This prospective sequential cohort study evaluated the association between prophylactic intranasal desmopressin use and bleeding complications following native kidney biopsy in adults with severe renal impairment. The study was conducted at the Sindh Institute of Urology and Transplantation (SIUT), Karachi, from October 2024 to September 2025. Adults aged 18 years or older with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m² who underwent native kidney biopsy for clinical indications were consecutively enrolled. Patients were sequentially enrolled into a non-desmopressin cohort from October 2024 to March 2025 and a desmopressin cohort from April 2025 to September 2025. All patients underwent ultrasound-guided kidney biopsy and were monitored clinically and by ultrasonography for 24 hours after the procedure. The study evaluated post-biopsy bleeding complications and safety outcomes, including perinephric hematoma, hemoglobin decline, gross hematuria, blood transfusion, invasive interventions, and changes in serum sodium.
