Unexpected delayed bleeding after native renal biopsy: a case report

Abstract

biopsy remains debated. Currently, the establishment of practical guidelines for renal biopsy performance is urgently needed [4]. To provide the optimal observation period, clini-cal data concerning late-onset complications is necessary, in addition to data on early complications. However, reports of delayed bleeding several days after renal biopsy are very limited. Here, we report a patient who developed serious post-procedure bleeding requiring angiographic emboliza-tion, diagnosed by computed tomography (CT) 7 days after renal biopsy. Case report A 42-year-old Japanese man with a history of obesity and diabetes mellitus presented to our hospital for evaluation of persistent proteinuria. He took no medications, including antithrombotics. His vital signs at first presentation were normal. His height was 173 cm and his weight was 91 kg. Fundoscopic examination showed simple diabetic retinopa-thy. Laboratory findings showed a serum albumin level of 4.2 g/dL, blood urea nitrogen level of 11.1 mg/dL, serum creatinine level of 0.98 mg/dL (estimated glomerular filtra-tion rate of 67.8 mL/min/1.73 m 2), hemoglobin A1c level of 5.7%, hemoglobin concentration of 15.8 g/dL, platelet count of 23.9 × 10 4 /uL, international normalized ratio/prothrom-bin time of 1.02, and activated partial thromboplastin time of 30.0 s. Urinalysis revealed a urine protein level of 2.9 g/day and urine red blood cell count of 11–20/high-power field. After preparing his skin in a sterile fashion, he underwent ultrasound-guided biopsy of the left kidney with a 16-gauge automated, spring-loaded needle (Tru-Core II, Angiotech Pharmaceuticals Inc., Gainesville, FL, USA). The procedure was uneventful and his vital signs remained stable. After the procedure, we prescribed bed rest in a supine position Abstract Percutaneous native renal biopsy is recognized as a safe procedure. The majority of bleeding events occur within 24 h after the procedure, and reports of delayed major complications are very limited. We report a patient present-ing with sudden flank pain 7 days after renal biopsy, in whom abdominal computed tomography showed increased hematoma size with extravasation and who was treated with radiological intervention. Careful attention should be paid to diagnose and treat delayed major complications in patients undergoing native renal biopsy.