A percutaneous kidney biopsy is associated with a 5.1% risk of major post-biopsy complications, a new study finds.

In a prospective study of 5304 native kidney biopsies performed at 54 Italian nephrology centers from 2012 to 2020, 273 patients experienced 400 major complications within approximately 24 hours, Simeone Andrulli, MD, of Alessandro Manzoni Hospital in Lecco, Italy, and colleagues reported in Nephrology Dialysis Transplantation. The biopsies were commonly performed for urine abnormalities (43%) or nephrotic syndrome (39%). Among the 273 patients, 57% had kidney failure.

The most frequent major complication was a more than 2 g/dL decrease in hemoglobin levels (2.2 %), followed by macrohematuria (1.2%), blood transfusion (1.1%), gross hematoma (0.9%), persistent arteriovenous fistula (0.7%), invasive intervention (0.5%), pain (0.5%), symptomatic hypotension (0.3%), and a rapid increase in serum creatinine levels (0.1%).

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In a multivariate logistic regression analysis, each 1 mg/dL increment in pre-biopsy plasma creatinine level was significantly associated with 12% increased odds of a major complication, the investigators reported. Concomitant liver disease was significantly associated with 2.3-fold increased odds of a major complication. For each additional needle pass, the likelihood of a major complication increased by 22%. Neither needle gauge nor the volume of kidney biopsies performed at each center were associated with the risk of major complications. Patient age, blood pressure, baseline hemoglobin levels, and final diagnosis also did not influence results. Each 1 g/d increment in proteinuria was significantly associated with a 5% lower risk of major complications. Ultrasound-guided biopsy was another protective factor.

According to Dr Andrulli’s team, this prospective quantitative data allows nephrologists to give patients more precise information on the risk of major complications after native percutaneous kidney biopsy for shared decision-making.


Andrulli S, Rossini M, Gigliotti G, et al. The risks associated with percutaneous native kidney biopsies: a prospective study. Published online May 19, 2022. Nephrol Dial Transplant. doi:10.1093/ndt/gfac177