Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 298-301. doi: 10.19723/j.issn.1671-167X.2021.02.011

Previous Articles     Next Articles

Analysis of bleeding risk in percutaneous renal biopsy in Tibet

ZHANG Lei1,LI Guo-liang1,DANG Zong-hui1, 1,A yong1,WU Ling-jie1,LIU Li-jun2,Δ()   

  1. 1. Department of Nephrology, People’s Hospital of Tibet Autonomous Region, Lhasa 850000, China
    2. Renal Division, Institute of Nephrology, Peking University First Hospital, Beijing 100034, China
  • Received:2019-07-16 Online:2021-04-18 Published:2021-04-21
  • Contact: Li-jun LIU E-mail:lijun.liu@aliyun.com

RICH HTML

 8   

PDF (PC)

201

Abstract:

Objective: To observe the postoperative bleeding after percutaneous renal biopsy (PRB) in Tibet, To analyze and summarize the risk factors associated with bleeding in high altitude patients to improve the safety of surgery. Methods: A retrospective analysis of 150 cases of PRB in the Department of Nephrology, People’s Hospital of Tibet Autonomous Region from May 2016 to May 2018 were carried out, and the correlations between the potential risk factors (gender, age, blood pressure, hemoglobin, platelet, serum creatinine) and postoperative bleeding events were analyzed. Results: During the study period, the 150 patients receiving procedure of PRB were enrolled in our hospital, with an average age of (41.2±15.6) years, of whom 58.7% (88/150) were male, 41.3% (62/150) were female, and major bleeding complications occurred in 12 biopsies (8.0%, 12/150). Six cases for men and women, respectively. The mean age in the bleeding group seemed to be higher than that in the non-bleeding group [(48.3±20.0) years vs. (40.6±15.1) years, P=0.099]. There was no significant difference in the incidence of hypertension, hemoglobinemia, urea nitrogen and prothrombin time between the two groups. The level of serum creatinine in the hemorrhage group seemed to be higher than that in the non-bleeding group (P=0.090), and the time of the hemorrhagic group was longer than that in the non-bleeding group (P=0.069). The platelet count in the bleeding group was significantly lower than that in the non-bleeding group (P<0.05). Multivariate Logistic regression analysis showed that the prolonged activation of partial prothrombin time and lower platelet count had a relatively high risk of bleeding, which was statistically significant (P=0.079, P=0.082). Conclusion: PRB is safe and reliable on the whole in plateau areas; Old age, low platelet count, decreased renal function and prolonged activated partial coagulation time are related to postoperative bleeding of PRB, and hyperhemoglobin is not a risk factor for bleeding. High hemoglobin is not a risk factor for postoperative bleeding of PRB at high altitude.

Key words: Tibet area, Percutaneous renal biopsy, Bleeding complication

CLC Number: 

  • R605

Table 1

Baseline data of bleeding group and non bleeding group"

Items Bleeding group
(n=12)		 Non bleeding group
(n=138)		 P
Gender, male/female 6/12 82/138 0.525
Age/years 48.3±20.0 40.6±15.1 0.099
Dystolic pressure/mmHg 141.4±29.3 132.1±23.8 0.202
Diastolic pressure/mmHg 93.9±19.8 93.2±75.0 0.974
Hypertension, n (%) 8 (66.7) 71 (51.4) 0.311
Hemoglobin/(g/L) 139.6±39.5 141.4±34.0 0.865
HAPC, n (%) 0 (0.0) 4 (2.7) 0.550
Scr/(μmol/L) 175.8±154.4 119.1±106.2 0.090
BUN/(mmol/L) 11.1±10.6 9.1±10.6 0.519
PT/s 13.1±1.5 13.1±3.9 0.940
APTT/s 43.9±7.1 40.1±7.0 0.069
Platelet/(×109/L) 178.5±78.5 226.8±79.3 0.045

Table 2

Logistic analysis of bleeding risk"

