An Audit of Appropriate Tests in Renal Biopsy Coagulation Screens

Hematological, biochemical, and clinical data was collected over a 15-month period on all adult (> 16 years) patients assessed for percutaneous biopsy of native kidneys in a major renal unit. The frequency, causes, interrelationship and treatment of the abnormalities, along with factors resulting in delay or cancellation of renal biopsies were sul sequently subjected to audit. Overall, 30 of 147 coagulation screens were abnormal. The most common coagulopathy was a prolonged bleeding time (BT), which accounted for 58.6% of these. A prolonged BT was not clearly related other hematological or biochemical indices, and proved to be treatable with arginine vasopressin (DDAVP). The majority of abnormalities occurred in isolation (23/30), and eight of 30 were related directly to current anticoagulant or antiplatelet medication. All but two patients with abnormalities proceeded to renal biopsy after successful corrective measure but 21 of 30 were delayed by between 1 hour and 14 days. None of the remaining 117 biopsies were delayed, although seven were cancelled for a variety of reasons. The prothrombin consumption index provided no additional usef management information. Our clotting screen, modified by this audit, should safely and efficiently detect clottir abnormalities before renal biopsy.