P188
DAY CASE RENAL BIOPSY IS SAFE AND EFFECTIVE IRRESPECTIVE OF RENAL
FUNCTION: RESULTS FROM A SINGLE-CENTER EXPERIENCE
Muthuppalaniappan V, Byrne C, Sheaff M, Rajakariar R & Blunden M
Department of Renal Medicine, The Royal London Hospital
INTRODUCTION – Percutaneous renal biopsy is an extremely useful diagnostic test in renal
disease in both native and transplant kidneys. There has been an increasing move towards day
case biopsy, as a more efficient use of patient and hospital time, saving 2 inpatient days per
biopsy at our centre. Concerns remain about the safety and efficiency of day case biopsies
especially in patients with significantly abnormal renal function (eGFR <60ml/min).
METHODS – Data was collected prospectively on 280 consecutive day-case renal biopsies,
performed in our dedicated short stay facility. All patients were deemed fit for day case biopsy
by virtue of a Hb >8g/dl, platelet count >100 and an INR and APTR <1.2. All patients had these
parameters measured less than a week prior to biopsy. Renal function as judged by serum
creatinine was also measured, patients with a creatinine >300umol/L received 20 mcg of
intravenous desmopressin (DDAVP) prior to biopsy. Blood pressure pre-procedure was under
160/90 and where possible anti-platelet agents were stopped one week prior to the biopsy. All
biopsies were either supervised or performed by a consultant nephrologist or renal trainee under
ultrasound guidance using either a Temno needle or biopsy gun of 16G or 18G. Patients were
observed for 6 hours post biopsy and discharged if deemed suitable following a review from the
Renal Registrar on call. Biopsies were reviewed in our weekly histopathology MDT for
diagnostic adequacy of sample.
RESULTS - In a one year period (November 2012 – Oct 2013) we performed 280 biopsies
(114 female, 166 male), comprised of 144 transplant renal biopsies and 136 native renal
biopsies. 57 of the transplant renal biopsies were 3 month protocol biopsies while the remaining
87 were to investigate cause of decline in graft function. There were 206 biopsies performed in
patients with eGFR<60ml/min. The amount of patients with an eGFR of 0-9ml/min, 1019ml/min, 20-29ml/min, 30-39ml/min, 40-59ml/min and 50-59ml/min, were 1, 28, 38, 64, 48
and 27 respectively. Biopsies were diagnostic in 277 cases (98.9%). Two transplant biopsies
and one native biopsy was not diagnostic due to inadequate sampling. Overall there were 3
minor complications with patients requiring an overnight admission for transient macroscopic
haematuria, with 2 cases being native kidney and 1 transplant kidney. The 3 patients were
haemodinamically stable with no drop in haemoglobin count throughout their admission. Both
the native renal biopsies had eGFR>60ml/min while the eGFR for the transplant renal biopsy
was 33ml/min. One patient had an accidental biopsy of their spleen as well as kidney and was
admitted to another trust four days later with a splenic haematoma.
CONCLUSION – Day case biopsy is generally a safe and an effective procedure. It provides
diagnostic information in >98% of cases and can be performed as an outpatient even when
significant renal impairment is present as demonstrated by our data. The cancellation rates for
biopsies were less when the procedure was organised as an outpatient as opposed to organising
a bed on the ward for inpatient biopsy. This has also improved patient satisfaction and
experience.