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

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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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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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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Adequacy and complication rates of percutaneous renal biopsy with 18- vs. 16-gauge needles in native kidneys in Chinese individuals.

10.21203/rs.2.17472/v3 ◽

2020 ◽

Author(s):

Weiji Xie ◽

Jing Xu ◽

Yi Xie ◽

Zhijun Lin ◽

Xiaochang Xu ◽

...

Keyword(s):

Renal Biopsy ◽

Disease Diagnosis ◽

Complication Rates ◽

Gross Hematuria ◽

Pathological Classification ◽

Percutaneous Renal Biopsy ◽

Significant Difference ◽

Group 2 ◽

Perinephric Hematoma ◽

Different Diameters

Abstract Background: Percutaneous renal biopsy (PRB) is the primary biopsy technique and it was used by 16G needles or 18G needles in China, but there is controversy about the effect and safety of the two different diameters. The study aims to compare the adequacy, complication rate and pathological classification when using 18G vs. 16G needles to perform renal biopsy with ultrasound-guidedance on native kidneys in Chinese individuals.Methods: We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients with the use of 18G or 16G needles from January 2011 to May 2017 and verified whether the needle gauge affected the disease diagnosis.Results: A total of 270 kidney biopsies were performed. Among them,72 were performed with 18G needles, and 198 were performed with 16G needles. There was no difference in the number of glomeruli under light microscope using 18G relative to 16G needles (24±11 vs. 25±11, p=0.265）, whereas more glomeruli were found in the 16G group than in the 16G group using immunofluorescence microscopy (3±2 vs. 5±3, p<0.05). There was no significant difference in the adequate sample rates between the 18G group and the 16G group (90.28% vs. 93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs. 7.07%, p = 0.57), gross hematuria (4.17% vs. 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs. 1.52%, p = 0.195), were not significantly different between the 18G and 16G groups. In the 16G group, 2 cases of serious complications occurred: severe gross hematuria requiring blood transfusion and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, although there was no significant difference in serious complications rates between the 18G and 16G groups (0% vs. 1.02%, p = 1).Conclusion: There was no significant difference in the number of glomeruli, adequate sample rates, or complication rates when using 18G or 16G needles to perform renal biopsy, and the use of an 18G needle with a smaller diameter did not affect the pathological diagnosis or classification of IgA nephropathy and lupus nephritis.

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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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A novel approach to ultrasound-guided percutaneous native renal biopsy: a better tissue sampling technique

Asian Biomedicine ◽

10.5372/1905-7415.0802.280 ◽

2014 ◽

Vol 8 (2) ◽

pp. 203-210 ◽

Cited By ~ 2

Author(s):

Wiwat Chancharoenthana ◽

Talerngsak Kanjanabuch ◽

Wipawee Kittikowit ◽

Nattachai Srisawat ◽

Khajohn Tiranathanagula ◽

...

Keyword(s):

Renal Biopsy ◽

Sampling Technique ◽

Middle Part ◽

Bleeding Complications ◽

Renal Diseases ◽

Lower Pole ◽

Tissue Sampling ◽

Ultrasound Guided ◽

Novel Approach ◽

Approach Group

AbstractBackground: Percutaneous renal biopsy (PRB) is an essential tool in diagnosis and management of various renal diseases. Conventional ultrasound-guided free-hand approaches to the lower pole of the kidney for PRB yield marginal tissue adequacy and causes a certain incidence of bleeding complications.Objective: To describe a novel ultrasound-guided approach to the middle part of the kidney for PRB to obtain better tissue sampling.Patients and methods: The plane angle between the renal biopsy needle and the skin was set at 30° for patients in the novel middle part approach group (n = 15) and 45° for patients in the conventional lower pole approach group (n = 15).Results: The perpendicular distance between the needle tip and renal capsule in the middle part approach was significantly shorter than the lower pole approach group (0.92 ± 0.6 vs. 1.49 ± 0.4 cm, p = 0.005). The middle part approach to PRB yielded a significantly higher number of glomeruli (22.8 ± 7.2 vs. 15.3 ± 4.1, p = 0.002) and arcuate arteries (0.9 ± 0.6 vs. 0.5 ± 0.1, p = 0.02). The bleeding complications in the middle part approach seemed to be less than in the lower pole approach technique. Pain scores between the two methods as assessed using a visual analog scale were not different.Conclusion: This novel approach to the middle part of the kidney for PRB provides comparable patient satisfaction and a superior adequacy of renal tissue when compared with the conventional lower pole approach with its consequent lower post biopsy bleeding complications. Larger studies to confirm this finding are warranted.

