Complications Associated with Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Abstract Introduction Kidney biopsy is an important tool for making diagnoses and for assessing the requirement for drug treatment and disease prognosis in the management of kidney diseases. There are variations in the rate of complications associated with kidney biopsies across countries and this depends on various clinical and technical factors. The aim of this study is to report on complications associated with kidney biopsy performed in low- and middle-income countries. Methods Two reviewers searched studies in MEDLINE, Embase, Cochrane Reviews and African Journals Online and we used random effects meta-analysis method to pool estimates of complications. Results We identified 39 studies reporting on 19,500 kidney biopsies with overall complications (major + minor) rate of 14.9% (95% CI: 11.4% – 18.7%). Fewer complications were reported in biopsies performed with real-time ultrasound scan compared to those pre-marked using ultrasound or blind procedures (12.4% vs 14.9% vs 24.5%; p=0.037), respectively. Complications, although lower for procedures performed with automated needles (13.3%) was not significantly different from those performed with non-automated needles (17.3%; p=0.588). Major complications included macroscopic haematuria (1.48%), nephrectomy (0.04%), blood loss requiring red cell transfusion (0.24%), angiographic intervention (0.22%) and death (0.01%). Conclusion Complications associated with kidney biopsy in low- and middle-income countries are low, comparable to other settings and occur more sparingly when real time ultrasound techniques or automated kidney biopsy needles are used. This suggests the need to expand the utilization of this procedure to improve diagnosis of kidney pathologies and choice of therapy when indicated.