Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications.
acute renal failure
chronic kidney disease
kidney biopsy
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
06 11 2020
06 11 2020
Historique:
received:
09
04
2020
accepted:
21
07
2020
pubmed:
17
10
2020
medline:
23
11
2021
entrez:
16
10
2020
Statut:
ppublish
Résumé
Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging. This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare. A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location. Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
Sections du résumé
BACKGROUND AND OBJECTIVES
Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare.
RESULTS
A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.
CONCLUSIONS
Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
Identifiants
pubmed: 33060160
pii: 01277230-202011000-00010
doi: 10.2215/CJN.04710420
pmc: PMC7646247
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1595-1602Subventions
Organisme : NIDDK NIH HHS
ID : UH3 DK114908
Pays : United States
Organisme : NIDDK NIH HHS
ID : U2C DK114886
Pays : United States
Organisme : NIDDK NIH HHS
ID : UH3 DK114861
Pays : United States
Organisme : NIDDK NIH HHS
ID : UH3 DK114937
Pays : United States
Organisme : NIDDK NIH HHS
ID : UG3 DK114861
Pays : United States
Organisme : NIDDK NIH HHS
ID : UG3 DK114870
Pays : United States
Organisme : NIDDK NIH HHS
ID : U24 DK114886
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : ErratumIn
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
Corapi KM, Chen JL, Balk EM, Gordon CE: Bleeding complications of native kidney biopsy: A systematic review and meta-analysis. Am J Kidney Dis 60: 62–73, 2012 22537423
DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials 7: 177–188, 1986 3802833
Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in meta-analyses. BMJ 327: 557–560, 2003 12958120
Raudenbush S, Bryk A: Empirical Bayes meta-analysis. J Educ Behav Stat 10: 75–98, 1985
Freeman M, Tukey J: Transformations related to the angular and the square root. Ann Math Stat 21: 607–611, 1950
Ma Y, Chu H, Mazumdar M: Meta-analysis of proportions of rare events-A comparison of exact likelihood methods with robust variance estimation. Commun Stat Simul Comput 45: 3036–3052, 2016 27605731
Miller J: The inverse of the Freeman-Tukey double arcsine transformation. Am Stat 32: 138, 1978
Al Turk AA, Estiverne C, Agrawal PR, Michaud JM: Trends and outcomes of the use of percutaneous native kidney biopsy in the United States: 5-Year data analysis of the nationwide inpatient sample. Clin Kidney J 11: 330–336, 2018 29988286
Ishikawa E, Nomura S, Hamaguchi T, Obe T, Inoue-Kiyohara M, Oosugi K, Katayama K, Ito M: Ultrasonography as a predictor of overt bleeding after renal biopsy. Clin Exp Nephrol 13: 325–331, 2009 19381759
Tanaka K, Kitagawa M, Onishi A, Yamanari T, Ogawa-Akiyama A, Mise K, Inoue T, Morinaga H, Uchida HA, Sugiyama H, Wada J: Arterial stiffness is an independent risk factor for anemia after percutaneous native kidney biopsy. Kidney Blood Press Res 42: 284–293, 2017 28531895
Moledina DG, Luciano RL, Kukova L, Chan L, Saha A, Nadkarni G, Alfano S, Wilson FP, Perazella MA, Parikh CR: Kidney biopsy-related complications in hospitalized patients with acute kidney disease. Clin J Am Soc Nephrol 13: 1633–1640, 2018 30348813
Aaltonen S, Finne P, Honkanen E: Outpatient kidney biopsy: A single center experience and review of literature. Nephron 144: 14–20, 2020 31578024
Charu V, O’Shaughnessy MM, Chertow GM, Kambham N: Percutaneous kidney biopsy and the utilization of blood transfusion and renal angiography among hospitalized adults. Kidney Int Rep 4: 1435–1445, 2019 31701053
Kawaguchi T, Nagasawsa T, Tsuruya K, Miura K, Katsuno T, Morikawa T, Ishikawa E, Ogura M, Matsumura H, Kurayama R, Matsumoto S, Marui Y, Hara S, Maruyama S, Narita I, Okada H, Ubara Y; Committee of Practical Guide for Kidney Biopsy 2019: A nationwide survey on clinical practice patterns and bleeding complications of percutaneous native kidney biopsy in Japan [published correction appears in Clin Exp Nephrol 24: 389–401, 2020]. Clin Exp Nephrol 24: 389–401, 2020 32189101
Palsson R, Short SAP, Kibbelaar ZA, Amodu A, Stillman IE, Rennke HG, McMahon GM, Waikar SS: Bleeding complications after percutaneous native kidney biopsy: Results from the boston kidney biopsy cohort. Kidney Int Rep 5: 511–518, 2020 32274455
Varnell CD Jr., Stone HK, Welge JA: Bleeding complications after pediatric kidney biopsy: A systematic review and meta-analysis. Clin J Am Soc Nephrol 14: 57–65, 2019 30522995
Hogan JJ, Owen JG, Blady SJ, Almaani S, Avasare RS, Bansal S, Lenz O, Luciano RL, Parikh SV, Ross MJ, Sharma D, Szerlip H, Wadhwani S, Townsend RR, Palmer MB, Susztak K, Mottl AK; TRIDENT Study Investigators: The feasibility and safety of obtaining research kidney biopsy cores in patients with diabetes: An interim analysis of the TRIDENT study. Clin J Am Soc Nephrol 15: 1024–1026, 2020 32341009