A Comparison between Kidney Allograft Biopsies Performed by Nephrologists and Surgeons Versus Interventional Radiologists

Abstract

Introduction: Renal biopsy is an integral part of clinical nephrology practice that helps in the diagnosis of various renal diseases. Across the globe, it is performed by nephrologists and/or surgeons under ultrasound guidance. Lately, this novel procedure has been performed more frequently by the interventional radiologist (IR) as compared to nephrologists and surgeons. Methods: We completed a retrospective review of 378 consecutive renal biopsies performed at our university hospital in the city center of Philadelphia, Pennsylvania, between September 2008 and June 2011 for various indications. Baseline characteristics were comparable except systolic blood pressure (SBP), prothrombin time (PT), and international normalized ratio (INR) which was higher. Hemoglobin was lower in patients who underwent biopsy by the IR compared to those who were biopsied by nephrologists and/or surgeons. Results: The primary outcome showed the average number of glomeruli obtained with each biopsy was significantly lower by nephrology or surgical teams, 9.09 ± 5.17 vs. 19.17 ± 11.11 obtained by the interventional radiology team, p-value <0.0001. The number of cores obtained with each biopsy was significantly lower by nephrologist or surgeon at the bedside, 1.57 ± 1.05 vs. 2.42 ± 1.26, p-value <0.0001. The average number of attempts to obtain one core was 2.00 ± 1.10 vs. 2.60 ± 1.17 by nephrologist and surgeon vs. IR, respectively, p-value <0.0001. Conclusion: Our study clearly shows the superior success of renal biopsy by the IR as compared to the nephrology and surgical teams. This calls for more robust training of nephrology fellows and surgery residents to obtain the renal biopsy to prevent the loss of this unique procedure skill by non-radiology clinicians.

The evolution of performing a kidney biopsy: a single center experience comparing native and transplant kidney biopsies performed by interventional radiologists and nephrologists

“…Sparse data exists comparing kidney biopsy outcomes between nephrology fellows and those done by radiology, with one small study showing equal efficacy and another larger study showing better success of kidney biopsy performed by IR as compared to nephrologist or surgeons [ 7 , 15 ]. Another study which compared ultrasound marked blind biopsy with real time ultrasound guided biopsies by nephrologists and radiologists did not show any difference among the three groups [ 16 ].…”

Value of interventional radiology and their contributions to modern medical systems

“…There is a large library of evidence that these IR procedures provide comparative advantages to these surgical and medical management ( Table 1 ). When there are cross-specialty operators, IR's specialty training can yield better results than alternatives including biopsies, pediatric implantable venous access devices, and IVC filter placement ( 38 , 129 , 136 ). IR's performance in biopsy has made them the predominant operator for all biopsies at most hospital systems over the past 20 years.…”

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“…Dates are also taken as a treatment for anemia resulting from iron deficiency due to the fact that dates contain folic acid as well as iron, which is one of the components of hemoglobin, which reduces anemia. Also, the alkaline mineral salts in dates work on Balance the acidity of the blood resulting from eating carbohydrates in abundance [12].…”