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Lim CY, Khay SL. Bleeding complications after percutaneous kidney biopsies - nationwide experience from Brunei Darussalam. World J Nephrol 2023; 12:147-158. [PMID: 38230299 PMCID: PMC10789084 DOI: 10.5527/wjn.v12.i5.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Kidney biopsy serves as a valuable method for both diagnosing and monitoring kidney conditions. Various studies have identified several risk factors associated with bleeding complications following the procedure, but these findings have shown inconsistency and variation. AIM To investigate the risk of bleeding complications following percutaneous kidney biopsy in Brunei Darussalam. We sought to explore the relevant clinical and pathological risk factors associated with these complications while also considering the findings within the broader international literature context. METHODS We conducted a retrospective study of all adult patients who underwent kidney biopsy in Brunei Darussalam from October 2013 to September 2020. The outcomes of interest were post-biopsy bleeding and the need for blood transfusions. Demographics, clinical, laboratory and procedural-related data were collected. Logistic regression analysis was used to identify predictors of outcomes. RESULTS A total of 255 kidney biopsies were included, with 11% being performed on transplanted kidneys. The majority of biopsies were done under ultrasound guidance (83.1%), with the rest under computer tomography guidance (16.9%). The most common indications for biopsy were chronic kidney disease of undefined cause (36.1%), nephrotic syndrome (24.3%) and acute kidney injury (11%). Rate of bleeding complication was 6.3% - 2% frank hematuria and 4.3% perinephric hematoma. Blood transfusion was required in 2.8% of patients. No patient lost a kidney or died because of the biopsy. Multivariate logistic regression identified baseline hemoglobin [odds ratio (OR): 4.11; 95% confidence interval (95%CI): 1.12-15.1; P = 0.03 for hemoglobin ≤ 11 g/dL vs. > 11 g/dL) and the presence of microscopic hematuria (OR: 5.24; 95%CI: 1.43-19.1; P = 0.01) as independent risk factors for post-biopsy bleeding. Furthermore, low baseline platelet count was identified as the dominant risk factor for requiring post-biopsy transfusions. Specifically, each 10 109/L decrease in baseline platelet count was associated with an 12% increase risk of needing transfusion (OR: 0.88; 95%CI: 0.79-0.98; P = 0.02). CONCLUSION Kidney biopsies were generally well-tolerated. The identified risk factors for bleeding and transfusion can help clinicians to better identify patients who may be at increased risk for these outcomes and to provide appropriate monitoring and management.
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Affiliation(s)
- Chiao Yuen Lim
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
| | - Sai Laung Khay
- Department of Renal Services, RIPAS Hospital, Bandar Seri Begawan BA1712, Brunei Darussalam
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Schnuelle P. Renal Biopsy for Diagnosis in Kidney Disease: Indication, Technique, and Safety. J Clin Med 2023; 12:6424. [PMID: 37835066 PMCID: PMC10573674 DOI: 10.3390/jcm12196424] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
Renal biopsies are the gold standard for diagnosis, staging, and prognosis of underlying parenchymal kidney disease. This article provides an overview of the current indications and highlights ways to reduce bleeding complications in order to achieve optimal diagnostic yield with minimal risk to the patient. Novel indications have emerged from the increasing use of new molecularly targeted oncologic therapies in recent years, which often induce immune-mediated renal disease. On the other hand, the detection of specific antibodies against target antigens on podocytes in the sera of patients with new-onset nephrotic syndrome has now relativized the indication for biopsy in membranous nephropathy. The use of semi-automatic spring-loaded biopsy devices and real-time ultrasound considerably declined the complication rate and is the current standard. Percutaneous renal biopsies are overall a safe procedure if contraindications are considered. A coagulation disorder needs to be excluded beforehand, and an elevated blood pressure must be reduced to the normotensive range with medications. A laparoscopic approach or a radiology interventional procedure through the internal jugular vein may be considered for obtaining a kidney tissue sample if there is an urgent indication and a bleeding tendency cannot be adequately corrected. Major bleeding after a percutaneous renal biopsy can usually be managed with selective arterial embolization of the injured renal vessel. The use of a 16-gauge needle is the most reasonable compromise between diagnostic benefit and risk of complication. In the routine diagnostic, the biopsy specimen is examined with light microscopy, immunohistochemistry, and electron microscopy. Combination with modern molecular pathology techniques will contribute to more precise insights into the development and progression of kidney disease, which will likely refine future treatments in nephrology.
