A woman in her 30s is admitted to undergo a renal biopsy. She has poor kidney function of unknown reason; a biopsy will give us a lot more information about the underlying disease.

Kidney and liver biopsies are usually simple but invasive procedures. In and out. Done. Most cases have a bit of pain but otherwise are well and are discharged 24 hours after their procedure. However, occasionally complications occur, most commonly bleeding. Minor bleeding is to be expected. Severe bleeding can kill.

My patient developed lightheadedness and fell over about four hours after her procedure. I saw her and felt her tummy and wound; they were both fine. I advised her to stay in bed for now and reviewed her after the pm outpatient session finished. It was a particularly hectic day in outpatient's and I only finished at 6:30pm, after which I completed some extra paperwork then went up to the ward, by which time it was past 7pm.

She was lying in bed, writhing in pain and crying.

"It hurts," she whimpered. I touched her abdomen. She screamed. Her abdomen was soft, but super tender. Her blood pressure was normal and her heart rate was normal. In a bleeding patient, blood pressure would drop and the heart rate soar.

However, she was on beta blockers, a type of blood pressure medication that also prevented heart rate from going too fast. Even if she were bleeding out, she wouldn't necessarily (be able to) develop a fast heart beat. She was also a renal patient, where high blood pressure that was quite resistant to medication was the norm. A normal blood pressure in a renal patient in severe pain could actually be low blood pressure.

The decision was difficult; she had a potential risk of bleeding from her wound. If it didn't stem, she could die. But we needed to confirm if she was bleeding and also from where she was bleeding, because the treatment was embolisation, which was blocking the relevant bleeding vessel. To do that, she needed a contrast CT scan. The contrast could potentially kill off any potential residual kidney function she has left and make her dependent on dialysis. But if we block off an artery willy-nilly, we kill off at least a portion of one kidney function when she might not necessarily be bleeding.

After discussion with the on-call senior and the on-call interventional radiologist (who would perform the procedure), it was decided she would proceed with the embolisation. The radiologist injected a small amount of dye into the kidney vessels, blocked off the bleeder, and managed to seal the bleeding. She was transferred to ICU afterwards, where she remained stable.

A week or so later, she was safely discharged.