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. 2025 Jun 17.
doi: 10.1007/s00261-025-05067-8. Online ahead of print.

Hemorrhagic complications after ultrasound-guided percutaneous native renal biopsy: a prediction model based on clinical and ultrasonographic features under a nest case-control design

Xin Zheng  1 , Fuqiu Tang  1 , Tongyi Huang  1 , Xiaoer Zhang  1 , Xiaoyan Xie  1 , Ming Xu  2
Affiliations

Hemorrhagic complications after ultrasound-guided percutaneous native renal biopsy: a prediction model based on clinical and ultrasonographic features under a nest case-control design

Xin Zheng et al. Abdom Radiol (NY). .

Abstract

Purpose: To identify independent risk factors for hemorrhagic complications after ultrasound-guided percutaneous native renal biopsy (UG-PRB) from clinical and ultrasonographic parameters, and to develop prediction models.

Methods: The single-center retrospective study included 2822 patients who underwent a UG-PRB between May 2022 and July 2024. Patients with post-procedural hemorrhagic complications were included as the case group. Under a nest case-control design, one procedure date-matched control without complication was randomly selected for each case. Independent predictors for overall hemorrhagic complication and severe hemorrhagic complication were investigated by multivariate logistic regression.

Results: A total of 204 patients (36.0 years ± 16.1[SD]; 104 [51%] female) developed post-biopsy hemorrhagic complications in this study. The incidence of overall and severe bleeding complications was 8.8% (204/2328) and 1.03% (24/2328), respectively. Right renal biopsy (OR 0.40, p = 0.02), number of needle passes (OR 0.40, p = 0.002), and hypertension (OR 1.29, p = 0.02) were independent risk factors for overall bleeding complications. Hyperlipidemia (OR 0.10, p = 0.04), D-dimer (OR 1.27, p = 0.03), and eGFR (OR 0.90, p = 0.002) were independent risk factors for severe hemorrhagic complications. The prediction models for overall and severe complications had AUCs of 0.64 and 0.91, and a five-cross validation in the cohort showed a mean AUC of 0.65 and 0.85 in each model. In predicting severe complications, the sensitivity and specificity were 87.5% and 75.3%, respectively.

Conclusion: The developed prediction models provide effective tools for risk stratification, early prevention, monitoring, and management for patients undergoing UG-PRB.

Keywords: Complication; Percutaneous renal biopsy; Prediction model; Ultrasound.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

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