P254
DAYCASE RENAL BIOPSY IS SAFE AND EFFECTIVE: OUTCOMES OF THE LARGEST
REPORTED SERIES OF DAYCASE NATIVE RENAL BIOPSY
Nache, A, Topham, P
John Walls Renal Unit, University Hospitals of Leicester
INTRODUCTION: Percutaneous renal biopsy (PRB) is an essential tool for the investigation of patients
with renal disease. Historically patients who had undergone native PRB were subjected to overnight bedrest to minimise the risk of post-biopsy bleeding. Daycase (outpatient) native PRB has become
increasingly popular largely because of the financial and resource benefits. However, recent publications
have reported that up to a third of significant complications only become apparent beyond 8 hours postbiopsy, which raises concern about the safety of this approach.
Here we describe outcomes of the largest reported series of daycase native PRB.
METHODS; Data on patient outcome and biopsy adequacy were collected prospectively between
December 1998 and July 2008. PRB was undertaken as a daycase procedure unless the following
exclusion criteria were present: a lack of post-discharge supervision at home; significant renal impairment
(defined as a serum creatinine > 250μmol/l and/or urea > 20mmol/l); morbid nephrosis requiring
parenteral diuretic therapy; any other requirement for inpatient care.
RESULTS: 1259 PRBs were performed over this period, of which 455 were performed as a daycase
procedure. The biopsies were performed by either nephrology consultants or specialist registrars. A tissue
diagnosis was reached in 96.5% of patients. Eight (1.8%) of the daycase biopsies, and 26 (3.3%) of the
inpatient biopsies were technical failures that yielded no renal tissue.
Complications occurred after 41 daycase (9%) and 59 (7.3%) inpatient biopsies. Complications of
daycase biopsy included 47 (5.8%) visible haematuria, 9 (1.1%) pain, 17 (2.1%) perinephric haematoma,
24 (2.9%) drop in haemoglobin > 1gm/dL. Major complications occurred following 3 (0.7%) of daycase
biopsies and 22 (2.9%) of inpatient biopsies. Of the 3 major daycase biopsy complications, 3 required
blood transfusion and 1 underwent angiography although no active bleeding point was identified. A
significant fall in haemoglobin and the development of a perinephric haematoma was significantly more
common following inpatient biopsy.
Two episodes (8%) of visible haematuria that occurred after daycase biopsy developed after the 6 hour
observation period. A further 4 patients presented after 24 hours post-biopsy with loin pain but without
evidence of significant blood loss. After inpatient biopsy the majority of significant complications
occurred within 6 hours post biopsy. For example, 93% of visible haematuria presented during this
period. However, in 44% of patients, loin pain developed later than 12 hours post-biopsy.
Multivariate analysis showed that serum creatinine and the number of passes with the biopsy needle
increased the overall complication risk, whilst older age, elevated systolic blood pressure and raised
creatinine increased the risk of major complications.
DISCUSSION: Our findings differ from 2 recent studies which examined the timing of complications
after PRB. These reported that 20% and 33% of complications can be missed if an 8 hour observation
period is applied. However, neither paper stratified patients as either low or high risk as a way to select
patients to outpatient biopsy.
Our experience has also shown that daycase PRB provides adequate tissue to reach a histopathological
diagnosis in over 95% of cases with an acceptable complication rate. Furthermore the low risk daycase
environment has also provided an excellent training and education opportunity for nephrology registrars
to learn how to perform PRB. Finally there is a substantial financial benefit of daycase PRB: the tariff for
outpatient PRB is currently around £250 while the cost of overnight admission for PRB is £ 500.