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Multicenter Study
. 2023 Feb 28;38(3):655-663.
doi: 10.1093/ndt/gfac177.

The risks associated with percutaneous native kidney biopsies: a prospective study

Simeone Andrulli  1   2 , Michele Rossini  3 , Giuseppe Gigliotti  4 , Gaetano La Manna  5 , Sandro Feriozzi  6 , Filippo Aucella  7 , Antonio Granata  8   9 , Elisabetta Moggia  10 , Domenico Santoro  11 , Lucio Manenti  12 , Barbara Infante  13 , Angelo Ferrantelli  14 , Rosario Cianci  15 , Mario Giordano  16 , Domenico Giannese  17 , Giuseppe Seminara  9 , Marina Di Luca  18 , Mario Bonomini  19 , Leonardo Spatola  20 , Francesca Bruno  4 , Olga Baraldi  5 , David Micarelli  6 , Matteo Piemontese  7 , Giulio Distefano  8 , Francesca Mattozzi  21 , Paola De Giovanni  22 , Davide Penna  23 , Maurizio Garozzo  24 , Luigi Vernaglione  25 , Cataldo Abaterusso  26 , Fulvia Zanchelli  27 , Rachele Brugnano  28 , Enrica Gintoli  29 , Laura Sottini  30 , Marco Quaglia  31 , Gioacchino Li Cavoli  32 , Marco De Fabritiis  33 , Maria Maddalena Conte  34 , Massimo Manes  35 , Yuri Battaglia  36 , Francesco Fontana  37 , Loreto Gesualdo  3 ; ITA-KID-BIO-Group
Affiliations
Multicenter Study

The risks associated with percutaneous native kidney biopsies: a prospective study

Simeone Andrulli et al. Nephrol Dial Transplant. .

Abstract

Background: The known risks and benefits of native kidney biopsies are mainly based on the findings of retrospective studies. The aim of this multicentre prospective study was to evaluate the safety of percutaneous renal biopsies and quantify biopsy-related complication rates in Italy.

Methods: The study examined the results of native kidney biopsies performed in 54 Italian nephrology centres between 2012 and 2020. The primary outcome was the rate of major complications 1 day after the procedure, or for longer if it was necessary to evaluate the evolution of a complication. Centre and patient risk predictors were analysed using multivariate logistic regression.

Results: Analysis of 5304 biopsies of patients with a median age of 53.2 years revealed 400 major complication events in 273 patients (5.1%): the most frequent was a ≥2 g/dL decrease in haemoglobin levels (2.2%), followed by macrohaematuria (1.2%), blood transfusion (1.1%), gross haematoma (0.9%), artero-venous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), a rapid increase in serum creatinine levels (0.1%) and death (0.02%). The risk factors for major complications were higher plasma creatinine levels [odds ratio (OR) 1.12 for each mg/dL increase, 95% confidence interval (95% CI) 1.08-1.17], liver disease (OR 2.27, 95% CI 1.21-4.25) and a higher number of needle passes (OR for each pass 1.22, 95% CI 1.07-1.39), whereas higher proteinuria levels (OR for each g/day increase 0.95, 95% CI 0.92-0.99) were protective.

Conclusions: This is the first multicentre prospective study showing that percutaneous native kidney biopsies are associated with a 5% risk of a major post-biopsy complication. Predictors of increased risk include higher plasma creatinine levels, liver disease and a higher number of needle passes.

Keywords: kidney biopsy; logistic regression; major complications; prospective cohort study; risk.

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