Complications of Percutaneous Renal Biopsy

Abstract

Percutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.

Keywords: bleeding complication; embolization; hemorrhage; interventional radiology; renal biopsy.

Fig. 1

A 51-year-old woman with nephrotic proteinuria and acute kidney injury on chronic kidney disease who was sent for native renal biopsy. Risk factors at the time of biopsy included inpatient status, elevated creatinine, anemia, thrombocytopenia, hypertension (controlled on medications), and mildly elevated INR. A 17-gauge coaxial biopsy cannula was placed. Biopsy was cancelled by the referring service mid-procedure, and no cores were taken. ( a ) Coronal noncontrast CT 10 days after aborted biopsy for acute hemoglobin drop demonstrates large right renal subcapsular hematoma ( arrowheads ). ( b ) CT angiography confirms pseudoaneurysm ( arrowhead ) and active extravasation ( arrow ). ( c ) Digital subtraction right renal arteriogram demonstrates focal intrarenal arterial vasospasm. No pseudoaneurysm or extravasation is visualized. ( d ) Digital subtraction inferior pole accessory renal arteriogram demonstrates active extravasation ( arrow ). ( e ) Digital subtraction angiography following coil and microvascular plug embolization of the accessory right renal artery. No further extravasation is present. The patient died from respiratory failure and acute blood loss anemia the following day.

Fig. 2

Bleeding postbiopsy in a renal allograft. Biopsy was taken 2 weeks after living related transplantation to evaluate for rejection. Risk factors at the time of biopsy included systolic and diastolic hypertension (150/96 mm Hg), aspirin therapy, and elevated blood urea nitrogen (50 mg/dL). ( a ) Ultrasound-guided biopsy of the lower pole of the renal allograft. Three passes were required to obtain two 18-gauge cores. ( b ) Grayscale and color Doppler ultrasound demonstrates 2.4 cm renal hilar pseudoaneurysm ( arrowheads ) 1 year after biopsy. ( c ) Spectral Doppler ultrasound shows arterialized waveform within the transplant renal vein consistent with arteriovenous shunt. ( d ) Carbon dioxide arteriogram confirms transplant renal pseudoaneurysm ( arrowhead ) and arteriovenous fistula. Transplant renal artery ( arrow ), early filling of transplant renal vein ( curved arrow ). ( e ) Successful coil embolization with no filling of the pseudoaneurysm or arteriovenous shunting. ( f ) Postembolization surveillance ultrasound with no detectable color signal within the coiled pseudoaneurysm ( arrowheads ).