Authors (including presenting author) :
Law WP(1), Lam CK(1), Wong YH(1), Chan Z(1), KL Chan(1), WL Pak(1), Yip WS(1), Chan KH (1), Wong SH(1)
Affiliation :
(1)Renal Unit, Medicine and Geriatric Department, United Christian Hospital
Introduction :
Renal biopsy(RB) is an important diagnostic tool for renal disease. The optimal observation period post-procedure is not established. The RB information sheet prepared by Hospital Authority[1] recommended “bed-rested for at least 24 hours” after the procedure. But there were papers suggested outpatient biopsy is safe and cost effective[2,3,4]. So, day RB was piloted in our unit since March 2019.
Objectives :
To assess the safety of day RB.
Methodology :
Low risk patients were offered the option of day RB. Exclusion criteria included: obesity, age >70 years old, BP≥180/100, unable to lie flat and prone, significant comorbidity, bleeding disorder, hemoglobin level(Hb) < 8g/dL and creatinine level > 200umol/L. Patients were admitted to day ward. Baseline Hb was checked. RB was performed with automated biopsy needle under USG guide by nephrologist. Patient was observed and bed-rested for around 8hours post biopsy. Hb was checked at 4hours after procedure. Bedside USG was performed before discharge of patient. Patient would be admitted for haemodynamic instability, haemoglobin drops for more the 1g/dL, ≥5 passes and at the discretion of the attending nephrologist. Data collected included: demographic data, reasons for RB, laboratory results, any complication and admission. Nurses would follow up patients’ condition for those not admitted by phone on next day.
Result & Outcome :
There were 61 patients underwent day RB from 25-3-2019 to 7-11-2022. Average age was 47.5 years old. 41 patients were female(67.21%). Indications for renal biopsy were: non-nephrotic proteinuria: 38(62.3%), nephrotic syndrome: 15(24.59 %) and renal derangement: 8(13.11%). There were no major complications while 7 had minor complications (4 had small perinephric hematoma, 2 had gross hematuria). Three patients with minor complications not required admission.
There were 22(36.07%) patients admitted for overnight observation. The reasons for admission included: Hb drop: 9(40.90%), hypertension: 2(9.09%), bleeding: 2(9.09%), fever: 1(4.55%) and multiple punctures 3(13.64%). Two patients stayed for 2 nights due to reasons not related to renal biopsy procedure. Other admitted patients were discharged after 24hours observation. For those admitted for Hb drop, repeated Hb was higher than the previous one. None of them required blood transfusion or intervention.
Conclusions:
Day RB is safe and is a feasible option in selected patients to reduce hospitalization.
References:
1. Information on Renal Biopsy. Coordinating Committee in Internal Medicine. Hospital Authority.
2. Melissa Schorr, Pavel S. Roshanov, Matthew A Weir, and Andrew A. House. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Canadian Journal of Kidney Health and Disease. Vol 7: 1-10.
3. Dario Roccatello, Savino Sciascia, Daniela Rossi, Carla Naretto, Mario Bazzan, Laura Solfietti, Simone Baldovino, Elisa Menegatti. Outpatient percutaneous native renal biopsy: safety profile in a large monocentric cohort. BMJ Open 2017; 7; e015243.
4. Christopher P. Carrington, Aled Williams, David F. Griffiths, Stephen G. Riley and Kieron L. Donovan. Adult day-case renal biopsy: a single-centre experience. NDT (2011) 26: 1559-1563
