{"id":21387,"date":"2017-06-22T12:29:51","date_gmt":"2017-06-22T16:29:51","guid":{"rendered":"http:\/\/www.stepwards.com\/?page_id=21387"},"modified":"2025-03-21T23:51:43","modified_gmt":"2025-03-22T03:51:43","slug":"common-pitfallscomplications-performing-a-renal-biopsy-under-non-ideal-conditions","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=21387","title":{"rendered":"Common Pitfalls\/Complications: Performing A Renal Biopsy Under Sub-Optimal Conditions"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_HYPERTENSION\"><span class=\"toc_number toc_depth_1\">2<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYPERTENSION<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_HYDRONEPHROSIS\"><span class=\"toc_number toc_depth_1\">3<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYDRONEPHROSIS<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_AN_ELEVATED_INR\"><span class=\"toc_number toc_depth_1\">4<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH AN ELEVATED INR<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_LOW_PLATELETS\"><span class=\"toc_number toc_depth_1\">5<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW PLATELETS<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_LOW_HEMOGLOBIN_ANEMIA\"><span class=\"toc_number toc_depth_1\">6<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW HEMOGLOBIN (ANEMIA)<\/a><\/li><li><a href=\"#AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_THE_RECENT_USAGE_OF_8220BLOOD_THINNERS8221\"><span class=\"toc_number toc_depth_1\">7<\/span> AVOIDING A RENAL BIOPSY IN PATIENTS WITH THE RECENT USAGE OF &#8220;BLOOD THINNERS&#8221;<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>This page is dedicated to discussing an important pitfall that is experienced often in the field of radiology:<strong> performing a renal biopsy under sub-optimal conditions<\/strong>. Read <a href=\"http:\/\/www.stepwards.com\/?page_id=21390\">this page<\/a> for more information on how to conduct an ultrasound guided non-focal renal biopsy.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>While the evidence base in some cases in anecdotal\/limited, there are a few clinical contexts under which a renal biopsy should NOT be performed.<\/strong><\/span><\/p>\n<ul>\n<li><strong>High blood pressure<\/strong><\/li>\n<li><strong>Hydronephrosis<\/strong><\/li>\n<li><strong>Elevated INR<\/strong><\/li>\n<li><strong>Low platelets <\/strong><\/li>\n<li><strong>Low hemoglobin (anemia)<\/strong><\/li>\n<li><strong>Recent usage of &#8220;blood thinning&#8221; medications\u00a0<\/strong><\/li>\n<\/ul>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_HYPERTENSION\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYPERTENSION<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>The kidneys of a patient with elevated blood pressure can be though of as a high pressure system. Given that a large amount of a patient&#8217;s blood will perfuse the parenchyma of the kidney, puncturing this organ in the setting of elevated pressure may lead to excessive bleeding.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>Vital signs (unsurprisingly the blood pressure of the patient). Recent values, in addition to the pressure right before the procedure can be informative. <strong>Generally speaking, a systolic blood pressure of 160 mm Hg or above is a risk factor for serious bleeding during a kidney biopsy.\u00a0<\/strong><\/p>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_HYDRONEPHROSIS\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYDRONEPHROSIS<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>In the setting of hydronephrosis, the collecting system of the kidneys can be thought of as an over-distended balloon (and is a high pressure setting). In such a setting, if a biopsy needle was to puncture the collecting system the risk of developing a urinoma is high.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>Signs of hydronephrosis reported on imaging in the patient&#8217;s recent past. Whats more, when imaging the kidneys with the ultrasound probe\/CT scanner prior to conducting the biopsy the kidneys should be evaluated for signs of hydronephrosis BEFORE the biopsy is conducted.<\/p>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_AN_ELEVATED_INR\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH AN ELEVATED INR<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>Given that a large amount of an individual&#8217;s blood circulates through the kidneys, any patient who has compromised coagulation should not be subjected to a kidney biopsy due to the risk of excessive bleeding.\u00a0<strong>Generally speaking, an INR of 1.5 or higher is a risk factor for serious bleeding during a kidney biopsy.\u00a0<\/strong><\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>An INR should be ordered and evaluated on all patients before biopsy.<\/p>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_LOW_PLATELETS\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW PLATELETS<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>Given that a large amount of an individual&#8217;s blood circulates through the kidneys, any patient who has an impaired ability to stop bleeding should not be subjected to a kidney biopsy (due to the risk of excessive bleeding).<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>A CBC should be conducted before a renal biopsy.\u00a0<strong>Generally a patient with platelets below\u00a050 x 10\u00b3\/\u00b5l of blood can be concerning for a serious bleed due to a biopsy.\u00a0<\/strong><\/p>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_LOW_HEMOGLOBIN_ANEMIA\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW HEMOGLOBIN (ANEMIA)<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>Given that a large amount of an individual&#8217;s blood circulates through the kidneys, any patient with anemia should not be subjected to a kidney biopsy due to the risk of excessive bleeding. A moderate amount of bleeding in the setting of anemia may be enough to bring about serious complications, and may even require a blood transfusion.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>A CBC should be conducted before a renal biopsy.\u00a0<strong>Generally speaking, a Hg of below 9.0 mg\/dLis a risk factor for serious\u00a0complications after a kidney biopsy.\u00a0<\/strong><\/p>\n<h5><span id=\"AVOIDING_A_RENAL_BIOPSY_IN_PATIENTS_WITH_THE_RECENT_USAGE_OF_8220BLOOD_THINNERS8221\"><span style=\"text-decoration: underline;\">AVOIDING A RENAL BIOPSY IN PATIENTS WITH THE RECENT USAGE OF &#8220;BLOOD THINNERS&#8221;<\/span><\/span><\/h5>\n<p><span style=\"text-decoration: underline;\"><strong>Why should it be avoided?<\/strong><\/span><\/p>\n<p>Given that a large amount of an individual&#8217;s blood circulates through the kidneys, any patient who has their ability to stop bleeding compromised by recent medication usage (i.e &#8220;blood thinners:) should avoid having a renal biopsy performed.<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>What do I look for before performing the biopsy?<\/strong><\/span><\/p>\n<p>A patients medication history is important to evaluate prior to the procedure. Special attention should be paid to the usage of medications such as warfarin, aspirin or NSAIDs. \u00a0<strong>Generally\u00a0speaking anticoagulation\/anti-platelet therapy that was stopped less then 7 days prior to the biopsy is a\u00a0risk factor for serious bleeding\u00a0occurring after the kidney biopsy.\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<pre>Page Updated: 06.22.2017<\/pre>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYPERTENSION3 AVOIDING A RENAL BIOPSY IN PATIENTS WITH HYDRONEPHROSIS4 AVOIDING A RENAL BIOPSY IN PATIENTS WITH AN ELEVATED INR5 AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW PLATELETS6 AVOIDING A RENAL BIOPSY IN PATIENTS WITH LOW HEMOGLOBIN (ANEMIA)7 AVOIDING A RENAL BIOPSY IN PATIENTS WITH &#8230; <a title=\"Common Pitfalls\/Complications: Performing A Renal Biopsy Under Sub-Optimal Conditions\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=21387\" aria-label=\"More on Common Pitfalls\/Complications: Performing A Renal Biopsy Under Sub-Optimal Conditions\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-5yX","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/21387"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21387"}],"version-history":[{"count":2,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/21387\/revisions"}],"predecessor-version":[{"id":28759,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/21387\/revisions\/28759"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}