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Affiliation(s)
- Peter Schnuelle
- Center for Renal Diseases Weinheim, Academic Teaching Practice of the University Medical Center Mannheim, University of Heidelberg, D-69469 Weinheim, Germany
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3
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Villeneuve T, Prévot G, Pugnet G, Plat G, Héluain V, Faguer S, Guibert N. Role of bronchoscopy for respiratory involvement in granulomatosis with polyangiitis and microscopic polyangiitis. ERJ Open Res 2023; 9:00141-2023. [PMID: 37701367 PMCID: PMC10493713 DOI: 10.1183/23120541.00141-2023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/05/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives This study describes data from bronchoscopy performed at the diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods We conducted a retrospective study between 2004 and 2019 in patients aged >18 years with a diagnosis of microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) who underwent bronchoscopy at onset of the disease. We collected bronchoalveolar lavage (BAL) and histological findings obtained during bronchoscopy. Results 274 patients with AAV were identified. Among 92 bronchoscopies, 62 were performed at diagnosis, and 58 procedures were finally analysed. Cough was more frequent in patients with MPA than GPA (p=0.02). The presence of endobronchial lesions (24.1%) was found to be significantly associated with GPA (p<0.0001) and proteinase 3-ANCA (p=0.01). The most frequent endobronchial lesions were inflammation and hyperaemia of the bronchial mucosa (50%), followed by stenoses (28%), ulcerations (21%) and mass-like granulomatosis (7%). The diagnostic yield of bronchial biopsies was useful for visible lesions (66.6% versus 0%; p=0.006). On BAL, diffuse alveolar haemorrhage (DAH) was detected in 31 (53.4%) patients and was more frequent in MPA patients (70.4% versus 38.7%; p=0.016). In 16.1% of DAH cases, BAL confirmed the diagnosis despite the absence of clinical or biological arguments. The incidence of microbial infections on BAL (38%) was similar between MPA and GPA (p=0.54). Conclusion Bronchoscopy is an informative procedure at the onset of AAV disease in patients with respiratory manifestations. Endobronchial lesions are more frequently found in GPA and should be biopsied. BAL can be used to confirm DAH or diagnose superadded infection.
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Affiliation(s)
- Thomas Villeneuve
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Grégoire Prévot
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Grégory Pugnet
- Internal Medicine Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Valentin Héluain
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, National Referral Center for Rare Renal Diseases, University Hospital Center (CHU) of Toulouse, Toulouse, France
| | - Nicolas Guibert
- Pulmonology Department, University Hospital Center (CHU) of Toulouse, Toulouse, France
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Jaturapisanukul S, Chavanisakun C, Benjakul N, Ngamvichchukorn T, Laungchuaychok P, Kurathong S, Pongsittisak W. Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial. Int J Nephrol Renovasc Dis 2023; 16:93-101. [PMID: 37013086 PMCID: PMC10066630 DOI: 10.2147/ijnrd.s400639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Background Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance. Methods This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle. Results A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group. Conclusion The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.
