Abstract
Background and Aims
Renal biopsy is an essential procedure for diagnosis and prognosis of the glomerular diseases, however needs a lot of skill and experience to do and usually requires admission for a couple of days, unless sometimes needs an embolization, transfusion, nephrectomy etc. We have an experience of more than 3,000 cases of renal biopsy without major complications such as bleeding, embolization, nephrectomy etc.. Recently we performed 309 cases of renal biopsies, whose age is under 20 year old, at the OPD level without admission.
Method
Before renal biopsy we checked bleeding tendencies and blood thinning agents were hold for more than 1 week. Kidney biopsy was done under local lidocain anesthetic at biopsy site and IV ketamine in uncooperative children. Biopsy needle was inserted under the ultrasound guide(GE LogiQ E9) at the lower pole of the kidney. We checked renal hematoma, AV-fistula formation etc. by ultrasound 3 times every one hour until go home. Biopsy materials were sent to H.S.Lee’s pathology lab. All patients went home in 6 hours after procedure. As far as we know, our clinic is the world’s first time try doing kidney biopsy at OPD plus pathology together, although some kidney pathology reading centers are available in some place.
IF results were reported by on-line on the day of kidney biopsy after 5 hours and LM and EM were reported by on-line within two days. All cases went home after 6 hours of procedure.
Results
We performed 309 cases of renal biopsy at OPD level without any major complications, of which 43 cases were follow up renal biopsies. No major complications were noted such as bleeding, AV fistular, embolization, nephrectomy etc.. Male to female ratio was 1.24. Age distribution was from 2 to 20 year-old.
Biopsy results were as follows; mesangial proliferative glomerulonephritis 82 cases(26.51%), IgA nephropathy 81 cases(26.2%), mild focal nonspecific glomerulonephritis 45 cases(14.6%), HSP 23 cases(7.4%), focal segmental glomerulosclerosis 17 cases(5.5%), podocyte disease 13 cases (4.2%), Alport’s syndrome 10 cases(3.2%), minor glomerular change 10 cases (3.2%), MPGN 8 cases (2.6%), membranous nephropathy 6 cases(1.9%), and Lupus nephritis, C1q nephropathy, C3 nephropathy, obesity related nephropathy were 11 cases respectively and others include acute PSGN, chronic tubulointerstitial nephritis.
Conclusion
OPD level percutaneous renal biopsy in children is no more a dangerous procedure if performed exactly at lower pole of the kidney, with close follow up for 6 hours by ultrasound examination.
The efficacy of blind versus real-time ultrasound-guided percutaneous renal biopsy in developing country
