Abnormal coagulation tests before kidney biopsies—what next?

INTRODUCTION: Bleeding is one of the most feared risks from a renal biopsy. To determine this risk, a clotting screen is performed prior to the biopsy to identify any coagulation abnormalities. In addition, concerns exist with respect to bleeding from platelet dysfunction and the special cases of paraprotenemia. METHOD: Literature search of all the relevant articles in relation to bleeding risk from clotting abnormalities and platelet dysfunction in the setting of kidney biopsy was conducted. RESULTS: Bleeding risk from abnormal clotting screen is minimal in the absence of prior bleeding history in patients with renal disease. Administration of fresh frozen plasma in these cases is probably unnecessary and often causes delay in the procedure. In a similar way, platelet transfusions may not be appropriate in those with platelet dysfunction. CONCLUSIONS: Global coagulation function tests are now available which need to be considered to determine bleeding risk before kidney biopsy, in conjunction with a good patient history.