The efficacy of blind versus real-time ultrasound-guided percutaneous renal biopsy in developing country

Introduction: Renal biopsy is a useful diagnostic procedure. In developing countries, two techniques of renal biopsy, blind percutaneous renal biopsy and real-time ultrasound-guided percutaneous renal biopsy, have been performed. The majority of studies compared these using different types and sizes of biopsy needle. The aim of this study was to compare both techniques in resource constraint country. Method: We reviewed renal biopsy database, between 1 January 2014 to 30 June 2017. The primary outcome was the total number of glomeruli. The other outcomes were tissue adequacy and bleeding complications. We also analyzed multivariable logistic regression to find factors associated with tissue adequacy and bleeding complications. Result: Of the 204 renal biopsies, 100 were blind percutaneous renal biopsy and 104 real-time ultrasound-guided percutaneous renal biopsy. The number of native renal biopsies was 169 (82.8%). Baseline characteristics of two groups were comparable. The mean number of total glomeruli from real-time ultrasound-guided percutaneous renal biopsy was significantly more than blind percutaneous renal biopsy (20.8 ± 12.1 vs 16.0 ± 13.0, p = 0.001). The real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissues than blind percutaneous renal biopsy (45.2% vs 16%, p < 0.001) and was the only factor associated with adequate tissue. Moreover, 16 renal biopsies from blind percutaneous renal biopsy obtained inadequate tissue. The overall bleeding complications were not statistically different. We found being female, lower eGFR and lower hematocrit were associated with bleeding complications. Conclusion: In comparison with blind percutaneous renal biopsy, real-time ultrasound-guided percutaneous renal biopsy obtained more adequate tissue and number of glomeruli. While the complications of both were comparable. We encourage to practice and perform real-time ultrasound-guided percutaneous renal biopsy in resource constraint countries.

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Percutaneous Renal Biopsy: Comparison of Blind and Real-time Ultrasound Guided Technique

Journal of Nepal Health Research Council ◽

10.3126/jnhrc.v16i1.19369 ◽

2018 ◽

Vol 16 (1) ◽

pp. 66-72 ◽

Cited By ~ 2

Author(s):

Anil Pokhrel ◽

Rajendra Kumar Agrawal ◽

Anil Baral ◽

Ajaya Rajbhandari ◽

Rajani Hada

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Randomized Study ◽

Bleeding Complications ◽

Renal Diseases ◽

Ultrasound Guided ◽

Macroscopic Hematuria ◽

Percutaneous Renal Biopsy ◽

Significant Difference ◽

Perinephric Hematoma

Background: Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique.Methods: It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma.Results: Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours.Conclusions: Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.

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Ultrasound-Guided Renal Biopsy with Biopsy Gun Technique — Efficacy and Complications

Acta Radiologica ◽

10.1177/028418519503600313 ◽

1995 ◽

Vol 36 (3) ◽

pp. 276-279 ◽

Cited By ~ 22

Author(s):

J. Christensen ◽

S. Lindequist ◽

D. Ulrik Knudsen ◽

R. Smith Pedersen

Keyword(s):

Renal Biopsy ◽

Severe Hypertension ◽

Ultrasound Guided ◽

Histologic Diagnosis ◽

Biopsy Technique ◽

Major Complications ◽

Renal Biopsies ◽

The Mean ◽

Adequate Tissue

One hundred and thirty-one ultrasound-guided renal biopsies performed in 127 patients with automated spring-loaded biopsy technique were evaluated. Adequate tissue for histologic diagnosis was obtained in 92% of the procedures (94% of the patients). The mean glomerular yield was 16.8 glomeruli. Complications were seen in 21% of the patients, 18% having minor and 3% having major complications. Patients with severe hypertension had significantly more complications than the rest of the patients. The rate of complications in patients who had 3 or 4 biopsy passes was not increased compared to patients who had one or 2 biopsy passes. Thus, this study indicates that the risk of complications and the safety of the procedure is not influenced by increasing the number of biopsy passes in order to obtain representative specimens.

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Life-Threatening Complications Following Percutaneous Ultrasound-Guided Renal Biopsy: a Rare Case Report

International Archives of Medicine ◽

10.3823/2292 ◽

2017 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Yuan-Hung Lo ◽

Po-Jen Hsiao ◽

Szu-Han Chiu ◽

Kun-Lin Wu ◽

Che-Fu Chang ◽

...

