For outpatients undergoing a kidney biopsy, do you routinely recommend an overnight admission for continued hemoglobin monitoring?

If I perform an uneventful kidney biopsy in the morning on a patient with well-controlled BP and normal hemoglobin, I can observe the patient all day. If vitals are stable and the repeat hemoglobin at 8 hours is stable, I would discharge the patient. However, if I did the biopsy later in the day or there was a drop in hemoglobin, I would keep the patient overnight for observation.

At our institution (The Ohio State University) and where I trained (Mount Sinai Hospital) where both IR and Nephrology perform outpatient renal biopsies, we do not routinely admit overnight. However, they are kept for monitoring for at least 4-6 hours and if the HgB is stable and the patient is asymptomatic, return precautions are given. I do have strict blood pressure goals, and if the patient is hypertensive (my goal is <150/90, ideally <140/80), which increases their risk of bleeding, or requires heparin bridge, I will either cancel the biopsy and reschedule once blood pressure is stable, or admit for planned biopsy depending on urgency/circumstances.

Anecdotally, I have had a handful of patients return that night or next day due to pai...

I see the value in close monitoring if the patient is a high risk of bleeding and/or unstable from other conditions. However - these patients should probably not be scheduled for outpatient biopsies in the first place.

For my ambulatory, low-risk outpatients I do not recommend overnight admission or prolonged observation, primarily because I am selecting for stable patients. Most have families and are working so taking 2 days off from their usual life to be monitored is undesirable and they would elect to not get a biopsy at all. They get their biopsies, are observed for 30-60 minutes, and then leave. I do instruct my patients to lie down at home with a wadded-up towel underneath them putting pressure on the biopsy site, and not to lift any...

I think it is a good idea to admit overnight after a Kidney biopsy as complications can occur many hours after a biopsy. The 2004 JASN paper found:

"Complications were identified in 38 (42%) patients by ≤4 h, in 61 (67%) patients by ≤8 h, in 77 (85%) patients by ≤12 h, and in 81 (89%) patients at ≤24 h."

It may be a good idea to do the biopsy early in the morning and observe the patient. If hemoglobin has not dropped > 2gm and a repeat US does not show any hematoma, then the patient may be discharged but adequate post-biopsy orders should be given to the patient.

I used to admit the patient, but these days I don't.

Reference: Whittier & Korbet., PMID 14694166

During my fellowship training in University of Wisconsin - Madison we did almost all biopsies. We used to do inpatient biopsies around 1-2 pm. Then obsserve patient for 4 hours and repeat hgb. If BP is stable and no gross hematuria and hgb is stable then we discharge patients home. My experience was discharging 90% of patients. If hgb was low or patient very symptomatic then we used to do a CT scan and then decide clinically if we will admit the patient. I remember that when IR did biopsies they observed patients clinically for some time then send patients home. Based on my experience over there I think making a rule to admit all patient is going to create too many unecessary admissions. I think deciding after the biopsy is better than maki...

Patients with native or transplant kidney biopsies can easily be sent home after a period of a few hours observation. If patients are going to bleed, this usually happens relatively soon after the procedure. If vital signs are stable, there is no pain, the hemoglobin is stable, and there is not severe bleeding in the urine then the patient can go home as long as they limit their activities for 24 hours. In special circumstances, such as a lot of hematuria that does not clear within a few hours, a low platelet count, severe anemia, or if BP becomes very high or low after the procedure after the procedure, monitoring overnight may occasionally be warranted.

Currently, at our hospital, we are not doing that. As far as I know, we have not had any adverse issues because of that. Having said that, I do think it is a good idea, as it is a safer thing to do. Significant bleeding events do occur after kidney biopsy. Usually, we are able to determine that within a few hours but probably not always.

I have been doing renal biopsies (US and CT guided) since 2000 in the acute hospital facilities until 2018. Following the protocol practiced from the fellowship days, I used to keep the patients overnight and discharge by about 8 AM after the overnight nursing shift change. From 2012, I have started sending patients after the biopsy in about 4 to 8 hours time with an average time of 6 hours. Due to the time efficiency, I have started doing biopsies with only US guidance in the vascular access center since 2018, and the patients are usually discharged in about 4 to 6 hours (including those patients who had undergone biopsy with single kidney and horseshoe kidney). Obviously, patients who had transjugular kidney biopsies done are observed in ...