Percutaneous Native Renal Biopsy: Comparison of a 1.2-mm Spring-driven System With a Traditional 2-mm Hand-driven System

Doyle, Anthony; Gregory, Martin C.; Terreros, Daniel

doi:10.1016/s0272-6386(12)80370-2

Cited by 70 publications

(41 citation statements)

References 27 publications

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“…The latter should, in fact, be regarded as an epiphenomenon because of the high incidence (reported in up to 60%-90% of cases after examination prospectively with ultrasonography or computertomography). Of note, several authors found that a hematoma alone is not a reliable predictor of a serious adverse outcome (7,16,26,27). Perirenal hematomas should not be regarded as a clinical significant complication in the absence of significant bleeding or persisting pain necessitating delayed hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Safety and Complications of Percutaneous Kidney Biopsies in 715 Children and 8573 Adults in Norway 1988–2010

Tøndel

Vikse

Bostad

et al. 2012

Clinical Journal of the American Society of Nephrology

233

238

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Summary Background and objectives Skepticism about performing renal biopsies is often because of uncertainty regarding risk of complications. The aim of this study was to evaluate safety and relevant complications of renal biopsies in pediatric and adult patients in a large national registry study. Design, setting, participants, & measurements Kidney biopsies reported in the Norwegian Kidney Biopsy Registry from 1988 to 2010 were included. Risk factors for major complications (blood transfusion and/or surgical or catheter intervention) were analyzed using logistic regression statistics. Results Of the 9288 biopsies included, 715 were from children, and 8573 were from adults (≥18 years). Median age was 49 years (range=2 weeks to 94 years). Gross hematuria appeared after biopsy in 1.9% of the patients; 0.9% of patients needed blood transfusion, and 0.2% of patients needed surgical intervention/catheterization. The frequencies were 1.9%, 0.9%, and 0.2% in adults and 1.7%, 0.1% and 0.1% in children, respectively; 97.9% of the biopsies were without complications. In unadjusted analyses, risk factors for major complications were age>60 years, estimated GFR<60 ml/min per 1.73 m2, systolic hypertension, acute renal failure, and smaller clinical center size (<30 biopsies/yr). Adjusted analyses (adjusted for age and/or estimated GFR) showed higher odds ratios (OR) only for smaller clinical center (OR=1.60 [1.02–2.50]) and low estimated GFR (estimated GFR=30–59 ml/min per 1.73 m2 [OR=4.90 (1.60–14.00)] and estimated GFR<30 ml/min per 1.73 m2 [OR 15.50 (5.60–43.00)]). Conclusions Percutaneous renal biopsy is a low-risk procedure in all ages. Reduced estimated GFR and smaller center size are associated with an increased risk of major complications.

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Section: Discussionmentioning

confidence: 99%

Safety and Complications of Percutaneous Kidney Biopsies in 715 Children and 8573 Adults in Norway 1988–2010

Tøndel

Vikse

Bostad

et al. 2012

Clinical Journal of the American Society of Nephrology

233

238

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Korbet

Volpini

Whittier³

2014

Am J Nephrol

137

118

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Background: Percutaneous renal biopsy (PRB) of native kidneys is an essential tool in the diagnosis and management of renal disease. We report one of the largest single-center experiences on the success and safety of the procedure. Methods: From June 1983 to March 2012, 1,055 adults underwent PRB using real-time ultrasound guidance and 14-gauge biopsy needles. Data were collected prospectively for 826 biopsies (78%). Statistical analysis was performed using the Mann-Whitney test, Wilcoxon matched pairs test and Kruskal-Wallis test for continuous data or the Fisher's exact test and χ² test for categorical data. Multivariate analysis using logistic regression was performed to determine which feature at baseline was predictive of a complication following renal biopsy. Results: Patients were aged 46 ± 17 years; 38% were male, 40% were white and 43% were African-American. Serum creatinine (SCr) was 2.3 ± 2.3 mg/dl (>1.5 mg/dl in 47%). The pre-PRB hemoglobin was 12 ± 2 g/dl (<11.0 g/dl in 35%). Adequate tissue for diagnosis was obtained in 99% of biopsies. Minor complications occurred in 8.1% of biopsies (mainly gross hematuria, in 4.5%). Major complications occurred in 6.6% of biopsies, with transfusions required in 5.3%. Only 1 death (0.09%) resulted from post-PRB bleeding. By multivariate analysis, baseline features predictive of a complication were systolic blood pressure >170 mm Hg (OR 4.2, 95% CI 1.8-9.8), bleeding time >7.5 min (OR 1.7, CI 1.2-2.5) and SCr >3.5 mg/dl (OR 1.8, CI 1.2-2.9). Conclusions: PRB of native kidneys using real-time ultrasound with a 14-gauge automated needle remains a successful and safe procedure.

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“…Studies that have addressed this issue in native kidney biopsies have been flawed as they compared complications in patients who were biopsied with smaller gauge automated needles to those of patients who were biopsied with larger gauge manual needles; thus, their results may reflect the impact of biopsy technique rather than needle size (12)(13)(14). To date, the only prospective study to evaluate the impact of needle size using automated biopsy needles has been conducted in renal allograft biopsies; no significant difference in complication rate was found, but the sample was significantly greater with the 14-gauge needle biopsies (15).…”

Section: Discussionmentioning

confidence: 99%

Timing of Complications in Percutaneous Renal Biopsy

Whittier

Korbet²

2004

Journal of the American Society of Nephrology

398

354

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Abstract. Percutaneous renal biopsy (PRB) is a safe and effective tool in the diagnosis and management of renal disease; however, the optimal timing of observation after biopsy is not clearly established. With the use of real-time ultrasound guidance, PRB of native kidneys was performed in 750 adult patients at an academic institution by an attending nephrologist or fellow between June 1983 and June 2002. All patients were observed for 23 to 24 h after biopsy for the presence, severity, and timing of complications. Biopsy-related complications occurred in 98 (13%) patients; minor complications occurred in 50 (6.6%) patients, and major complications occurred in 48 (6.4%) patients. One (0.1%) patient died as a result of the biopsy. Multivariate analysis using logistic regression found only serum creatinine at baseline predictive of a complication. Patients with a serum creatinine Ն5.0 mg/dl were 2.3 times as likely to have a complication (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.1; P Ͻ 0.005). Complications were identified in 38 (42%) patients by Յ4 h, in 61 (67%) patients by Յ8 h, in 77 (85%) patients by Յ12 h, and in 81 (89%) patients at Յ24 h. The PRB remains a safe procedure, but the risk of complication is higher in patients with advanced renal insufficiency. After biopsy, an observation time of up to 24 h remains optimal as an observation period of Յ8 h risks missing Ն33% of complications.

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Percutaneous Native Renal Biopsy: Comparison of a 1.2-mm Spring-driven System With a Traditional 2-mm Hand-driven System

Cited by 70 publications

References 27 publications

Safety and Complications of Percutaneous Kidney Biopsies in 715 Children and 8573 Adults in Norway 1988–2010

Safety and Complications of Percutaneous Kidney Biopsies in 715 Children and 8573 Adults in Norway 1988–2010

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

Timing of Complications in Percutaneous Renal Biopsy

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