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Affiliation(s)
- Solos Jaturapisanukul
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
| | - Chutima Chavanisakun
- Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nontawat Benjakul
- Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Tanun Ngamvichchukorn
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Punnawit Laungchuaychok
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sathit Kurathong
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
| | - Wanjak Pongsittisak
- Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand
- Correspondence: Wanjak Pongsittisak, Tel +66818345228, Email
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Oliveira MC, Silva ACFED, Almeida TD, Lucena ADF. Indicadores clínicos da Nursing Outcomes Classification para avaliar o paciente submetido à biópsia renal percutânea. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.40292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Objetivos: selecionar indicadores clínicos dos resultados de Enfermagem Coagulação Sanguínea (0409), Estado Circulatório (0401), Gravidade da perda de Sangue (0413), Nível de dor (2102) e Estado de Conforto: físico (2010) da Nursing Outcomes Classification e elaborar suas definições conceituais e operacionais para avaliação de pacientes submetidos à biópsia renal percutânea. Método: estudo de consenso de especialistas realizado em um hospital universitário do Sul do Brasil. A amostra foi de 12 especialistas. A coleta de dados ocorreu por meio de formulário eletrônico no Google Forms, no qual foram listados os indicadores clínicos a serem selecionados para avaliar pacientes submetidos ao procedimento de biópsia renal. Foram selecionados os indicadores que obtiveram concordância mínima de 80% entre os especialistas. Os dados foram organizados em um quadro para a elaboração das definições de cada indicador. Resultados: foram selecionados 11 indicadores clínicos: sangramento, hematoma, hematúria, pressão arterial sistólica, pressão arterial diastólica, distensão abdominal, palidez da pele e das mucosas, dor relatada, expressões faciais de dor, bem-estar físico e posição confortável. Posteriormente, com base na literatura, foram elaboradas as definições conceituais e operacionais para esses indicadores. Conclusão: os indicadores clínicos selecionados estão em consonância com as possíveis complicações da biópsia renal percutânea descritas na literatura, podendo auxiliar os enfermeiros na avaliação dos pacientes submetidos ao procedimento. Infere-se que as definições conceituais e operacionais reduzem a subjetividade e facilitam avaliações mais acuradas dos pacientes na prática clínica.
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Kolonko A, Dwulit T, Skrzypek M, Więcek A. Potential Utility of Neutrophil-to-Lymphocyte, Platelet-to-Lymphocyte, and Neutrophil, Lymphocyte, and Platelet Ratios in Differential Diagnosis of Kidney Transplant Acute Rejection: A Retrospective, Propensity Score Matched Analysis. Ann Transplant 2022; 27:e937239. [PMID: 36536590 PMCID: PMC9789674 DOI: 10.12659/aot.937239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute kidney transplant rejection can negatively affect long-term graft function. The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio have been proposed as non-invasive predictors of acute rejection in stable kidney transplant recipients. The aim of this study was to validate the predictive value of these ratios, as well as neutrophil, lymphocyte, and platelet ratios in the diagnosis of acute rejection during the early post-transplant period. MATERIAL AND METHODS After propensity score matching, we compared 71 kidney recipients with biopsy-proven acute rejection with 71 patients without rejection and also subjects with different histologic types of rejection. All 3 types of blood cell count-derived ratios were calculated 6 and 3 days prior to biopsy and on the day of biopsy. RESULTS There were 15 patients with T cell-mediated rejection, 33 with vascular rejection, and 23 with antibody-mediated rejection. The values of all examined ratios did not differ between subgroups with and without rejection. However, at all post-transplant study time-points, patients with antibody-mediated rejection had significantly higher values of all analyzed ratios than subjects with other types of rejection. In multivariate regression models, higher values of blood cell count-derived ratios were independently associated with the occurrence of antibody-mediated rejection. CONCLUSIONS In the early post-transplant period, the values of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and neutrophil, lymphocyte, and platelet ratios were similar in patients with and without an acute rejection episode, but significantly higher values were found in subjects with antibody-mediated rejection as compared with other types of rejection and those without rejection. High values of analyzed ratios in patients with satisfactory early kidney graft function may be helpful in selecting subjects with increased risk of subclinical antibody-mediated rejection.