Items Multivariate Logistic analysis
OR (95%CI) P
Age 1.02 (0.97-1.07) 0.456
Dystolic pressure 1.00 (0.98-1.03) 0.769
Diastolic pressure 1.00 (0.99-1.01) 0.939
Hemoglobin 1.00 (0.98-1.02) 0.749
Scr 1.00 (1.00-1.01) 0.340
BUN 1.01 (0.93-1.10) 0.861
PT 0.77 (0.45-1.31) 0.331
APTT 1.09 (0.99-1.19) 0.079
Platelet 0.99 (0.98-1.00) 0.082
[1] Torres-Munoz A, Valdez-Ortiz R, Gonzalez-Parra C, et al. Percutaneous renal biopsy of native kidneys: efficiency, safety and risk factors associated with major complications[J]. Arch Med Sci, 2011,7(5):823-831.
pmid: 22291827
[2] Xu DM, Chen M, Zhou FD, et al. Risk Factors for severe bleeding complications in percutaneous renal biopsy[J]. Am J Med Sci, 2017,353(3):230-235.
doi: 10.1016/j.amjms.2016.12.019 pmid: 28262208
[3] Korbet SM, Volpini KC, Whittier WL. Percutaneous renal biopsy of native kidneys: a single-center experience of 1,055 biopsies[J]. Am J Nephrol, 2014,39(2):153-162.
pmid: 24526094
[4] Prasad N, Kumar S, Manjunath R, et al. Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications[J]. Clin Kidney J, 2015,8(2):151-156.
pmid: 25815170
[5] Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy[J]. Kidney Int, 2004,66(4):1570-1577.
pmid: 15458453
[6] 高文祥, 高玉琪. 慢性高原病分型、诊断与治疗的研究进展[J]. 第三军医大学学报 2016,38(5):431-436.
[7] Surgeons ACo: advanced trauma life support[M]. 10th ed. American: American College of Surgeons, 2018: 474.
[8] Corapi KM, Chen JL, Balk EM, et al. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis[J]. Am J Kidney Dis, 2012,60(1):62-73.
[9] Al Turk AA, Estiverne C, Agrawal PR, et al. Trends and outcomes of the use of percutaneous native kidney biopsy in the United States: 5-year data analysis of the nationwide inpatient sample[J]. Clin Kidney J, 2018,11(3):330-336.
doi: 10.1093/ckj/sfx102 pmid: 29988286
[10] Tondel C, Vikse BE, Bostad L, et al. Safety and complications of percutaneous kidney biopsies in 715 children and 8 573 adults in Norway 1988-2010[J]. Clin J Am Soc Nephrol, 2012,7(10):1591-1597.
pmid: 22837269
[11] Lees JS, McQuarrie EP, Mordi N, et al. Risk factors for bleeding complications after nephrologist-performed native renal biopsy[J]. Clin Kidney J, 2017,10(4):573-577.
[12] Eiro M, Katoh T, Watanabe T. Risk factors for bleeding complications in percutaneous renal biopsy[J]. Clin Exp Nephrol, 2005,9(1):40-45.
pmid: 15830272
[13] Martin DS, Pate JS, Vercueil A, et al. Reduced coagulation at high altitude identified by thromboelastography[J]. Thromb Haemost, 2012,107(6):1066-1071.
pmid: 22437051
[14] Chen W, Liu Q, Wang H, et al. Prevalence and risk factors of chronic kidney disease: a population study in the Tibetan population[J]. Randomized Controlled Trial, 2011,26(5):1592-1599.
[15] Jonathan JH, Michaela M, Jeffrey SB. The native kidney biopsy: update and evidence for best practice[J]. Clin J Am Soc Nephrol, 2016,11(2):354-362.
pmid: 26339068
[16] Preuss S, Kuechle C, Wagenpfeil S, et al. Retrospective analysis of ultrasound-detected bleeding complications after ultrasound-guided transcutaneous kidney biopsies[J]. Ultrasound Med Biol, 2017,43(1):153-162.
[17] Riehl J, Maigatter S, Kierdorf H, et al. Percutaneous renal biopsy: comparison of manual and automated puncture techniques with native and transplanted kidneys[J]. Nephrol Dial Transplant, 1994,9(11):1568-1574.
pmid: 7870344
[18] Pokhrel A, Agrawal RK, Baral A, et al. Percutaneous renal biopsy: comparison of blind and real-time ultrasound guided technique[J]. J Nepal Health Res Counc, 2018,16(1):66-72.
[19] Mai J, Yong J, Dixson H, et al. Is bigger better? A retrospective analysis of native renal biopsies with 16 Gauge versus 18 Gauge automatic needles[J]. Nephrology (Carlton), 2013,18(7):525-530.
No related articles found!
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] . [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 456 -458 .
[2] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 125 -128 .
[3] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 135 -140 .
[4] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 158 -161 .
[5] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 217 -220 .
[6] . [J]. Journal of Peking University(Health Sciences), 2009, 41(1): 52 -55 .
[7] . [J]. Journal of Peking University(Health Sciences), 2009, 41(1): 109 -111 .
[8] . [J]. Journal of Peking University(Health Sciences), 2009, 41(3): 297 -301 .
[9] . [J]. Journal of Peking University(Health Sciences), 2009, 41(5): 599 -601 .
[10] . [J]. Journal of Peking University(Health Sciences), 2009, 41(5): 516 -520 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd