Major complications of percutaneous native and transplant kidney biopsy: a complete 10-year national prospective cohort study

Abstract

Background: Previous reports of incidence of major complications (MC) of kidney biopsy vary depending on definitions of MC, single or multicentre analysis, and prospective or retrospective data collection. We aimed to provide accurate, unbiased information about the incidence of MC by analysing 10-year data from a prospective national renal biopsy registry.

Methods: The Scottish Renal Biopsy Registry has prospectively collected data on all native and transplant kidney biopsies undertaken in the nine adult renal centres in Scotland since 2014. Nephrologists from each centre report demographics, operator, coded indication, coded diagnosis and coded MC.

Results: A total of 8476 biopsies were reported in the 10 years between 2014 and 2023 (6167 native, 2309 transplant). The overall incidences of MC following native and transplant kidney biopsy were 2.1% and 1.4%, respectively (P < .001). The most common MC of native kidney biopsy was the requirement for 'arteriography with embolization' (0.63% of biopsies) and the most common MC of transplant biopsy was 'blood transfusion only' (0.30%). Nine deaths (0.15%) and no nephrectomies were attributed to native biopsy, and one death and one nephrectomy were attributed to transplant biopsy. MC were more common in women than men (2.2 vs 1.5%; P = .01). MC incidence was identical for biopsies performed by nephrologists (n = 5373) and radiologists (n = 2709). A positive association between quartile of serum creatinine at the time of native biopsy and incidence of MC diminished when acute kidney injury as indication for biopsy was excluded. Transplant biopsies >10 years after transplant had a higher risk of MC (3.4%).

Conclusion: MC of kidney biopsy in the modern era remain rare. This registry analysis provides accurate estimates of risk based on unbiased national data. The increased incidence of MC in women merits further study.

Keywords: acute kidney injury; complication; haemorrhage; kidney biopsy; kidney transplant.

Figure 1:

Incidence of MC of native and transplant kidney biopsy by age category.

Figure 2:

Time since transplant and the incidence of MC of transplant biopsy.