Purpose: Identifying bleeding post-renal biopsy using Doppler ultrasound and evaluating the
value of local deep compression for hemostasis. Introduction Postprocedure renal hematoma
is a known complication after renal biopsies. Though most hematoma are self resolving
and reported with incidence of 0.3 to 13% in various studies. Large hematomas are
potentially devastating and can cause acute kidney injury post-hypotension and can
also compress the kidney leading to page kidney. The predisposing factors include
uncontrolled hypertension, use of NSAID, elevated creatine and pyelonephritis. All
the patients need screening for these potential predisposing factors and appropriate
corrective measures employed. Severe bleeding can furthermore deteriorate the already
compromised renal function, prolong the hospital stay, require endovascular embolization
of the bleeder requiring use of iodinated contrast having potential risk of furthering
Nephrotoxicity and financial repercussions. Nephrectomy is a devastating extreme measure.
Materials and Methods: Being a tertiary care hospital with dedicated nephrology services, dialysis and organ
transplant number of biopsies are done annually. An annual audit of the above methodology
to identify and prevent significant posttransplant hematoma was done. 30 patients
underwent ultrasound guided renal biopsy The indications included unexplained proteinuria,
rising creatinine, diabetic nephropathy. Check ultrasound was done prior to posting
for biopsy. Small kidneys with loss of corticomedullary differentiation were excluded.
Blood pressure and coagulation parameters were checked. Anticoagulation was stopped.
The patient was prepared in prone position for the biopsy. The lower pole of the left
kidney was chosen for the biopsy. The part was sterilized using betadine and antiseptic
sterillium solution. The ultrasound curvilinear probe having frequency of 3.5 to 5
MHz was covered with plastic camera cover. Local anesthetic was injected deep Subcutaneously
and also deep in the perinephric space. Good local control of pain was achieved. Postprocedure
pain score never exceeded 2 on the visual analog pain scale. None of the patients
needed paracetamol as pain medication postprocedure. Under ultrasound guidance an
automatic 18 gauge biopsy needle was used to take biopsy cores from the lower renal
pole. These samples were obtained for light microscopy, Electron microscopy and immunofluorescence.
Due to years of expertise most biopsies were achieved by using only three passes.
Post-biopsy power Doppler was used for evaluation of the bleeder. The bleeder was
identified on Doppler as a color jet (Fig. 1). On identification of the color jet
of bleeding. Local compression for 10 to 15 minutes was given. Post-compression Doppler
was done to check for absence of color jet which implied local thrombosis. The hematoma
was assessed and measured. Pre and post-biopsy hemoglobin was assessed. None of the
patients suffered significant hematoma requiring intervention or transfusion (Fig.
2). As the compression was given only till the bleeding stopped and was not prolonged
no vagal episodes or drop in blood pressure was experienced as noted in few studies
where prolonged compression was given.
Results: None of the patients suffered significant hematoma requiring intervention or transfusion
with this methodology /protocol.
Conclusion: Doppler for assessment of post-biopsy renal bleeding and compression can aid in reducing
the incidence of significant hematoma.
