, and coagulation parameters. Material for light microscopy, immunofluorescence microscopy, and electron microscopy was obtained in 98.9%, 98.9%, and 97.8% of cases, respectively, with the use of the automatic core biopsy system, and these values did not differ significantly from those with the use of the standard needle (99.6%, 96.1%, and 97.8%). Significantly more glomeruli were obtained by light microscopy per biopsy specimen with the use of the automatic core biopsy system versus the standard needle (28 +/- 15 and 21 +/- 13, respectively; P < 0.0001). Complications were assessed and separated by severity. Total complications were observed in 13 patients (14.3%) with the automatic core device and in 31 patients (13.4%) with the standard needle.(ABSTRACT TRUNCATED AT 250 WORDS)
