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Original article

Vol. 155 No. 6 (2025)

Bleeding risk after native and transplant kidney biopsy – a single-centre observational study

Cite this as:
Swiss Med Wkly. 2025;155:4409
Published
05.06.2025

Summary

STUDY AIM: Renal biopsies provide important and decisive information for diagnosis and therapy. Although biopsies are considered safe, bleeding complications remain a concern. We analysed the complication rate after kidney biopsies in native and transplant kidneys and their association with platelet function analyser bleeding time (PFA BT) and estimated glomerular filtration rate (eGFR).

METHODS: This single-centre observational study included all patients who underwent an ultrasound-guided kidney biopsy at the University Hospital Basel from 2015 to August 2019. The main objective was to investigate the association of PFA BT with significant bleeding complications in kidney biopsies. Significant bleeding was defined as a haemoglobin decrease of >10 g/l within 48 hours or the need for transfusion after bleeding, according to the discretion of the treating physician. The pre-biopsy assessment included bleeding time using PFA BT, INR, thrombocyte count, and eGFR.

RESULTS: A total of 819 kidney biopsies—285 native and 534 transplant—were analysed. Complications occurred in 32 biopsies (3.9%): 18 (6.3%) in native and 14 (2.6%) in transplant kidneys. Bleeding was the most frequent complication in both groups. Overall, low eGFR (p = 0.01) and prolonged PFA BT (p = 0.02) were associated with bleeding complications. In native kidney biopsies, inpatient biopsy was associated with bleeding complications (p = 0.005), while in transplant kidney biopsies, bleeding complications were associated with time after transplantation (p <0.001), prolonged PFA BT (p <0.001), and diagnostic biopsies (p = 0.01). In the multivariable model, low eGFR was the only significant factor associated with bleeding complications (odds ratio 3.57, 95% confidence interval 1.76-7.23, p <0.001).

CONCLUSIONS: A low eGFR, especially below 30 ml/min, is associated with increased bleeding risk in native and transplant kidney biopsies.

References

  1. Trajceska L, Severova-Andreevska G, Dzekova-Vidimliski P, Nikolov I, Selim G, Spasovski G, et al. Complications and Risks of Percutaneous Renal Biopsy. Open Access Maced J Med Sci. 2019 Mar;7(6):992–5. 10.3889/oamjms.2019.226
  2. Feldmann Y, Böer K, Wolf G, Busch M. Complications and monitoring of percutaneous renal biopsy - a retrospective study . Clin Nephrol. 2018 Apr;89(4):260–8. 10.5414/CN109223
  3. Redfield RR, McCune KR, Rao A, Sadowski E, Hanson M, Kolterman AJ, et al. Nature, timing, and severity of complications from ultrasound-guided percutaneous renal transplant biopsy. Transpl Int. 2016 Feb;29(2):167–72. 10.1111/tri.12660
  4. Brachemi S, Bollée G. Renal biopsy practice: what is the gold standard? World J Nephrol. 2014 Nov;3(4):287–94. 10.5527/wjn.v3.i4.287
  5. Schorr M, Roshanov PS, Weir MA, House AA. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Can J Kidney Health Dis. 2020 May;7:2054358120923527. 10.1177/2054358120923527
  6. Corapi KM, Chen JL, Balk EM, Gordon CE. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis. 2012 Jul;60(1):62–73. 10.1053/j.ajkd.2012.02.330
  7. Furness PN, Philpott CM, Chorbadjian MT, Nicholson ML, Bosmans JL, Corthouts BL, et al. Protocol biopsy of the stable renal transplant: a multicenter study of methods and complication rates. Transplantation. 2003 Sep;76(6):969–73. 10.1097/01.TP.0000082542.99416.11
  8. Stratta P, Canavese C, Marengo M, Mesiano P, Besso L, Quaglia M, et al. Risk management of renal biopsy: 1387 cases over 30 years in a single centre. Eur J Clin Invest. 2007 Dec;37(12):954–63. 10.1111/j.1365-2362.2007.01885.x
  9. Kawaguchi T, Nagasawsa T, Tsuruya K, Miura K, Katsuno T, Morikawa T, et al.; 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 [Erratum in: Clin Exp Nephrol. 2020 May;24] [5] [:402-403. doi: 10.1007/s10157-020-01883-y. PMID: 32189101; PMCID: PMC7174253]. Clin Exp Nephrol. 2020 May;24(5):389–401. 10.1007/s10157-020-01869-w 10.1007/s10157-020-01869-w
  10. Schwarz A, Gwinner W, Hiss M, Radermacher J, Mengel M, Haller H. Safety and adequacy of renal transplant protocol biopsies. Am J Transplant. 2005 Aug;5(8):1992–6. 10.1111/j.1600-6143.2005.00988.x
  11. Morgan TA, Chandran S, Burger IM, Zhang CA, Goldstein RB. Complications of Ultrasound-Guided Renal Transplant Biopsies. Am J Transplant. 2016 Apr;16(4):1298–305. 10.1111/ajt.13622
  12. Ferguson C, Winters S, Jackson S, McToal M, Low G. A retrospective analysis of complication and adequacy rates of ultrasound-guided native and transplant non-focal renal biopsies. Abdom Radiol (NY). 2018 Aug;43(8):2183–9. 10.1007/s00261-017-1405-z
  13. Xu DM, Chen M, Zhou FD, Zhao MH. Risk Factors for Severe Bleeding Complications in Percutaneous Renal Biopsy. Am J Med Sci. 2017 Mar;353(3):230–5. 10.1016/j.amjms.2016.12.019
  14. Andrulli S, Rossini M, Gigliotti G, La Manna G, Feriozzi S, Aucella F, et al.; ITA-KID-BIO-Group. The risks associated with percutaneous native kidney biopsies: a prospective study. Nephrol Dial Transplant. 2023 Feb;38(3):655–63. 10.1093/ndt/gfac177
  15. Whittier WL, Gashti C, Saltzberg S, Korbet S. Comparison of native and transplant kidney biopsies: diagnostic yield and complications. Clin Kidney J. 2018 Oct;11(5):616–22. 10.1093/ckj/sfy051
  16. Palsson R, Short SA, Kibbelaar ZA, Amodu A, Stillman IE, Rennke HG, et al. Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort. Kidney Int Rep. 2020 Mar;5(4):511–8. 10.1016/j.ekir.2020.01.012
  17. Manno C, Strippoli GF, Arnesano L, Bonifati C, Campobasso N, Gesualdo L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int. 2004 Oct;66(4):1570–7. 10.1111/j.1523-1755.2004.00922.x
  18. van den Hoogen MW, Verbruggen BW, Polenewen R, Hilbrands LB, Nováková IR. Use of the platelet function analyzer to minimize bleeding complications after renal biopsy. Thromb Res. 2009;123(3):515–22. 10.1016/j.thromres.2008.07.001
  19. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344–9. 10.1016/j.jclinepi.2007.11.008
  20. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al.; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate [Erratum in: Ann Intern Med. 2011 Sep 20;155] [6] [:408. PMID: 19414839; PMCID: PMC2763564]. Ann Intern Med. 2009 May;150(9):604–12. 10.7326/0003-4819-150-9-200905050-00006
  21. Bonani M, Seeger H, Weber N, Lorenzen JM, Wüthrich RP, Kistler AD. Safety of Kidney Biopsy when Performed as an Outpatient Procedure. Kidney Blood Press Res. 2021;46(3):310–22. 10.1159/000515439
  22. Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial. 2006;19(4):317–22. 10.1111/j.1525-139X.2006.00179.x