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

Positioning for Renal Biopsy

The supine anterolateral position is suggested for native renal biopsy in obese patients or those with respiratory difficulty.

Because of the lack of comparator trials, it is impossible to make evidence-based statements in regard to patient position for biopsy.

Care After Renal Biopsy

It is recommended that after a renal biopsy procedure, the patient remain in hospital for strict bed rest with frequent observations for a period ranging from 6 to 24 hours. Accepted practice for low-risk patients is a 6- to 8-hour period of observation with same-day discharge.

It is suggested that patients at highest risk for postbiopsy complications be targeted for longer periods of hospitalization (usually up to 24 hours). These include patients with significant renal impairment, patients undergoing biopsy for acute kidney injury, patients with elevated blood pressure before the biopsy, patients older than 70 years, and patients who have an abnormal bleeding profile or who require early recommencement of anticoagulation.

Routine performance of postbiopsy US for early detection of asymptomatic renal hematomas is not suggested.

Routine measurement of hemoglobin following an uncomplicated renal biopsy is not suggested.

Management of Postbiopsy Bleeding

It is suggested that moderate-to-severe bleeding (indicated by severe pain, large perinephric hematoma, and/or postbiopsy hypotension) be initially managed by means of intravenous (IV) resuscitation with crystalloid or colloid fluid.

Either radiologic intervention or surgical management (according to local resources and expertise) is recommended to arrest bleeding and secure hemostasis in cases of severe bleeding with hypotension or a large perinephric blood collection not responding to conservative measures.

It is suggested that Doppler US scanning is satisfactory for detecting arteriovenous fistulae (AVFs) without the requirement for invasive procedures such as angiography.

Routine screening for AVFs or aneurysms is not suggested with routine uneventful biopsies.

For more information, please go to Renal Biopsy.

For more Clinical Practice Guidelines, please go to Guidelines.


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