A hospitalized client is scheduled for a percutaneous kidney biopsy at 10 AM. At 8 AM, the nurse reviews the client's vital signs and most current serum laboratory results. Which finding is most important to report to the health care provider (HCP)? A)Blood pressure of 180/100 mm Hg B)Creatinine of 2 mg/dL (176.8 µmol/L) C)Hemoglobin of 9.8 g/dL (98 g/L) D)Platelet count of 120,000/mm³ (120 x 10⁹/L)

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Percutaneous kidney biopsy is an invasive diagnostic procedure. It involves inserting a needle through the skin to obtain a tissue sample that is then used to determine the cause of certain kidney diseases. The kidney is a highly vascular organ; therefore, uncontrolled hypertension is a contraindication for kidney biopsy as increased renal arterial pressure places the client at risk for post-procedure bleeding. Blood pressure must be lowered and well-controlled (goal <140/90 mm Hg) using antihypertensive medications before performing a kidney biopsy (Option A). (Option B) An elevated serum creatinine level (normal: 0.6-1.3 mg/dL [53-115 µmol/L) can be expected in a client with probable renal disease. This is not the most important finding to report to the HCP. (Option C) A decreased hemoglobin level (normal adult male: 13.2-17.3 g/dL [132-173 g/L]; normal adult female: 11.7-15.5 g/dL [117-155 g/L]) can be expected in a client with probable renal disease due to decreased erythropoietin production. The nurse should continue to monitor the client's hemoglobin post-procedure as it can decrease further (within 6 hours) if bleeding occurs. (Option D) Only neurosurgery and ocular surgery require a platelet count >100,000/mm³ (100 x 10⁹/L). Most other surgeries can be performed when the platelet count is >50,000/mm³ (50 x 10⁹/L). Although the platelet count is low (normal 150,000-400,000/mm³ [150-400 x10⁹/L]), it is not the most important finding to report to the HCP. Educational objective: The kidney is a highly vascular organ and the risk of bleeding is a major complication after a percutaneous biopsy. The client should have normal coagulation studies, an adequate platelet count, and well-controlled blood pressure prior to the procedure to reduce bleeding risk.

A Hospitalized Client Is Scheduled for a Percutaneous Kidney Biopsy