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Renal Biopsy Haematoma Management — ESENeph MCQ

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ModerateAcute Kidney InjuryRenal Biopsy Haematoma ManagementESENeph

A 40-year-old man with CKD G3b undergoes renal biopsy. Post-procedure he develops macroscopic haematuria and flank pain. CT shows a perinephric haematoma. His Hb drops from 130 to 100 g/L. What is the incidence and management of this complication?

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Correct answer: D — Clinically significant bleeding (requiring transfusion or intervention) occurs in approximately 1-2% of native kidney biopsies; management is usually conservative (bed rest, monitoring, transfusion if needed); embolisation for ongoing haemorrhage

Post-biopsy haematoma is the most common complication. Microscopic perirenal haematoma is detectable by US in up to 60-90% if actively looked for, but is clinically insignificant in most. Clinically significant bleeding (Hb drop requiring transfusion, symptomatic haematoma, macroscopic haematuria) occurs in 1-2%. Risk factors include: uncontrolled hypertension, coagulopathy, small kidneys, amyloidosis, and solitary kidney. Management is usually conservative. Angiographic embolisation is reserved for ongoing haemorrhage. Mortality from kidney biopsy is approximately 0.02%. Post-biopsy monitoring (6-8 hours bed rest, serial observations, Hb check) is standard.

Reference: UKKA – Renal Biopsy Standards; Whittier et al 2004 – Biopsy Complications