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Clinical Journal of the American... Nov 2020Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Native kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
This is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman-Tukey double-arcsine transformations were used to stabilize variance as complications were rare.
RESULTS
A total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.
CONCLUSIONS
Although the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.
Topics: Blood Transfusion; Hematoma; Hematuria; Hemostasis, Surgical; Hospitalization; Humans; Image-Guided Biopsy; Kidney; Kidney Diseases; Pain; Risk Factors
PubMed: 33060160
DOI: 10.2215/CJN.04710420 -
Medicina 2019Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in...
Nutcracker syndrome is a vascular anomaly consisting in the compression of the left renal vein between the superior mesenteric artery and the aorta. Clinical features in nutcracker syndrome include pelvic pain, flank pain, haematuria, gonadal varices or simply asymptomatic. We are presenting two cases, one of them with macroscopic haematuria and flank pain and the other was studied for hypertension but with previous antecedents of left renal vein embolization in the setting of varicocele. We discuss the clinical presentation as well as diagnostic and therapeutic aspects related to this syndrome.
Topics: Adolescent; Adult; Computed Tomography Angiography; Female; Hematuria; Humans; Renal Nutcracker Syndrome; Renal Veins
PubMed: 31048282
DOI: No ID Found -
Kidney International Feb 1995IgAN is the most common type of glomerulonephritis worldwide, and is found more in men and distinctly less in blacks. It presents with macroscopic hematuria in about 40... (Review)
Review
IgAN is the most common type of glomerulonephritis worldwide, and is found more in men and distinctly less in blacks. It presents with macroscopic hematuria in about 40 to 45% of patients, with microscopic hematuria and proteinuria in about 35 to 40%, and with nephrotic syndrome or acute renal failure in the remainder. The diagnosis continues to rely on the finding of the dominant or codominant mesangial deposition of IgA on immunohistologic examination of the kidney. No blood or urine test is sufficiently reliable for diagnosis. While the pathogenesis remains unknown, accumulating evidence suggests that polyclonal stimulation of immunoglobulins perhaps coupled with structural abnormalities of IgA play pivotal roles. These defects may account for the variety of autoantibodies detected in patients with both IgAN and HSP. While IgAN has an indolent course, about 30% of patients will reach ESRD after 20 years, particularly in those who present with hypertension, heavy proteinuria or renal insufficiency. At present, therapy is disappointing, but immunoglobulin supplementation and newer agents that interrupt the pathways of mesangial proliferation and sclerosis hold promise for the future. Kidney transplantation has shown excellent allograft survival.
Topics: Glomerulonephritis, IGA; Humans; Immunoglobulin A; Prognosis
PubMed: 7723227
DOI: 10.1038/ki.1995.50 -
Clinical Journal of the American... Jan 2012Hematuria is a common finding in various glomerular diseases. This article reviews the clinical data on glomerular hematuria and kidney injury, as well as the... (Review)
Review
Hematuria is a common finding in various glomerular diseases. This article reviews the clinical data on glomerular hematuria and kidney injury, as well as the pathophysiology of hematuria-associated renal damage. Although glomerular hematuria has been considered a clinical manifestation of glomerular diseases without real consequences on renal function and long-term prognosis, many studies performed have shown a relationship between macroscopic glomerular hematuria and AKI and have suggested that macroscopic hematuria-associated AKI is related to adverse long-term outcomes. Thus, up to 25% of patients with macroscopic hematuria-associated AKI do not recover baseline renal function. Oral anticoagulation has been associated with glomerular macrohematuria-related kidney injury. Several pathophysiologic mechanisms may account for the tubular injury found on renal biopsy specimens. Mechanical obstruction by red blood cell casts was thought to play a role. More recent evidence points to cytotoxic effects of oxidative stress induced by hemoglobin, heme, or iron released from red blood cells. These mechanisms of injury may be shared with hemoglobinuria or myoglobinuria-induced AKI. Heme oxygenase catalyzes the conversion of heme to biliverdin and is protective in animal models of heme toxicity. CD163, the recently identified scavenger receptor for extracellular hemoglobin, promotes the activation of anti-inflammatory pathways, opening the gates for novel therapeutic approaches.
Topics: Acute Kidney Injury; Animals; Anticoagulants; Glomerulonephritis, IGA; Hematuria; Heme; Hemoglobinuria; Humans
PubMed: 22096039
DOI: 10.2215/CJN.01970211 -
Jornal Brasileiro de Nefrologia 2017The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely...
The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.
Topics: Aneurysm, False; Biopsy; Humans; Male; Middle Aged; Postoperative Complications; Renal Artery
PubMed: 29319774
DOI: 10.5935/0101-2800.20170080 -
The Pan African Medical Journal 2018Renal needle biopsy (RNB) is the gold standard in the diagnosis of kidney diseases. It is an invasive technique causing several complications, in particular hemorrhagic...
Renal needle biopsy (RNB) is the gold standard in the diagnosis of kidney diseases. It is an invasive technique causing several complications, in particular hemorrhagic events. This study aims to evaluate our RNB practice, to update the current understanding of the technique for percutaneous renal biopsy, to assess complications and to determine the prevalence of kidney diseases diagnosed in our region. We conducted a retrospective study between January 2015 and June 2017. Sixty-nine patients hospitalized in the Division of Nephrology at the University Hospital Mohamed VI Oujda having undergone native kidney biopsy were included in the study. The average age of patients, at the time of RNB, was 38.16 ±13 years [12-77 years], with a sex ratio (M/F) of 0.86. Nephrotic syndrome was the most frequent indication for RNB in all age groups. Glomerular kidney diseases accounted for 81% of kidney diseases, divided as follows: extra-membranous glomerulonephritis in 19% of patients, focal and segmental hyalinosis in 18%, lupus nephritisin in 11%, chronic glomerulonephrites in 11%, membranoproliferative glomerulonephritis in 7%, extracapillary glomerulonephritis in 5% shared equally with renal amyloidosis. Four percent of RNB showed diabetic nephropathy. Histopathological examination revealed acute post-infectious glomerulonephritis, minimal glomerular lesion, immunoglobulin A (IgA) nephropathy, vasculitis, tubulo-interstizial nephropathies as well as thrombotic microangiopathy, with an estimated rate of 2% respectively. Five percent of RNB showed non-glomerular disease. Macroscopic haematuria was the main complication observed in our case series, with a rate of 2.8%. RNB is the gold standard in the diagnosis of renal disease. However, syndromic diagnosis enables clinician to identify the most probable renal disease and to guide any emergency treatment.
Topics: Adolescent; Adult; Aged; Biopsy, Needle; Child; Female; Glomerulonephritis; Hematuria; Humans; Kidney Diseases; Male; Middle Aged; Nephrotic Syndrome; Retrospective Studies; Young Adult
PubMed: 30918570
DOI: 10.11604/pamj.2018.31.44.15604 -
Kidney & Blood Pressure Research 2017Hematuria is one of the basic clinical manifestations of IgA nephropathy (IgAN). Isolated microscopic hematuria or microscopic hematuria combined with proteinuria is... (Review)
Review
Hematuria is one of the basic clinical manifestations of IgA nephropathy (IgAN). Isolated microscopic hematuria or microscopic hematuria combined with proteinuria is risk factor for the long-term prognosis of IgAN. Current evidence of the consequences of glomerular hematuria rests on insights from basic research on the molecular mechanisms of hemoglobin and related reactive oxygen species-induced tubular injury as well as on the clinical evidence of macroscopic hematuria-associated acute kidney injury (AKI) in IgAN. These researches may simply elucidate some effects of macroscopic hematuria but not microscopic hematuria. Recent studies conducted on blood and urinary erythrocytes have made progress. Researches have revealed that mature erythrocytes contain abundant, long, non-coding RNA, miRNA (microRNA) and Y RNA. Among the top 50 expressions of erythrocyte-derived miRNAs, 33 (66%) of them may be the potential urinary biomarkers of IgAN. Moreover, when urinary erythrocytes are compressed while exiting out of an impaired nephron, erythrocyte-derived vesicles (including microvesicles and apoptotic vesicles) may increase. Animal models for hematuria and human biopsy tissues confirm renal parenchymal cells could phagocytose red blood cells and erythrocyte-derived vesicles. These vesicles, which contain miRNAs, may alter the transcriptome of recipient cells and impact the occurrence and development of IgAN.
Topics: Biomarkers; Erythrocytes; Glomerulonephritis, IGA; Hematuria; Humans; MicroRNAs
PubMed: 29050002
DOI: 10.1159/000481970 -
Medicine Feb 2020Ageing people with hemophilia (PWH) have a higher prevalence of hypertension than the general population. This study aimed to determine whether macroscopic hematuria was...
Ageing people with hemophilia (PWH) have a higher prevalence of hypertension than the general population. This study aimed to determine whether macroscopic hematuria was associated with hypertension in PWH in a post hoc analysis using data from a cross-sectional study conducted by the ADVANCE Working Group (the H3 study), which included PWH ≥ 40 years of age. Data from 16 contributing centers, located in 13 European countries and Israel, were analyzed using logistic regression models. Of 532 recruited PWH in the H3 study, 117 had hypertension and a positive family history of hypertension (hypertension FH+), 75 had hypertension and a negative family history of hypertension (hypertension FH-), 290 had no diagnosis of hypertension, and the remaining 50 had missing hypertension data. Logistic regressions showed that macroscopic hematuria was associated with hypertension FH+, both in the univariate (OR = 1.84 [1.17-2.90], P = .01) and in the multivariate model (OR = 1.80 [1.03-3.16], P = .04). Macroscopic hematuria was not associated with hypertension FH-. Moreover, in a multivariate logistic regression the odds of hypertension FH+ were increased with the number of macroscopic hematuria episodes. The association between macroscopic hematuria and hypertension was significant for PWH with a family history of hypertension.
Topics: Adult; Aged; Aged, 80 and over; Aging; Cross-Sectional Studies; Female; Hematuria; Hemophilia A; Humans; Hypertension; Israel; Logistic Models; Male; Middle Aged; Risk Factors
PubMed: 32118768
DOI: 10.1097/MD.0000000000019339