Kidney Biopsy Adequacy and Complications in Children – Does Technique Matter?

Abstract Background Kidney biopsy is part of the diagnostic workup of many children with renal disease. Traditionally a perpendicular approach to the biopsy has been used but more recently some proceduralists have favoured a tangential approach. It is not clear if one technique is superior with regards to tissue adequacy or complication rates. In our centre interventional radiologists (IR) use general anaesthetic and a tangential approach whereas paediatric nephrologists (PN) use sedation and a perpendicular approach. Methods We examined consecutive kidney biopsies performed between January 2008 and December 2017 for adequacy (sufficient tissue for light and electron microscopy and immunofluorescence) and examined the electronic medical records for data regarding technique and complications. Results IR performed 72 (29.4%) of the 245 native kidney biopsies, obtaining more total glomeruli (median 39 vs 16, p<0.001) and more glomeruli per tissue core (median 13.2 vs 8.0, p<0.001) than PN. No differences in specimen adequacy were observed between the two groups (79.2% IR vs 80.9% PN, p=0.75) and a diagnosis could be made in 98.6% and 93.6% respectively (p=0.1). A statistically lower rate of peri-nephric haematoma (27.8% vs 41.6%, p=0.04) was detected in the IR group, but there were no significant differences in other complications. One patient required a blood transfusion (PN) and another required surgical intervention for a perinephric haematoma (IR). Conclusion IR obtained larger samples and number of glomeruli, but the overall adequacy for native kidney biopsies was good using both perpendicular and tangential techniques, with similar low rates of significant complications.

Download Full-text

Systematic Review and Meta-Analysis of Native Kidney Biopsy Complications

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.04710420 ◽

2020 ◽

Vol 15 (11) ◽

pp. 1595-1602 ◽

Cited By ~ 2

Author(s):

Emilio D. Poggio ◽

Robyn L. McClelland ◽

Kristina N. Blank ◽

Spencer Hansen ◽

Shweta Bansal ◽

...

Keyword(s):

Systematic Review ◽

Kidney Biopsy ◽

Kidney Diseases ◽

Meta Analysis ◽

Hospitalized Patients ◽

Bleeding Complications ◽

Study Patient ◽

Complication Rates ◽

Native Kidney ◽

Acute Kidney Disease

Background and objectivesNative kidney biopsies are commonly performed in the diagnosis of acute kidney diseases and CKD. Because of the invasive nature of the procedure, bleeding-related complications are not uncommon. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases–sponsored Kidney Precision Medicine Project requires that all participants undergo a kidney biopsy; therefore, the objective of this analysis was to study complication rates of native kidney biopsies performed using automated devices under kidney imaging.Design, setting, participants, & measurementsThis is a systematic review and meta-analysis of the literature published from January 1983 to March 2018. The initial PubMed search yielded 1139 manuscripts. Using predetermined selection criteria, 87 manuscripts were included in the final analysis. A random effects meta-analysis for proportions was used to obtain combined estimates of complication rates. Freeman–Tukey double-arcsine transformations were used to stabilize variance as complications were rare.ResultsA total of 118,064 biopsies were included in this study. Patient age ranged from 30 to 79 years, and 45% of patients were women. On the basis of our meta-analysis, pain at the site of biopsy is estimated to occur in 4.3% of biopsied patients, hematomas are estimated to occur in 11%, macroscopic hematuria is estimated to occur in 3.5%, bleeding requiring blood transfusions is estimated to occur in 1.6%, and interventions to stop bleeding are estimated to occur in only 0.3%. Death attributed to native kidney biopsy was a rare event, occurring only in an estimated 0.06% of all biopsies but only 0.03% of outpatient biopsies. Complication rates were higher in hospitalized patients and in those with acute kidney disease. The reported complications varied on the basis of study type and geographic location.ConclusionsAlthough the native kidney biopsy is an invasive diagnostic procedure, the rates of bleeding complications are low. Albeit rare, death can occur postbiopsy. Complications are more frequently seen after kidney biopsies of hospitalized patients with AKI.

Download Full-text

Retrospective analysis of computed tomography-guided percutaneous nephrostomies in cancer patients

Radiologia Brasileira ◽

10.1590/0100-3984.2018.0023 ◽

2019 ◽

Vol 52 (3) ◽

pp. 148-154 ◽

Cited By ~ 3

Author(s):

Marcio dos Santos Meira ◽

Paula Nicole Vieira Pinto Barbosa ◽

Almir Galvão Vieira Bitencourt ◽

Maria Fernanda Arruda Almeida ◽

Chiang Jeng Tyng ◽

...

Keyword(s):

Computed Tomography ◽

Cancer Patients ◽

Electronic Medical Records ◽

Medical Records ◽

Malignant Neoplasm ◽

Percutaneous Nephrostomy ◽

Complication Rates ◽

Success Rates ◽

Ct Guided ◽

Referral Center

Abstract Objective: To establish an overview of computed tomography (CT)-guided percutaneous nephrostomy performed at a referral center for cancer, addressing the characteristics of patients submitted to this intervention, as well as the indications for it, the technical specificities of it, and its main complications. Materials and Methods: This was a retrospective study involving a review of the electronic medical records and images of patients submitted to CT-guided percutaneous nephrostomy at a referral center for cancer between 2014 and 2016. Results: A total of 201 procedures were evaluated. In most cases, the obstruction was caused by a malignant neoplasm. Complications occurred in 9.5% of the cases, and an additional intervention was required (typically for catheter repositioning) in 36.6%. Post-procedure complications were not found to be significantly associated with the type of previous cancer treatment, the technique used, the caliber of the drain used in the procedure, or the degree of dilatation of the collection system prior to the procedure. Conclusion: In cancer patients, CT-guided percutaneous nephrostomy is an effective treatment, with success rates and complication rates similar to those reported in the general population.

Download Full-text

Outcomes after surgery for spinal metastatic leiomyosarcoma

Journal of Neurosurgery Spine ◽

10.3171/2012.8.spine12331 ◽

2012 ◽

Vol 17 (5) ◽

pp. 432-437 ◽

Cited By ~ 8

Author(s):

John E. Ziewacz ◽

Darryl Lau ◽

Frank La Marca ◽

Paul Park

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Surgical Intervention ◽

Prolonged Survival ◽

Single Institution ◽

Repeat Surgery ◽

Aggressive Management ◽

Initial Surgery ◽

Relieve Pain ◽

The Mean

Object Leiomyosarcoma is a smooth-muscle sarcoma that rarely metastasizes to the spine. Its clinical course is variable, although patients with metastatic leiomyosarcoma can experience prolonged survival as compared with patients with more aggressive metastatic tumors. The authors report their single-institution experience in the surgical treatment of patients with leiomyosarcoma metastatic to the spine. Methods A retrospective review of the electronic medical records was performed to obtain details on clinical management and outcomes for patients who had undergone surgical intervention for metastatic leiomyosarcoma of the spine. The few articles available in the current literature on this topic were also analyzed. Results Eight patients with metastatic leiomyosarcoma of the spine underwent surgical management between 2005 and 2011. Six patients (75%) had improvement in their Nurick grade. Patients who had presented with pain as a primary symptom experienced significant relief. Five patients (63%) had lesion recurrence, and 4 underwent repeat surgery at a mean of 10.2 months after their initial surgery. The mean duration of survival was 11.7 months (range 3.3–23.0 months). Conclusions Leiomyosarcoma rarely metastasizes to the spine. However, surgical intervention can relieve pain and improve neurological function. Given the potential for prolonged survival, aggressive management should be considered in well-selected patients.

Download Full-text