Keyword(s):

Renal Biopsy ◽

Hypovolemic Shock ◽

Bleeding Complications ◽

Ultrasound Guided ◽

Basic Tool ◽

Gross Hematuria ◽

Percutaneous Renal Biopsy ◽

Major Complications ◽

Rare Case Report ◽

Life Threatening

Ultrasound-guided percutaneous renal biopsy has been a basic tool for the diagnosis of kidney disease, but minor and major complications cannot be completely avoided. Major complications including gross hematuria, renal hematoma and arteriovenous fistula, and usually develop within 24 hours after renal biopsy. We present an educational case of female having major bleeding complications after renal biopsy with unusual clinical courses. The patient developed hypovolemic shock at 48 hours after renal biopsy along with perirenal hematoma and hemothorax. The case highlight the need to remain the major complications in mind for physicians. Key words: Hemothorax, renal biopsy.

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Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

Clinical Kidney Journal ◽

10.1093/ckj/sfv012 ◽

2015 ◽

Vol 8 (2) ◽

pp. 151-156 ◽

Cited By ~ 38

Author(s):

N. Prasad ◽

S. Kumar ◽

R. Manjunath ◽

D. Bhadauria ◽

A. Kaul ◽

...

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy ◽

Biopsy Complications

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Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2018.11.006 ◽

2019 ◽

Vol 70 (4) ◽

pp. 361-366 ◽

Cited By ~ 1

Author(s):

Katherine Sawicka ◽

Noman Hassan ◽

Chance Dumaine ◽

Allison Budd ◽

Chris Wall ◽

...

Keyword(s):

Renal Biopsy ◽

Biopsy Specimen ◽

Bleeding Risk ◽

Bleeding Complications ◽

Lower Pole ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Risk Of Bleeding ◽

Technical Factors

Introduction Although medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the role of technical factors. The purpose of our study was to examine the effects of biopsy needle direction on renal biopsy specimen adequacy and bleeding complications. Methods Two hundred and forty-two patients who had undergone ultrasound-guided renal biopsies were included. A printout of the ultrasound picture taken at the time of the biopsy was used to measure the biopsy angle (“angle of attack” [AOA]) and to determine if the biopsy needle was aimed at the upper or lower pole and if the medulla was targeted or avoided. Results Of the 3 groups of biopsy angle, an AOA of between 50°–70° yielded the most glomeruli per core ( P = .001) and the fewest inadequate specimens (4% vs 15% for > 70°, and 9% for < 50°, P = .038). Biopsy directed at a pole vs an interpolar region resulted in fewer inadequate specimens (8% vs 23%, P = .005), while biopsies that were medulla-avoiding resulted in fewer inadequate specimens (5% vs 16%, P = .004) and markedly reduced bleeding complications (12% vs 46%, P < .001) compared to biopsies where the medulla was entered. Discussion An AOA of approximately 60°, aiming at the poles, and avoiding the medulla were each associated with fewer inadequate biopsies and bleeding complications. While biopsy of the medulla is necessary for some diagnoses, the increased bleeding risk emphasizes the need for communication between nephrologist, pathologist, and radiologist.

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Comparison of yield and complications of craniocaudal versus caudocranial needle trajectory for kidney biopsy

The Journal of Vascular Access ◽

10.1177/1129729819854009 ◽

2019 ◽

Vol 21 (1) ◽

pp. 73-78

Author(s):

Narayan Prasad ◽

Rahul Shukla ◽

Manas Behera ◽

Monika Yachha ◽

Dharmendra Bhadauria ◽

...

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Random Allocation ◽

Deep Inspiration ◽

Lower Pole ◽

Biopsy Needle ◽

Needle Trajectory ◽

Number Of Passes ◽

Adequate Tissue ◽

Similar Yield

Background: Percutaneous renal biopsy can result in serious complications. The study is aimed to compare the safety and yield between the two approaches of biopsy techniques: the conventional craniocaudal and the caudocranial trajectory of the biopsy needle under real-time ultrasound guidance. Methods: In this prospective observational study, a total of 80 serial kidney biopsies were performed, 40 with craniocaudal angulation and 40 with caudocranial angulation of the biopsy needle on the random allocation of 1:1 in each group. In the craniocaudal approach, the patient must hold the breath in deep inspiration to make a lower pole of the kidney approachable during unloading the biopsy gun, which was not required in caudocranial trajectory as the lower pole was approachable without holding the breath in deep inspiration. All kidney biopsies were performed percutaneously under real-time ultrasonogram guidance with a 16-cm-long, 16- or 18-gauge needles with a penetration depth of 22 mm and a sample notch of 18 mm. The yield and complications between the two groups were analyzed. Results: Both the groups were comparable in essential demographic characteristics. The study found that the caudocranial position of renal biopsy is equally suitable concerning tissue yield without any increase in the risk of complications and a smaller number of passes to obtain adequate tissue. Conclusion: Caudocranial trajectory of the biopsy needle using a probe needle guide is as safe as the craniocaudal approach. Both approaches have similar yield and complications; however, the caudocranial approach provides ease to the patient during the procedure.

