Abstract
Background
Reduced estimated glomerular filtration rate (eGFR) is a suspected risk factor for bleeding after percutaneous renal biopsy, but its association with hemorrhage requiring embolization is unclear. We evaluated this association using a matched case‑control study.Methods
This single‑center, retrospective, matched case‑control study included patients who underwent ultrasound‑guided native renal biopsy between 2012 and 2025 at a Chinese tertiary hospital. Cases (n = 16) were patients with severe bleeding requiring selective renal artery embolization; controls (n = 64) had no post‑biopsy bleeding, matched 1:4 by sex and age. eGFR was calculated using the CKD‑EPI equation, analyzed as a continuous variable and categorized according to KDIGO criteria (2). Multivariable logistic regression, restricted cubic spline analysis, subgroup analyses, LASSO regression, and sensitivity analyses (ROC curve, dichotomized eGFR, complete‑case analysis) were performed.Results
In fully adjusted models, each 1 mL/min/1.73m2 increase in eGFR was associated with 4% lower bleeding risk (OR 0.96, 95% CI 0.93-0.98, p = 0.007). eGFR ≥60 versus 2 gave OR 0.09 (95% CI 0.01-0.75, p = 0.03), with a significant dose‑response trend (P for trend = 0.02). Restricted cubic spline analysis revealed a linear inverse association. Results were consistent across subgroups and sensitivity analyses.Conclusions
Lower eGFR may be independently associated with increased risk of embolization-requiring bleeding after renal biopsy in a linear dose-response manner. Given the limited sample size, these exploratory findings require validation in larger, prospective cohorts. eGFR may aid in preoperative risk stratification.