How long is strict bed rest necessary after renal biopsy?

BACKGROUND: No consensus exists on the amount of bed rest required after renal biopsy. Moreover, forced prolonged bed rest can be uncomfortable in patients undergoing renal biopsy. OBJECTIVE: To evaluate whether the length of strict bed rest affects the incidence of pain and other complications after renal biopsy. STUDY DESIGN, FACILITY, AND PATIENTS: This single-center retrospective observational study was conducted in 94 consecutive patients undergoing biopsy of a native kidney between November 2005 and December 2006 at Mie University Hospital. The control group was composed of 317 patients who underwent biopsy of a native kidney between January 2001 and October 2005. METHODS: The incidence of biopsy-related complications was compared between two periods of strict bed rest: 2 h of strict bed rest with no abdominal bandage (November 2005 to December 2006) and 7 h of strict bed rest with an abdominal bandage (January 2001 to October 2005). The primary outcome was the incidence of back pain requiring analgesics. The secondary outcomes were: need for transfusion or hemostatic intervention, decrease of >/=10% in hemoglobin (Hb) after biopsy, macroscopic hematuria, infection possibly related to biopsy, need for single or indwelling bladder catheterization, and other biopsy-related complications. RESULTS: The incidence of back pain requiring analgesics decreased with a shorter period of strict bed rest [7.5% versus 21.1%, odds ratio (OR) 0.30, 95% confidence interval (95% CI) 0.12-0.64, p = 0.004]. Even after adjustment for age, sex, perinephric hematoma size, and number of biopsy punctures, the incidence of back pain decreased significantly (OR 0.34, 95% CI 0.14-0.73, p = 0.01). With a shorter period of strict bed rest, there were no significant differences in bleeding complications (need for transfusion or other hemostatic intervention), decrease of >or=10% in Hb or macroscopic hematuria. However, the need for indwelling bladder catheterization decreased significantly (36.2% versus 50.5%, OR 0.55, 95% CI 0.34-0.88, p = 0.013). CONCLUSIONS: Shortening the period of strict bed rest after renal biopsy from 7 h to 2 h decreased the incidence of back pain, but there was no increase in bleeding or other biopsy-related complications. Our findings suggest that a shorter period of strict bed rest can safely reduce discomfort in renal biopsy patients.

Ultrasonography as a predictor of overt bleeding after renal biopsy.

BACKGROUND: Renal biopsy is essential for the diagnosis of kidney diseases, but complications, particularly bleeding incidents, remain problematic. METHODS: To evaluate the frequency of renal biopsy complications, and to reveal clinical and laboratory factors associated with overt bleeding complications, focusing on those available at hospital ward, we conducted a retrospective observational study for the period between 2001 and 2005 at Mie University Hospital in patients who underwent percutaneous renal biopsy of a native kidney. Of a total of 323 patients, 317 met the inclusion criteria. RESULTS: Only one patient (0.3%) required blood transfusion or intervention to stop bleeding. The mean decrease in hemoglobin (Hb) after biopsy was 0.43 +/- 0.7 g/dL. Hb decreased > or =1.0 g/dL in 66 patients (20.8%) and > or =10% in 32 patients (10.1%). On ultrasonography, perirenal hematoma was detected immediately after biopsy in 273 patients (86.1%), and 41 patients (12.9%) showed hematoma > or =2 cm in width. Analgesics were required for back pain in 67 patients (21.1%). Vasovagal response developed in 31 patients (9.8%). Macrohematuria occurred in 12 patients (3.8%). Urinary catheter was used in 161 patients (50.8%). For Hb decrease > or =10% after biopsy, multivariate analysis revealed perirenal hematoma (> or =2 cm) as a significant factor. Other significant factors were prolonged international normalized ratio of prothrombin time, elevated blood pressure on hospital admission, older age, increased serum creatinine level, and steroid use. CONCLUSION: Perirenal hematoma > or =2 cm on ultrasonography immediately after biopsy might well represent a predictive factor for bleeding complications.

Unusual glomerulopathy with aggregated subepithelial microspheric particles resembling membranous nephropathy: a variant of glomerulopathy associated with podocytic infolding?

A 69-year-old woman presented with unusual electron microscopic findings. The patient was admitted to ascertain the cause of her persistent proteinuria, and kidney biopsy was performed. While light microscopic findings and immunofluorescence study suggested membranous nephropathy, electron microscopic study showed microspheric particles aggregated in the subepithelial space where electron-dense deposits should have existed. While the microspheric particles could have been unusual and rough deposits, detailed study suggested that the particles could be parts of glomerular podocytes, for example foot processes. This unusual finding was considered as being in a unique clinical course of membranous nephropathy, but a variant of glomerulopathy associated with podocytic infolding, proposed by Joh et al. (J Nephrol 49:61-67, 2007), could not be excluded.

A case of isolated tricuspid valve infective endocarditis caused by Abiotrophia defectiva.

A 17-year-old man with a history of dental caries was admitted to our hospital because of 1-week high fever. There was no history of previous cardiac disease. He denied drug abuse. Blood culture was positive for Abiotrophia defectiva. Echocardiography demonstrated large vegetation attached to the anterior cusp of the tricuspid valve with moderate regurgitation. Although he was treated with antibiotics for more than 3 weeks, he had chest pain due to septic pulmonary emboli on chest computed tomography. Surgical resection of the vegetation was performed. The postoperative course was uneventful and he is doing well at the time of follow-up.