Comparative Safety and Efficiency of Five Percutaneous Kidney Biopsy Approaches of Native Kidneys: A Multicenter Study

Abstract

Background: Renal biopsy (RB) is necessary for the diagnosis, prognosis, and therapy guidance of native kidney diseases. Few studies have compared outcomes of RB procedures. We retrospectively compared the safety and efficiency of five biopsy procedures. Methods: The number of glomeruli on light microscopy (LM) and on immunofluorescence (IF) and serious adverse events following RB performed in five nephrology units (C1–C5) were collected. C1 performed ultrasound (US) assessment before RB and used a 14-gauge core-cutting needle biopsy gun, C2 US guidance and a 14-gauge needle, C3 tomodensitometry guidance and a 14-gauge needle, C4 US guidance and a 16-gauge needle, and C5 tomodensitometry guidance and a 16-gauge needle. Results: RB was performed in 943 adults between January 2006 and July 2010. Serious adverse events occurred in 1.5% of biopsies. The complication rate was not different between nephrology units. The mean number of glomeruli on biopsy was 14.2 ± 8.6 with LM and 4.4 ± 3.3 on IF. It was different according to the nephrology unit for LM (p = 0.01) and for IF (p < 0.001). The number of failed biopsies was influenced by the nephrology unit and radiological guidance technique, favoring real-time US guidance. Failed biopsies using US or tomodensitometry assessment before RB was certainly due to kidney imprecise localization since it was often non-renal tissue sampling. At least 10 glomeruli were found in 69% of biopsies on LM. This rate varied according to the nephrology unit (p = 0.004) and was higher when 14-gauge needles were used in comparison with 16-gauge needles. Conclusion: RB is safe regardless of the technical procedure, but radiological guidance and needle size influence the efficiency of biopsies.

Renal Parenchymal Thickness as a Predictor of Post Percutaneous Kidney Biopsy Complication

“…While there was no major complication during the third decade between 1993 and 2002, the proportion of patients who had minor complications actually increased from 19 to 28% [13]. In a more recent French multicenter trials, the lowest major complication was 0.7% [14]. The rate of major complications in our study was closer to the one reported by Stratta et al [13] than the French research.…”

Percutaneous Renal Biopsy of Native Kidneys: A Single-Center Experience of 1,055 Biopsies

“…However, in the prospective trial by Nicholson et al [37], no differences in complication rates were found for biopsies performed with 14-, 16- or 18-gauge automated needles. Similarly, a number of other studies have found no differences in complication rates or transfusion requirements based on needle size [4,8,11,21,32,44,45], including the 2013 report of the Norwegian Kidney Biopsy Registry [21] of 9,288 PRBs. However, in a recent meta-analysis by Corapi et al [12], the rate of transfusion was greater in patients biopsied with a 14-gauge automated needle compared to 16- and 18-gauge needles (2.1 vs. 0.5%, p = 0.009), and this led to the recommendation that the use of 14-gauge needles be discouraged.…”

“…The number of glomeruli per biopsy was significantly less with the 18-gauge needle (9 glomeruli) compared to that obtained with the 14- or 16-gauge needles (12 glomeruli each, p < 0.001), and the adequacy rate was lower at 94.3%. A number of studies have shown that the diagnostic yield is greater with 14-gauge automated needles compared to 16- or 18-gauge needles, and the quality of the sample has been shown to be superior, with more ‘intact' glomeruli and less ‘crush or fragmentation' artifact [3,8,11,21,29,32,33,34,35,36,37,38]. In the only prospective study assessing the differences between automated needle sizes, Nicholson et al [37] demonstrated that the use of a 14-gauge needle resulted not only in a significantly larger sample size (15 vs. 11 vs. 9 glomeruli, p < 0.05) but also greater diagnostic success (85 vs. 76 vs. 53%, p < 0.05) compared to the use of 16- or 18-gauge needles.…”

“…Improvements in imaging techniques and biopsy needles have resulted in the ability to obtain adequate renal tissue for diagnosis in ≥99% of renal biopsies [3,4,5,6,7,8,9,10,11]. Additionally, these technical improvements have led to increased safety of the procedure, with the rate of life-threatening complications resulting in death decreasing from 0.12 to 0.02% over the past 60 years [3,12]; during the past 20 years, death resulting from PRB of native kidneys has been an extremely rare event [13,14,15,16,17,18,19,20,21].…”

Transvenous Renal Transplant Biopsy via a Transfemoral Approach

“…Percutaneous renal biopsy (PRB) of kidney transplants is the standard procedure for obtaining tissue samples (4)(5)(6)(7). However, PRB is associated with an increased risk of complications in patients who have bleeding disorders, are undergoing anticoagulation therapy or suffer from uncontrolled hypertension.…”