Use of recombinant activated factor VII to stop post-kidney biopsy bleeding in a child

Kidney biopsy is the standard of diagnosis for many kidney diseases and conditions. Severe bleeding following a kidney biopsy is a complication for which limited therapeutic interventions exist. The use of recombinant activated factor VII (rFVIIa) is described in pediatric patients to control severe intra-operative hemorrhage and has been used in at least one adult patient to manage post-kidney biopsy hemorrhage. We present a 10-year-old female who presented with acute kidney injury, thrombocytopenia, and hypertension, ultimately diagnosed with ANCA-vasculitis. Following a kidney biopsy, the patient experienced a large, expanding hematoma with active bleeding that did not improve despite pre-biopsy desmopressin, 90 min of pressure to the biopsy site, and platelet transfusions. Recombinant activated FVIIa was administered, and the bleeding immediately stopped. This case supports the use of recombinant FVIIa in post-kidney biopsy hemorrhage when bleeding is not controlled using conventional strategies.