Safety and feasibility of outpatient percutaneous native kidney biopsy in the developing world: Experience in a large tertiary care centre in Eastern India

• Published in: Nephrology (Carlton, Vic.) Vic.), 2013-01, Vol.18 (1), p.36-40
• Main Authors: Golay, Vishal, Sarkar, Dipankar, Thomas, Punnoose, Trivedi, Mayuri, Singh, Ametashver, Roychowdhary, Arpita, Dasgupta, Sanjay, Pandey, Rajendra
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Surgical Procedures; Biopsy, Needle - adverse effects; Biopsy, Needle - methods; complications; Developing Countries; Feasibility Studies; Female; haematuria; Humans; India; Kidney - pathology; Male; native kidney biopsy; outpatient; Prospective Studies; Tertiary Care Centers; ultrasound guided
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/j.1440-1797.2012.01663.x

Golay and colleagues reported a prospective observational study on outpatients with percutaneous renal biopsies. They compared the efficacy and safety of percutaneous renal biopsies in outpatients and overnight inpatients and suggested percutaneous renal biopsies could be safely performed in outpatients with low risks. Aim Optimal time of observation following percutaneous biopsy has not been clearly established. Outpatient biopsy protocol was established in our centre for low risk patients and we assessed its efficacy and safety. Methods Patients fulfilling the low risk profile underwent a real time ultrasound‐guided percutaneous native kidney biopsy. They were observed for 6 h and any complication was recorded. Ultrasound and hematocrit was done only in those patients with complications. Patients were contacted on telephone after 24 h and in case of any emergency. Results A total of 403 native kidney biopsies were performed from June 2011 to June 2012 of which 115 (28.5%) were on an outpatient basis. This was a 41.4% increase in the number of biopsies compared to the same period in the previous year. Fifteen patients (13.04%) had macroscopic haematuria within 2, 4 and 6 h in eight (53.33%), six (40%) and one (6.67%) patient, respectively. One of them had haematuria on follow‐up phone call resolving without intervention. Only two (1.74%) patients developed significant bleeding with a drop in haematocrit needing overnight observation, with one requiring blood transfusion (with perinephric haematoma not requiring intervention). Complication rates were also similar in the 288 patients who had at least an overnight inpatient observation post‐biopsy. There was no biopsy related mortality. Conclusions Percutaneous native kidney biopsies can be safely performed on an outpatient basis in selected low risk patients. This approach increases the number of procedures, decreases the waiting periods and can have potential cost savings making it an attractive option in the developing world.