Invited commentary by Dr. Carlo Manno
In the recent article “Bleeding Complications of Native Kidney Biopsy: a Systematic Review and Meta-analysis” published in the American Journal of Kidney Diseases, Corapi et al based their systematic review and meta-analysis of the literature on the assumption that the primary complication of kidney biopsy is hemorrhage. As a result, the authors aimed to evaluate the incidence of hemorrhagic complication rates after native kidney biopsy performed with real-time ultrasonographic guidance and automated spring-loaded biopsy device. They wanted to identify potential risk factors for bleeding complications.
Methodologically, the study was well conducted even though the heterogeneity of 34 publications included for analysis was an important limitation of the review; only 1 study was a randomized controlled trial, 13 studies were prospective, and the others were retrospective. Moreover, 58 studies with fewer than 50 patients were excluded. Both transplant and native kidney biopsies were included, as well both manual and automated biopsy devices.
Regarding the primary outcome, the most frequent bleeding complication of kidney biopsy, i.e., the perinephric hematoma, was not considered among principal outcomes of this study. Routine post-biopsy ultrasonography demonstrates this complication in 17% of procedures, but the rate increases to 91% when using computed tomography. Even though the majority of these hematomas are asymptomatic, the presence of larger perinephric hematomas increase the discomfort for the patient and the cost due to additional testing, longer hospitalization, and therapeutic procedures (artery embolization).
Since risk factors for significant bleeds were difficult to identify, further studies are necessary to find more sensitive tests to assess coagulation disorders. The use of desmopressin should be considered among potential interventions since the unique randomized controlled trial included in this review demonstrates a risk reduction for bleeding complication in the treated group compared to controls.
Carlo Manno, MD
Assistant Professor of Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation at the University of Bari, Bari, Italy