Extensive hemorrhagic complication after a transcutaneous thick-needle biopsy of his own kidney

Transcutaneous biopsy of one's own kidneys (TBP) remains the gold standard for establishing the etiology of kidney disease and further treatment methods and predicting complications. TBP is considered a relatively safe procedure. However, this manipulation can lead to the formation of paranephral hematoma of various volumes, hematuria of varying intensity, which requires extreme procedures in very rare cases, such as nephrectomy. The article describes the case of the formation of an extensive hematoma after a transcutaneous thick–needle biopsy of the native kidney in a patient with chronic diffuse glomerulonephritis, hematuric form, CKD – 3b, A3. According to the biopsy data, IgA nephropathy with a picture of focal segmental and global glomerulosclerosis, hypertensive nephroangiosclerosis was diagnosed. Two hours after TBP, according to ultrasound of the right biopsied kidney, there is an isoechoic formation, with fuzzy contours, irregular shape, covering the lower pole and spreading along the lateral edge of the kidney. The approximate volume is 510.3 cm3. Despite the ongoing hemostatic therapy, an increase in paranephral hematoma was noted, up to 840 cmЗ. Surgical removal of it was not performed. It was decided not to perform the retroperitoneal space revision, guided by the following considerations: absence of pain syndrome, absence of a decrease in blood hemoglobin, blood hematocrit, leukocytosis, subfebrile temperature as a sign of suppurated hematoma, satisfactory condition of the patient himself. With surgical intervention, there is a high probability of infection of a hematoma, repeated bleeding due to the absence of a compression moment by a hematoma of the puncture site, with possible loss of the right kidney. It has been shown that the use of ultrasound during the first hour after TBP can play a role in determining further treatment tactics and predicting complications. Surgical tactics are explained when this complication occurs. The formation of an extensive hematoma after TBP is not a mandatory signal for performing an audit. Since possible bleeding and hematoma formation is the main primary complication, for this reason it is always necessary to assess the risk / benefit of TBP for the patient, and obtain informed consent before a kidney biopsy.