Timing of complications in percutaneous renal biopsy

Percutaneous renal biopsy (PRB) is a safe and effective tool in the diagnosis and management of renal disease; however, the optimal timing of observation after biopsy is not clearly established. With the use of real-time ultrasound guidance, PRB of native kidneys was performed in 750 adult patients at an academic institution by an attending nephrologist or fellow between June 1983 and June 2002. All patients were observed for 23 to 24 h after biopsy for the presence, severity, and timing of complications. Biopsy-related complications occurred in 98 (13%) patients; minor complications occurred in 50 (6.6%) patients, and major complications occurred in 48 (6.4%) patients. One (0.1%) patient died as a result of the biopsy. Multivariate analysis using logistic regression found only serum creatinine at baseline predictive of a complication. Patients with a serum creatinine greater than or equal to5.0 mg/dl were 2.3 times as likely to have a complication (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.1; P < 0.005). Complications were identified in 38 (42%) patients by less than or equal to4 h, in 61 (67%) patients by less than or equal to8 h, in 77 (85%) patients by less than or equal to12 h, and in 81 (89%) patients at less than or equal to24 h. The PRB remains a safe procedure, but the risk of complication is higher in patients with advanced renal insufficiency. After biopsy, an observation time of up to 24 It remains optimal as an observation period of less than or equal to8 h risks missing greater than or equal to33% of complications.