Lumbar Artery Bleed as a Complication of Percutaneous Renal Biopsy and a Proposed Workflow for Massive Bleeding

Injuries to extrarenal arteries caused by percutaneous biopsy needles are very rare but highly lethal due to delay in recognition. Here we report the case of an inadvertent lumbar artery puncture after native renal biopsy and provide a literature review and a proposed workflow for management of massive bleed after renal biopsy. This case highlights evidence-based management considerations regarding massive bleed after renal biopsy, including the first-line imaging modality and the need to consider extrarenal site bleed. While angiographic embolization is an effective method of control of haemorrhage, surgical exploration is required in a proportion of cases for control of bleeding. Centre-specific workflows should be adopted to minimize the mortality and morbidity associated with massive bleed after renal biopsy.