Percutaneous Renal Biopsy with Real-Time Ultrasonography

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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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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Percutaneous Renal Biopsy with the Use of Real-Time Ultrasound

American Journal of Nephrology ◽

10.1159/000168303 ◽

1991 ◽

Vol 11 (3) ◽

pp. 195-200 ◽

Cited By ~ 33

Author(s):

David M. Burstein ◽

Melvin M. Schwartz ◽

Stephen M. Korbet

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Percutaneous Renal Biopsy

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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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