Renal Biopsy Clinical Practice Guidelines (2019)

Kidney Health Australia–Caring for Australians with Renal Impairment (KHA-CARI)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

January 31, 2020

The guidelines on renal biopsy were released on October 23, 2019, by Kidney Health Australia–Caring for Australians with Renal Impairment (KHA-CARI).{ref1}

Biopsy Information and Education for Patients and Caregivers

Patients and their caregivers should be provided with education and information about renal biopsy, including reasons for its use, risks and complications, and pre‐ and postbiopsy management, with particular regard to psychological issues such as anxiety. The education and information provided should be in a format suited to their learning needs.

Prebiopsy Medication

Continuation of aspirin is recommended in patients at high risk for a cardiovascular event, including those with a history of coronary stenting (particularly within 3 months of bare-metal stent insertion or 12 months of drug-eluting stent insertion), symptomatic myocardial ischemia or peripheral vascular disease (including patients with a peripheral stent), or previous ischemic stroke.

Cessation of aspirin is recommended for patients at low risk for a cardiovascular event either 3 days (to prevent major bleeding) or 7 days (to prevent minor bleeding) prior to the renal biopsy.

The use of bridging anticoagulation is suggested in patients at highest risk for thromboembolism. This includes patients with a mechanical mitral valve, a mechanical aortic valve and additional stroke risk factors, antiphospholipid syndrome, an embolic event within the previous 3 months, atrial fibrillation (CHADS2 score 5 or 6), and a previous thromboembolic event with interruption of anticoagulation.

No recommendations or suggestions can be made regarding prebiopsy administration of desmopressin acetate, because of the lack of evidence.

Needles for Renal Biopsy

The use of a spring‐loaded automatic needle device is recommended for native renal biopsy because such devices are associated with fewer complications and yield better tissue samples.

The use of a spring‐loaded automatic needle device is recommended for transplant renal biopsy because such devices are associated with fewer complications and yield better tissue samples.

A 16-gauge needle is suggested for native and transplant renal biopsy because it provides the best balance between sample adequacy and risk of bleeding.

Imaging for Renal Biopsy

Imaging guidance is recommended for percutaneous native renal biopsy.

Real‐time ultrasonographic (US) guidance is recommended as the first-line imaging method for percutaneous renal biopsy in patients with a kidney transplant.

The use of real‐time US guidance or US localization is suggested for native renal biopsy.

The use of computed tomography (CT) for localization is suggested for native renal biopsy in difficult cases.

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