Study evaluates major complications associated with ultrasound-guided percutaneous renal biopsies in dogs

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Findings on a retrospective evaluation of major complications and risk factors associated with ultrasound-guided percutaneous renal biopsies in dogs were shared by lecturer Jasmine Zaibek, MVB, the study’s coauthor, at the 2024 American College of Veterinary Internal Medicine (ACVIM) Forum in Minneapolis, Minnesota. The most recent previous study regarding this procedure was recorded in 2005, at which time hemorrhage and death were reported as major complications with a rate of 13%. Since then, there have been changes in the techniques for renal biopsies in dogs, but no reevaluations of its complications nor any current literature available with out-patient procedure status, according to Zaibek.¹ 

Approximately 1 in 10 dogs and 1 in 3 cats suffer from renal disease, making it an extremely common disease among canines and felines. In order to properly diagnose kidney disease, renal biopsies may be required.²

The study presented at ACVIM was a multicenter retrospective observational study between the Schwarzman Animal Medical Center in New York, New York, and Friendship Animal Hospital in Washington, DC. It looked at 76 dogs aged 8 months to 13 years that were undergoing ultrasound-guided renal biopsy over the course of 5 years from 2017 to 2022. Of the 76 dogs, 35 were male and 41 were female. Biopsy samples were submitted to the renal pathology service with pre and post procedure monitoring. Exclusions consisted of incomplete medical records, which included patients that did not have appropriate post procedure monitoring.

For the medical record review, patient names; weight; age; pre procedure packed cell volume (PCV); post procedure PCV; pre procedure blood pressure; pre procedure creatinine; status of patient at discharge, 1 week post discharge, and 1 month post discharge, were included.

Furthermore, the researchers defined severe hemorrhage as a drop in PCV that was greater than 20%. “The reason that we did that was because we were…trying to mirror the 2005 study. And that's what they could use previously to define severe hemorrhage,” Zaibek, an internal medicine resident at the Schwarzman Animal Medical Center, explained during the ACVIM session.

Results

Complications were reported in 11 of 76 dogs. Additionally, major complications included death and hemorrhage, with minor complications being excluded from the study. None of the deaths were attributed to the procedure.

“We didn't investigate minor complications like [researchers did in] the previous study. And that's really just because the prior microcomplications that they had listed were…gross and microscopic hematuria, hematoma, and…infection at the site of surgery, which…we will provide for performing surgery in these patients,” Zaibek said.

Severe hemorrhage occurred in 6 of 76 patients. Pearson Chi-squared testing revealed a positive association between elevated creatinine levels and severe hemorrhage (P = .08). Dogs with a creatinine level of 5 mg/dL or more were more likely to experience hemorrhage (OR = 2.5). Furthermore, a positive correlation was observed between older age and severe hemorrhage (P =0.01). There was no increased risk of complications shown for hypertension (P = 0.14) and weight (P = 0.8). Additionally, hospitalized patients had a higher likelihood of experiencing hemorrhage (OR = 1.7) compared to outpatients.

Regarding limitations to the study, Zaibek explained, “Unfortunately, [our limitations include] our population size. Ideally, we would have had more. We could have assessed more variables, and the study didn't account for variability between the person obtaining the renal biopsy, but a majority of the people that were obtaining the biopsies were board certified radiologists.”

References

1. Zaibek J. Retrospective evaluation of major complications associated with ultrasound guided percutaneous renal biopsy in dogs. Presented at: American College of Veterinary Internal Medicine Forum; Minneapolis, MN; June 5, 2024.
2. Vaden SL. Renal biopsy of dogs and cats. Clinical Techniques in Small Animal Practice. 2005;20(1):11-22. https://doi.org/10.1053/j.ctsap.2004.12.003 
3. What you need to know about animal kidney disease. Naples Coastal Animal Hospital. Accessed June 6, 2024. https://naplescoastalvet.com/what-you-need-to-know-about-animal-kidney disease/#:~:text=Here's%20what%20you%20should%20know,effects%20on%20our%20furry%20friends.