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Observational Study
. 2016 Oct;48(10):1667-73.
doi: 10.1007/s11255-016-1411-z. Epub 2016 Aug 31.

Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys

Arkadiusz Lubas  1 , Anna Wojtecka  2 , Jerzy Smoszna  2 , Piotr Koziński  3 , Emilia Frankowska  3 , Stanisław Niemczyk  2
Affiliations
Observational Study

Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys

Arkadiusz Lubas et al. Int Urol Nephrol. 2016 Oct.

Abstract

Purpose: Renal biopsy-related arteriovenous fistula (RB-AVF), although usually asymptomatic, may sometimes result in serious clinical implications. The aim of the study was to prospectively evaluate the incidence of RB-AVF in native kidneys, together with the assessment of hemodynamic characteristics and the impact of the histopathological results of biopsy.

Methods: The study included 138 patients (age 46.2 ± 15.2; 70 F, 68 M), who underwent percutaneous renal biopsy (PRB) of the native kidney. In all patients, 2D and color Doppler ultrasound was performed 24 h after PRB in order to exclude RB-AVF.

Results: Bleeding complications in the form of hematomas were found in 136 patients (98.55 %), and 23 cases of RB-AVF were observed (16.67 %). RB-AVF group had an increased maximal hematoma diameter and reduced number of glomeruli in PRB. The segmental arteries supplying the fistulas are characterized by higher maximum flow velocity (FV) and a lower resistance index (RI) compared to the normal segmental arteries (difference 45.9 ± 20.0 cm/s and 0.252 ± 0.104, respectively). In the ROC analysis, RI ≤ 0.524 allowed to detect RB-AVF with a sensitivity of 91 % and specificity of 100 % (AUC 0.998, p < 0.001). In approximately 39 % of RB-AVF cases, 2D ultrasound detected a hyperechogenic ischemic area between the fistula and the renal capsule.

Conclusions: Arteriovenous fistula is a quite frequent complication of native renal biopsy and can cause ischemia in the renal parenchyma detected by ultrasound. The arteries supplying the fistula are characterized by an increased flow velocity and reduced resistance index.

Keywords: Arteriovenous fistula; Renal biopsy; Resistance index.

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Conflict of interest statement

Author Arkadiusz Lubas declares that he has no conflict of interest. Author Anna Wojtecka declares that she has no conflict of interest. Author Jerzy Smoszna declares that he has no conflict of interest. Author Piotr Koziński declares that he has no conflict of interest. Author Emilia Frankowska declares that she has no conflict of interest. Author Stanisław Niemczyk declares that he has no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Renal biopsy-related arteriovenous fistulas detected in color Doppler
Fig. 2
Fig. 2
Doppler hemodynamic assessment of renal biopsy-related arteriovenous fistulas
Fig. 3
Fig. 3
Hyperechogenic area in the neighborhood of the arteriovenous fistula
See this image and copyright information in PMC

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