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Adequacy and complication rates of percutaneous renal biopsy on native kidneys in Chinese with 18- vs. 16-gauge needles

10.21203/rs.2.13703/v1 ◽

2019 ◽

Author(s):

Weiji Xie ◽

Jing Xu ◽

Yi Xie ◽

Zhijun Lin ◽

Xiaochang Xu ◽

...

Keyword(s):

Renal Biopsy ◽

Immunofluorescence Microscopy ◽

Complication Rates ◽

Ultrasound Guided ◽

Gross Hematuria ◽

Pathological Classification ◽

Significant Difference ◽

Diagnosis And Classification ◽

Perinephric Hematoma

Abstract Aim: The study aims to compare the adequacy, complication and pathological classification rates of using 18G vs. 16G needles to perform renal biopsy with ultrasound-guided on native kidneys in Chinese. Methods: We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients who were used by 18G or 16G needles separately from January, 2011 to May, 2017，and verified whether the needle gauge affect the diagnosis of the disease. Results: A total of 270 kidney biopsies were performed. Among them :72 were with 18G needles, and 198 were with16G needles. There was no difference in the number of glomeruli count under light microscope using 18G relative to 16G needles（24±11vs25±11，p=0.265）, whereas more glomeruli count were found for the 16G group using immunofluorescence microscopy(3±2 vs 5±3， p＜0.05).There was no significant difference in the adequate sample rates between 18G group and 16G group (90.28%vs93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs 7.07%, p = 0.57), gross hematuria (4.17% vs 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs1.52%, p = 0.195) were not significantly different for 18G vs 16G group. In 16G group, there was 2 cases of serious complications occurred, including severe gross hematuria requiring blood transfusion, and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, even although there was no significant difference in serious complications rates between the 18G and 16G group (0% vs 1.02%，p = 1). Conclusion: There was no significant difference in the number of glomeruli, adequate sample rates, and complication rates of using the 18G and 16G needles to perform renal biopsy, and the 18G needle with smaller diameter did not affect the pathological diagnosis and classification of IgA nephropathy and lupus nephritis.

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Adequacy and complication rates of percutaneous renal biopsy with 18- vs. 16-gauge needles in native kidneys in Chinese individuals.

10.21203/rs.2.17472/v1 ◽

2019 ◽

Author(s):

Weiji Xie ◽

Jing Xu ◽

Yi Xie ◽

Zhijun Lin ◽

Xiaochang Xu ◽

...

Keyword(s):

Renal Biopsy ◽

Immunofluorescence Microscopy ◽

Complication Rates ◽

Gross Hematuria ◽

Pathological Classification ◽

Percutaneous Renal Biopsy ◽

Significant Difference ◽

Group 2 ◽

Perinephric Hematoma

Abstract Background The study aims to compare the adequacy, complication rate and pathological classification when using 18G vs. 16G needles to perform renal biopsy with ultrasound-guidedance on native kidneys in Chinese individuals.Methods We retrospectively analyzed the number of glomeruli, adequate sample rates, complication rates and pathological classification in 270 patients with the use of 18G or 16G needles from January 2011 to May 2017 and verified whether the needle gauge affected the disease diagnosis.Results A total of 270 kidney biopsies were performed. Among them,72 were performed with 18G needles, and 198 were performed with 16G needles. There was no difference in the number of glomeruli under light microscope using 18G relative to 16G needles (24±11 vs. 25±11, p=0.265), whereas more glomeruli were found in the 16G group than in the 16G group using immunofluorescence microscopy (3±2 vs. 5±3, p<0.05). There was no significant difference in the adequate sample rates between the 18G group and the 16G group (90.28% vs. 93.94%, p=0.298). Minor complications including the incidence of lumbar or abdominal pain (4.17% vs. 7.07%, p = 0.57), gross hematuria (4.17% vs. 3.54%, p = 0.729), and perinephric hematoma without symptoms (4.17% vs. 1.52%, p = 0.195), were not significantly different between the 18G and 16G groups. In the 16G group, 2 cases of serious complications occurred: severe gross hematuria requiring blood transfusion and retroperitoneal hematoma requiring surgery. No serious complications were observed in the 18G group, although there was no significant difference in serious complications rates between the 18G and 16G groups (0% vs. 1.02%, p = 1).Conclusion There was no significant difference in the number of glomeruli, adequate sample rates, or complication rates when using 18G or 16G needles to perform renal biopsy, and the use of an 18G needle with a smaller diameter did not affect the pathological diagnosis or classification of IgA nephropathy and lupus nephritis.

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