Ultrasound Doppler and Postprocedure Compression after Renal Biopsy

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.

 

MissingLinkText

Publication History

Article published online:
02 April 2024