This paper, while not specifically addressing the issue of outpatient vs. inpatient biopsies, should alleviate some of the concerns that people have. After 9288 biopsies, the rate of serious complications was 0.9% (transfusion or surgical intervention). This is similar to recently published studies. There were no deaths during the 20 years covered by the study. There was an increased risk of bleeding in patients with a low GFR, uncontrolled hypertension, older age and acute kidney injury. Notably there was no difference in bleeding complications when 14G needles were used as opposed to 18G needles although less glomeruli were obtained with the smaller needles.
There an interesting point for discussion here – in the course of the study, there was a marked decline in the number of nephrologists performing biopsies. The majority of biopsies are now performed by radiologists. These radiologists are more likely to use smaller needles and thus get less tissue. Should nephrologists take back the renal biopsy? Should we be more assertive in insisting that larger needles are used to ensure adequate biopsies? Head over the eJC for the discussion.