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

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

SAGE Open Medicine ◽

10.1177/2050312119849770 ◽

2019 ◽

Vol 7 ◽

pp. 205031211984977 ◽

Cited By ~ 1

Author(s):

Wanjak Pongsittisak ◽

Naphat Wutilertcharoenwong ◽

Tanun Ngamvichchukorn ◽

Sathit Kurathong ◽

Chutima Chavanisakun ◽

...

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Resource Constraint ◽

Bleeding Complications ◽

Ultrasound Guided ◽

Biopsy Needle ◽

Percutaneous Renal Biopsy ◽

Renal Biopsies ◽

Lower Egfr ◽

Adequate Tissue

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: Comparison of Blind and Real-Time Ultrasound-Guided Technique

Seminars in Dialysis ◽

10.1111/j.1525-139x.2007.00295.x ◽

2007 ◽

Vol 20 (4) ◽

pp. 355-358 ◽

Cited By ~ 55

Author(s):

Ivan D. Maya ◽

Prathyusha Maddela ◽

Jill Barker ◽

Michael Allon

Keyword(s):

Renal Biopsy ◽

Real Time ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy

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An improved technique for ultrasound guided percutaneous renal biopsy

Kidney International ◽

10.1038/ki.1985.13 ◽

1985 ◽

Vol 27 (1) ◽

pp. 80-82 ◽

Cited By ~ 32

Author(s):

Jason C. Birnholz ◽

Balakuntalam S. Kasinath ◽

Howard L. Corwin

Keyword(s):

Renal Biopsy ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy ◽

Improved Technique

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The association between diastolic blood pressure and massive transfusion in severe trauma: a retrospective single-center study

Journal of the Pakistan Medical Association ◽

10.47391/jpma.687 ◽

2020 ◽

pp. 1-14

Author(s):

Dong Hun Lee ◽

Hong Sug Kim ◽

Byung Kook Lee ◽

Yong Soo Cho ◽

Tag Heo ◽

...

Keyword(s):

Blood Pressure ◽

Diastolic Blood Pressure ◽

Injury Severity ◽

Massive Transfusion ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Severe Trauma ◽

Trauma Patients ◽

Single Center Study ◽

Blood Pressure Data

Abstract Objective: To evaluate the association between diastolic blood pressure and massive transfusion in severe trauma. Methods: The retrospective study was conducted at a tertiary emergency medical centre in Gwangju , Republic of Korea, and comprised data of severe trauma patients with injury severity score >15 presenting between January 2016 and December 2017. Multivariate logistic regression analysis was performed to evaluate the association between diastolic blood pressure and massive transfusion. Receiver operating characteristic curve analysis was performed to estimate the prognostic performance of diastolic blood pressure. Data was analysed using SPSS 18. Results: Of the 827 patients, 64(7.7%) underwent massive transfusion. After adjusting the confounders, diastolic blood pressure was found to be an independent factor in predicting massive transfusion (odds ratio: 0.965; 95% confidence interval: 0.956–0.975). Conclusion: Initially low diastolic blood pressure was found to be an independent predictor for massive transfusion in severe trauma cases. Key Words: Trauma, Diastolic blood pressure, Massive transfusion.

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The complications of ultrasound-guided percutaneous renal biopsy

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.202784 ◽

2017 ◽

Vol 28 (2) ◽

pp. 430

Author(s):

Gioacchino Li Cavoli ◽

Luisa Bono ◽

Calogera Tortorici ◽

TancrediVincenzo Li Cavoli ◽

Carlo Giammarresi ◽

...

Keyword(s):

Renal Biopsy ◽

Ultrasound Guided ◽

Percutaneous Renal Biopsy

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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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