Factors Associated with Major and Minor Complications of Percutaneous Kidney Biopsy: A Quality Improvement Project
Bibliographic record
Abstract
Background: Percutaneous kidney biopsies are commonly performed in the evaluation of acute and chronic kidney disease. Due to physiologic, anatomic, and equipment factors, complications are not uncommon. Fortunately, most complications are minor and self-resolving. Life-threatening complications include bleeding requiring blood transfusion, need for angioembolization, and death. Recent literature suggests that these major complications are exceedingly rare. This study aimed to determine the rate of major and minor complications in both outpatient and inpatient kidney biopsies at a tertiary centre and to understand the factors associated with these complications. Methods: A retrospective chart review of patients who received a kidney biopsy between 2020 and 2023 was conducted. Patients who were at least 15 years of age and underwent a biopsy in the outpatient or inpatient setting were included. Primary endpoints were minor complications (pain, hematoma formation, gross hematuria) and major complications (blood transfusion, admission to hospital, embolization, death). Factors including use of anticoagulation, use of antiplatelet agents, baseline blood pressure, hemoglobin, and platelet count were obtained. Results: Data from 120 patients were analyzed with 52.5% being male. Median age was 65 years (IQR 50-74) and 70.6% of biopsies were performed in the outpatient setting. All biopsies were performed by interventional radiology staff and the median number of needle passes was 3. Anti-platelet agents were held for a median of 4 days (IQR 1-7). Major complications were observed in 4.2% of patients (n = 5), including blood transfusion (1.67%), need for angiography (1.67%) and death (0.83%). Conclusion: The rate of major complications at this tertiary centre was higher compared to recently published literature. Significant practitioner variation was observed with respect to the use of anti-platelet medications and blood pressure targets peri-biopsy. Interventions to improve patient safety could include protocols to review all anti-platelet and anti-coagulant medications prior to percutaneous kidney biopsy, practitioner order sets to manage blood pressure, and education surrounding the use of post-procedure imaging when blood products or fluid resuscitation is required.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".