ArticleKidney medicine2026
Balancing Glomerular Adequacy and Bleeding Risk in Native Kidney Biopsy: A Multicenter Cohort Study of Multiple Needle Passes.
Article in Kidney medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
Rationale & Objective: Whether performing multiple needle passes during adult native kidney biopsy increases clinically significant bleeding is unclear. We evaluated the association between needle-pass number and major bleeding complications and hemoglobin level decline. Study Design: Multicenter retrospective cohort study. Setting & Participants: Adults undergoing percutaneous native kidney biopsy at 2 high-volume centers in Japan (January 2020 to December 2024) were included (n = 58). Open or lateral decubitus biopsies and cases with undocumented pass counts were excluded. Exposure: Number of needle passes. Outcomes: Major bleeding (transfusion, bladder irrigation, interventional radiology, surgical hemostasis, or death) and next-day hemoglobin level decline. Analytical Approach: Major bleeding was evaluated using Firth penalized logistic regression (unadjusted and estimated glomerular filtration rate adjusted). Hemoglobin level decline was evaluated using linear regression with a sensitivity analysis adjusting for baseline hemoglobin. Results: The median number of needle passes was 5 (interquartile range, 4-6). Glomerular adequacy (≥ 10 glomeruli) was achieved in 94.5%, with a median of 30 glomeruli (interquartile range, 17-52). Major bleeding occurred in 7 patients (1.5%), including transfusion in 3 (0.7%), bladder irrigation in 3 (0.7%), and interventional radiology in 1 (0.2%); no surgical hemostasis or deaths occurred. Needle-pass number was not significantly associated with major bleeding (odds ratio per pass, 1.23; 95% confidence interval [CI], 0.81-1.65; Limitations: Major bleeding events were few, limiting precision; the retrospective 2-center design may limit generalizability and introduce bias. Conclusions: In this cohort, needle-pass number was not significantly associated with major bleeding or next-day hemoglobin decline. These findings support performing additional passes when needed to obtain adequate tissue while considering baseline bleeding risk.
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