Percutaneous renal biopsy in the 1990s: Safety, value, and implications for early hospital discharge

To determine the parameters associated with significant bleeding and to exa mine the value of performing a renal biopsy, we studied 83 consecutive pati ents, including 24 renal allograff recipients, who had undergone percutaneo us renal biopsy. The patients were stratified into four groups according to the percentage of decline in their hematocrit (Hct) at 24 hours postbiopsy , as follows: 10% or greater (n = 21; 25%) and less than 10% decline (n = 6 2; 75%). The latter group was further subgrouped into 5% to 10% (n = 22) an d less than 5% decline (n = 40). There was a significant decline in Hct pos tbiopsy, with a linear correlation between the decrease In Hct at 6 and 24 hours (R-2 = 0.47; P < 0.0001), suggesting that the former was a predictor of the latter. There was a linear correlation between the number of passes and number of cores obtained for the first four passes, but an inverse corr elation when five passes or greater were required. Interestingly, there was no correlation between bleeding (>10% decline in Hct) and the number of pa sses or cores obtained. Gross hematuria and blood transfusion requirement w ere each encountered in three patients (3.6%). importantly the prebiopsy cl inical diagnosis was altered in 18 of 59 native kidney biopsies (33%) and 1 0 of 24 transplant biopsies (41%), We conclude that percutaneous renal biop sy using an automated spring-loaded gun device coupled with ultrasound guid ance is a safe technique and provides essential clinical information. Impor tantly, patients with a stable Hct at 6 hours were at low risk for bleeding at 24 hours while hospitalized. It remains to be determined if these findi ngs could be extrapolated to early discharge from hospital. (C) 1999 by the National Kidney Foundation, Inc.