Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Avoidance of Major Bleeding Complications Post Renal Biopsy In Lupus Nephritis Patients with Co-Existing Antiphospholipid Syndrome.

Jordan,  Natasha, Chaib,  Ahlem I., Sangle,  Shirish, Tungekar,  Fahim, Khamastha,  Munther, Sabharwal,  Tarun, Abbs,  Ian

Background/Purpose:

Renal biopsy remains the gold standard investigation of lupus nephritis. However it is not without potentially significant complications. In a previous retrospective review of 148 renal biopsies in 137 lupus nephritis patients at our centre over an 8 year period (1999–2007), 8.1% experienced minor bleeding and 7.4% developed major haemorrhagic complications. Major bleeding complications were significantly more common in those with coexisting Antiphospholipid syndrome and/or antiphospholipid antibodies (aPL).

Modification of our renal biopsy protocol was undertaken implementing strict management of anticoagulation, hypertensive control and biopsy tract plugging with gelofoam. The purpose of this study was to examine the current rate of bleeding complications post renal biopsy.

Methods:

A prospective review of post biopsy bleeding complications following 48 renal biopsies (2007–2010) was undertaken. All biopsies were performed on native kidneys by an experienced radiologist. Prior to biopsy, coagulation parameters were checked and anaemia and thrombocytopenia were corrected. Following biopsy, patients were maintained under observation for 24 hours, monitoring for hypotension, tachycardia, gross haematuria, and abdominal pain. Anticoagulation was strictly monitored with switching from warfarin to heparin one week prior to the procedure until two weeks post biopsy. Renal biopsy was only performed when patients were normotensive (<140/90).

Major complications were defined as those requiring post procedural intervention such as blood transfusion, surgical revision of hematoma, embolisation, nephrectomy or death. Minor complications including subcapsular hematomas, perinephric hematomas or hematuria requiring close observation only.

Results:

47 lupus nephritis patients underwent renal biopsy (48 biopsies) since implementation of the new renal biopsy protocol. Minor bleeding occurred in 6 patients (12.5%) with 3 events in SLE patients, 3 in SLE/aPL and none in SLE/APS. There were no major bleeding complications.

Table 1. Patient demographics pre and post modification of renal biopsy protocol.

 Renal biopsies 1999–March 2007Renal biopsies April 2007–present
 148 biopsies (137 patients)48 biopsies (47 patients)
Gender119 females 18 males40 females 8 males
Mean age35.31 years35.04 years
SLE49 (33.1%)25 (52.1%)
SLE/APS35 (23.7%)8 (16.7%)
SLE/APL64 (43.2%)15 (31.2%)
Hypertension67 (45.3%)15 (31.25%)
Mean serum creatinine (mg/dl):
  Bleeding group188.91130.33
  Non-bleeding group117.7993.92
Warfarin therapy35 (23.6%)6 (12.5%)
Aspirin therapy33 (22.3%)17 (35.4%)

Table 2. Rate of bleeding complications pre and post modification of renal biopsy protocol.

 Bleeding complications prior to protocol modification
No bleedingcomplicationOverallBleeding Rate% Minor Bleed% Major Bleed 
SLE463 (6.1%)2 (4.1%)1 (2.0%)
SLE/APL5311 (17.2%)6 (9.4%)5 (7.8%)
SLE/APS269 (25.7%)4 (11.4%)5 (14.3%)
Total12523 (15.5%)12 (8.1%)11 (7.4%)
 Bleeding complications post protocol modification
No bleedingcomplicationOverallBleeding Rate% Minor Bleed% Major Bleed 
SLE223 (12%)3 (12%)0%
SLE/APL123 (20%)3 (20%)0%
SLE/APS80%0%0%
Total426 (12.5%)6 (12.5%)0%

Conclusion:

A significant finding in this study is the higher rate of serious bleeding events in SLE/aPL patients and SLE/APS compared to the SLE patient group post renal biopsy. Identification of these at risk patients prior to renal biopsy and close clinical monitoring minimizing procedure associated morbidity and mortality.

To cite this abstract, please use the following information:
Jordan, Natasha, Chaib, Ahlem I., Sangle, Shirish, Tungekar, Fahim, Khamastha, Munther, Sabharwal, Tarun, et al; Avoidance of Major Bleeding Complications Post Renal Biopsy In Lupus Nephritis Patients with Co-Existing Antiphospholipid Syndrome. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :620
DOI:

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