Renal biopsy: assessing safety and efficacy in diverse renal pathologies

Introduction. Renal biopsy is a common procedure in patients with nephrological and onco-urological diseases. Histopathological examination of renal tissue is performed to clarify the diagnosis and stage of the pathological process, to guide treatment strategy, and to assess prognosis. Thus, renal biopsy has become an integral component of current clinical practice for a wide range of renal disorders.

Objective. To assess the safety and diagnostic effectiveness of renal biopsy in various pathological conditions and to analyze the spectrum, patterns, and risk factors of post‑biopsy complications.

Materials & methods. A retrospective analysis was performed of patients who underwent percutaneous kidney biopsy between January 2018 and September 2023. The study included 1,201 patients aged 18 to 84 years. Biopsy for a renal tumor was performed in 24 (2.1%) patients, and 1,177 (97.9%) patients underwent biopsy for nephrological indications (evaluation of renal disease or characterization of renal dysfunction, including renal failure). Post‑biopsy events were graded according to the Clavien–Dindo classification. A complication was considered severe if it required interventions such as blood transfusion or radiological or surgical procedures.

Results. Of the 1,201 patients, 625 (52%) were men (mean age 57 ± 15 years) and 576 (48%) were women (mean age 55 ± 17 years). The diagnostic yield did not differ between patients from whom two or more cores were obtained; its value increased from 83% to 91% and was significantly higher than in cases with only one core (46.4%, p = 0.002). Post‑biopsy complications occurred in 122 patients. Major complications were observed in 15 (1.2%) patients; 1 patient (0.08%) required urgent nephrectomy, and 9 (0.7%) underwent angiography with renal artery embolization. No procedure‑related deaths were recorded. In most cases (n = 112; 91.8%), clinically relevant changes were detected within the first 6 hours after biopsy. The highest complication rates were observed in women, in younger patients, in those with higher azotemia, and in patients with elevated INR and reduced prothrombin index values; complications were also more frequent in patients with arterial hypertension. Blood transfusion corresponded to Clavien–Dindo grade III–IV complications. The incidence of complications in the postoperative period was higher in patients who required four needle passes (p = 0.044).

Conclusion. Kidney biopsy is a minimally invasive and generally safe procedure. Obtaining two cores of renal tissue is sufficient to ensure adequate diagnostic yield while minimizing the risk of complications. Careful pre‑procedural assessment and correction of modifiable risk factors (such as arterial hypertension and coagulopathy), together with close monitoring for at least six hours after the procedure, helps keep the risk of post‑biopsy complications to a minimum.

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