Is the bleeding time predictive of bleeding prior to a percutaneous renal biopsy?

The bleeding time is used by many nephrologists to predict risk of hemorrha ge before percutaneous kidney biopsy. Developed in 1910, the bleeding time is a nonspecific test that may be prolonged in multiple disease stales. Whe n accompanied by a platelet count, hematocrit, and a thorough investigation of family or personal history of bleeding, the bleeding time is the best p redictor of hemorrhagic risk in patients with kidney disease. Because there is a small but significant risk of bleeding with percutaneous kidney biops y, a prolonged bleeding time should be treated with 1-deamino-8-D-arginine vasopressin, cryoprecipitate, estrogens, or dialysis as indicated before bi opsy. Treating all patients with 1-deamino-8-D-arginine vasopressin without checking bleeding times may be cost-ineffective when compared with treatin g only those patients with prolonged bleeding times. Curr Opin Nephrol Hype rtens 8:715-718. (C) 1999 Lippincott Williams & Wilkins.