Use of computerized tomography to diagnose complications of percutaneous renal biopsy

Rosenbaum, Robert; Hoffsten, Phillip E.; Stanley, Robert J.; Klahr, Saulo

doi:10.1038/ki.1978.93

Cited by 95 publications

(40 citation statements)

References 11 publications

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“…Although clinically significant perinephric hematomas occur in 6% or fewer of biopsies, perinephric hematomas have been demonstrated at 24 to 72 h after biopsy in Ͼ90% of cases evaluated prospectively (1,16). The majority of hematomas are asymptomatic and small in size, but in up to 50% of biopsies, they are moderate to large in size (17,18). As a result, the present practice of 24-h bed rest and observation after biopsy may be therapeutically important and contribute to the low incidence of clinically significant hematomas.…”

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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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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“…Studies from the 1970s and 1980s showed CT evidence of bleeding in 57%-91% of patients (versus 70% on ultrasound) using older scanners, biopsy techniques, and needles (31)(32)(33). A decrease in hemoglobin level after PRB is very common, but generalized bleeding rates after PRB are difficult to state given the heterogeneity in how bleeding is defined and diagnosed between studies.…”

Section: Bleedingmentioning

confidence: 99%

The Native Kidney Biopsy

Hogan

Mocanu

Berns

2016

Clinical Journal of the American Society of Nephrology

238

228

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The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training. These data are presented to develop best practice strategies for this essential procedure.

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“…However, several studies using this lower pole landmark reported inadequate tissue for diagnosis and/or bleeding complications after the procedure [5,[16][17][18][19]. The minimum renal tissue sample size adequate for diagnosis may vary greatly with the specific diagnosis [20].…”

Section: Discussionmentioning

confidence: 99%

“…All biopsies (100%) provided adequate tissue for definitive diagnoses. The middle part approach to PRB yielded a significantly greater number of glomeruli than the lower pole approach PRB [22.8 ± 7.2 (range 10-34) vs. 15.3 ± 4.1 (range [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], p = 0.002]. This occurred although there was more incidence of advanced interstitial fibrosis and tubular atrophy and diabetic nephropathy in the middle part approach to PRB group ( Table 2).…”

Section: Procedures and Adequacy Outcomesmentioning

confidence: 99%

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

et al. 2014

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Background: 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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Use of computerized tomography to diagnose complications of percutaneous renal biopsy

Cited by 95 publications

References 11 publications

Timing of Complications in Percutaneous Renal Biopsy

Timing of Complications in Percutaneous Renal Biopsy

The Native Kidney Biopsy

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

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