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Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal

American Journal of Nephrology ◽

10.1159/000512902 ◽

2021 ◽

pp. 1-6

Author(s):

George Sousanieh ◽

William L. Whittier ◽

Roger A. Rodby ◽

Vasil Peev ◽

Stephen M. Korbet

Keyword(s):

Diagnostic Accuracy ◽

Renal Biopsy ◽

Real Time ◽

Complication Rate ◽

Laboratory Data ◽

Transfusion Rate ◽

Needle Size ◽

Percutaneous Renal Biopsy ◽

Optimal Sample ◽

Renal Biopsies

Background: As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromise adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles. Methods: PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound. Baseline clinical and laboratory data, biopsy data (number of cores, total glomeruli, and total glomeruli per core), and outcome (hematoma on renal US at 1-h, complications, and transfusion) were collected prospectively. PRB with N14g (337) versus N16g (255) and T16g (892) versus T18g (131) needles were compared. A p value of <0.05 was significant. Results: PRB with an 18-g needle yielded the lowest number of total glomeruli per biopsy (N14g vs. N16g: 33 ± 13 vs. 29 ± 12, p < 0.01 and T16g vs. T18g: 34 ± 16 vs. 21 ± 11, p < 0.0001), significantly fewer total glomeruli per core (T16g vs. T18g: 12.7 ± 6.4 vs. 9.6 ± 5.0, p < 0.001 and N16g vs. T18g: 14.2 ± 6.3 vs. 9.6 ± 5.0, p < 0.001). A hematoma by renal US 1-h post-PRB was similar for native (14g–35% vs. 16g–29%, p = 0.2), and transplant biopsies (16g–10% vs. 18g–9%, p = 0.9) and the complication rate for native (14g–8.9% vs. 16g–7.1%, p = 0.5), transplant biopsies (16g–4.6% vs. 18g–1.5%, p = 0.2) and transfusion rate for native (14g–7.7% vs. 16g–5.8%, p = 0.4), and transplant biopsies (16g–3.8% vs. 18g–0.8%, p = 0.1) were similar irrespective of needle size. Conclusions: PRB of native and transplant kidneys with the use of a 16-gauge needle provides an optimal sample. However, our experience in transplant biopsies suggests the use of an 18-gauge needle stands to jeopardize the diagnostic accuracy of the PRB while not improving safety.

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Real time Ultrasound Guided Percutaneous Native Renal Biopsy- Approach, Safety and Complications

Journal of BP Koirala Institute of Health Sciences ◽

10.3126/jbpkihs.v1i2.22080 ◽

2018 ◽

Vol 1 (2) ◽

pp. 57-64

Author(s):

Ashok Raj Pant ◽

R.K. Rauniyar ◽

M.K. Gupta ◽

B. Bartaula ◽

M. Subedi ◽

...

Keyword(s):

Blood Pressure ◽

Renal Biopsy ◽

Diastolic Blood Pressure ◽

Real Time ◽

Clinical Laboratory ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Safe Procedure ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy

Introduction: Ultrasound guided percutaneous renal biopsy (PRB) is a relatively safe procedure; however, life threatening complications may occur even in current practice. There has been considerable decrease in the risk associated with percutaneous renal biopsy (PRB) in last few decades due to modifications in the biopsy needle as well as advancement in the image guidance. Objectives: To determine the complications and efficacy and to determine relationship between the clinical/ laboratory findings with rate of complications. Material and methods: We retrospectively evaluated hospital records of total of 150 patients who underwent PRB between September 2014 to August 2016 in the department of Radio diagnosis and Imaging at B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. The renal biopsies had been performed with the current automated biopsy gun under real-time ultrasound guidance. The collected data were entered in MS excel. Results: In the total 150 patients, the efficacy (adequacy of the sample) of the procedure was 97.3%. The complications were seen in 13 cases (8.6 %). Five out of these complications were major with 2 cases requiring blood transfusion. The univariate analysis demonstrated the risk factors for developing complications as follows: low platelet count, prolong PT/INR, elevated Blood Urea Nitrogen (BUN) and serum creatinine value and elevated systolic and diastolic blood pressure. However, elevated diastolic blood pressure and prolong PT/INR were associated with complications in multivariate logistic regression analysis. Conclusions: The percutaneous renal biopsy is the safe and efficacious procedure to establish histological diagnosis of renal parenchymal disease.

