This month's eJournal Club concerns a paper (with an accompanying editorial) reporting the experience of renal biopsies in Norway. One issue that arises again and again is whether or not patients should undergo outpatient biopsies. The argument against this is that many complications occur more than 8 hours following a biopsy and that the complication risk is too high to allow patients to remain unmonitored at home. These recommendations were based on older data which dated from before the era of live ultrasound and the more modern biopsy needles. More recent studies have suggested that outpatient biopsies are safe and I had a conversation with one attending at the ASN last year who was surprised that everyone was not doing outpatient biopsies because they had been doing it without a problem for years.
This paper, while not specifically addressing the issue of outpatient vs. inpatient biopsies, should alleviate some of the concerns that people have. After 9288 biopsies, the rate of serious complications was 0.9% (transfusion or surgical intervention). This is similar to recently published studies. There were no deaths during the 20 years covered by the study. There was an increased risk of bleeding in patients with a low GFR, uncontrolled hypertension, older age and acute kidney injury. Notably there was no difference in bleeding complications when 14G needles were used as opposed to 18G needles although less glomeruli were obtained with the smaller needles.
There an interesting point for discussion here - in the course of the study, there was a marked decline in the number of nephrologists performing biopsies. The majority of biopsies are now performed by radiologists. These radiologists are more likely to use smaller needles and thus get less tissue. Should nephrologists take back the renal biopsy? Should we be more assertive in insisting that larger needles are used to ensure adequate biopsies? Head over the eJC for the discussion.
This paper, while not specifically addressing the issue of outpatient vs. inpatient biopsies, should alleviate some of the concerns that people have. After 9288 biopsies, the rate of serious complications was 0.9% (transfusion or surgical intervention). This is similar to recently published studies. There were no deaths during the 20 years covered by the study. There was an increased risk of bleeding in patients with a low GFR, uncontrolled hypertension, older age and acute kidney injury. Notably there was no difference in bleeding complications when 14G needles were used as opposed to 18G needles although less glomeruli were obtained with the smaller needles.
There an interesting point for discussion here - in the course of the study, there was a marked decline in the number of nephrologists performing biopsies. The majority of biopsies are now performed by radiologists. These radiologists are more likely to use smaller needles and thus get less tissue. Should nephrologists take back the renal biopsy? Should we be more assertive in insisting that larger needles are used to ensure adequate biopsies? Head over the eJC for the discussion.
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