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Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120923527 ◽

2020 ◽

Vol 7 ◽

pp. 205435812092352

Author(s):

Melissa Schorr ◽

Pavel S. Roshanov ◽

Matthew A. Weir ◽

Andrew A. House

Keyword(s):

Retrospective Study ◽

Blood Transfusion ◽

Renal Biopsy ◽

Major Bleeding ◽

Bleeding Complications ◽

Minor Bleeding ◽

Risk Calculator ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy ◽

C Statistic

Background and Objectives: The risk and timing of bleeding events following ultrasound-guided percutaneous renal biopsy are not clearly defined. Design setting, participants, and measurements: We performed a retrospective study of 617 consecutive adult patients who underwent kidney biopsy between 2012 and 2017 at a tertiary academic hospital in London, Canada. We assessed frequency and timing of minor (not requiring intervention) and major (requiring blood transfusion, surgery, or embolization) bleeds and developed a personalized risk calculator for these. Results: Bleeding occurred in 79 patients (12.8%; 95% confidence interval [CI]: 10.4%-15.7%). Minor bleeding occurred in 67 patients (10.9%; 95% CI: 8.6%-13.6%). Major bleeding occurred in 12 patients (1.9%; 95% CI: 1.1%-3.4%); 2 required embolization or surgery (0.3%; 95% CI: 0.09%-1.2%) and 10 required blood transfusion (1.6%; 95% CI: 0.9%-3.0%). Seventy-three of 79 events were identified immediately on post-procedure ultrasound (92.4% of cases; 95% CI: 84.4%-96.5%). Four of 617 patients experienced a minor event not detected immediately (0.6%; 95% CI: 0.3%-1.7%). Two patients (0.3%; 95% CI: 0.09%-1.2%) suffered a major complication that was not recognized immediately; both required blood transfusions only. There were no deaths or nephrectomies. A risk calculator using age, body mass index, platelet count, hemoglobin concentration, size of the target kidney, and whether the kidney is native, or an allograft predicted minor (C-statistic, 0.70) and major bleeding (C-statistic, 0.83). Conclusions: This retrospective study of 617 patients who had percutaneous ultrasound-guided renal biopsies supports the safety of short post-biopsy monitoring for most patients. A risk calculator can further personalize estimates of complication risk ( http://perioperativerisk.com/kbrc ).

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Pilot Evaluation of a Vacuum-Assisted Biopsy Instrument for Percutaneous Renal Biopsy in Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5637 ◽

2011 ◽

Vol 47 (6) ◽

pp. 391-398 ◽

Cited By ~ 3

Author(s):

Marina Manashirova ◽

Barrak M. Pressler ◽

Hylton R. Gelb ◽

Hock Gan Heng ◽

Stephen D. Lenz ◽

...

Keyword(s):

Kidney Disease ◽

Renal Tissue ◽

Renal Capsule ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Future Studies ◽

Percutaneous Renal Biopsy ◽

Equivalent Number ◽

Renal Biopsies ◽

Healthy Dogs

Kidney biopsies in dogs are commonly obtained using automated spring-loaded biopsy instruments. Interpretation of biopsies from dogs with glomerular disease requires examination of at least 5–10 glomeruli, with at least two biopsies usually required for full evaluation. The purpose of this study was to compare quality and interpretability of renal biopsies obtained from healthy dogs with a large-gauge, vacuum-assisted biopsy instrument versus two biopsies obtained with a spring-loaded biopsy needle. Twenty dogs were randomized into two groups, and percutaneous, ultrasound-guided renal biopsies were evaluated using standard criteria. There were no significant differences in the number of biopsies that contained renal tissue, cortex, or medulla. Biopsies obtained with either instrument contained an adequate number of glomeruli and an equivalent number of arterioles and severity of tissue compression. Differences included easier penetration of the renal capsule and collection of sufficient tissue for interpretation with only one instrument pass when using the vacuum-assisted device (vs two passes required with the spring-loaded instrument). Before use in client-owned dogs, future studies should evaluate whether these differences are clinically relevant advantages in the diagnostic evaluation of dogs with kidney disease, and determine the prevalence and severity of complications when using this larger gauge device.

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