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Affiliation(s)
- Aureliusz Kolonko
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Tomasz Dwulit
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, Bytom, Poland
| | - Andrzej Więcek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
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Mattiazzi AD, Cortesi CA, Patil RJ, Carias Martinez KG, Sedki M, Cabeza Rivera FH, Ruiz P, Salsamendi JT, Guerra G. Percutaneous Ultrasound-Guided Kidney Transplant Biopsy Outcomes: From the Nephrologist to the Radiologist Standpoint. KIDNEY360 2022; 3:1746-1753. [PMID: 36514719 PMCID: PMC9717654 DOI: 10.34067/kid.0000332022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 01/28/2023]
Abstract
Background Kidney transplant biopsies are the gold standard for evaluating allograft dysfunction. These biopsies are performed by nephrologists and radiologists under real-time ultrasound guidance. A few studies have examined the outcomes of ultrasound-guided kidney transplant biopsy in transplant recipients; however, none have compared these outcomes between both specialties. Methods We retrospectively analyzed a cohort of 678 biopsies performed in a single center during a 44-month study period. Biopsies were stratified into two groups based upon the specialist performing the procedure: interventional radiology (IR; N=447) and transplant nephrology (TN; N=231). Results There were 55 (8%) complications related to biopsies in the entire cohort: 37 (8.2%) in the IR group and 18 (7.7%) in the TN group, without statistical difference between the groups (P=0.94). Blood pressure control and prior use of anticoagulation were significant predictors of complicated biopsies (P=0.004 and 0.02, respectively). Being a woman and prior use of anticoagulation were significant predictors of transfusion of blood products (P=0.01 and 0.01, respectively). Being a woman and blood pressure control were significant predictors of overall perinephric hematoma (P=0.01 and 0.01, respectively), and Black race was a significant predictor of perinephric hematoma without worsening of renal function (P=0.005). The specialist team performing the procedure was not a statistically significant predictor of biopsy complications, transfusion of blood products, or perinephric hematoma with comparable sample yield. Conclusions Percutaneous ultrasound-guided kidney transplant biopsy performed by transplant nephrologists have similar complication rates when compared with interventional radiologists in an academic center.
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Affiliation(s)
- Adela D. Mattiazzi
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
| | - Camilo A. Cortesi
- Department of Medicine, Division of Nephrology, University of California, San Francisco, California
| | - Rhea J. Patil
- School of Medicine, University of Miami, Miami, Florida
| | - Karla G. Carias Martinez
- Department of Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Mai Sedki
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Franco H. Cabeza Rivera
- Department of Medicine, Division of Nephrology, University of Mississippi, Oxford, Mississippi
| | - Phillip Ruiz
- Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida,Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jason T. Salsamendi
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida
| | - Giselle Guerra
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, Florida,Miami Transplant Institute, University of Miami/Jackson Memorial Hospital, Miami, Florida
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Lawrence EM, Lubner MG, Pickhardt PJ, Hartung MP. Ultrasound-guided biopsy of challenging abdominopelvic targets. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2567-2583. [PMID: 34322727 DOI: 10.1007/s00261-021-03223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/18/2023]
Abstract
Percutaneous ultrasound-guided biopsies have become the standard of practice for tissue diagnosis in the abdomen and pelvis for many sites including liver, kidney, abdominal wall, and peripheral nodal stations. Additional targets may appear difficult or impossible to safely biopsy by ultrasound due to interposed bowel loops/vasculature, deep positioning, association with the bowel, or concern for poor visibility; however, by optimizing technique, it is often possible to safely and efficiently use real-time ultrasound guidance for sampling targets that normally would be considered only appropriate for CT guided or surgical/endoscopic biopsy.
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Affiliation(s)
- Edward M Lawrence
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792, USA.
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Trinh K, Bency R, Kairaitis L. Native renal biopsy: outcomes with a 4‐h observation period in low‐risk outpatients. Intern Med J 2022; 52:130-133. [DOI: 10.1111/imj.15645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Katie Trinh
- Western Renal Service Sydney New South Wales Australia
| | - Rosamma Bency
- Western Renal Service Sydney New South Wales Australia
- Tamworth Base Hospital Sydney New South Wales Australia
| | - Lukas Kairaitis
- Western Renal Service Sydney New South Wales Australia
- School of Medicine Western Sydney University Sydney New South Wales Australia
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10
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Liu W, Jin C, Lian Q, Xu L, Lin Z, Lu J, Gong X. Ultrasound-Guided Lauromacrogol Injection for the Treatment of Active Bleeding After Renal Biopsy. Front Pharmacol 2022; 12:723634. [PMID: 35002689 PMCID: PMC8733379 DOI: 10.3389/fphar.2021.723634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to describe the technique and outcomes of hemostasis for ultrasound-guided lauromacrogol injection for active bleeding after renal biopsy. Methods: Data from patients with active bleeding after renal biopsy between January 2018 and December 2020 were retrospectively collected. Patients who still had active bleeding after 30 min of compression were then injected with lauromacrogol under ultrasound guidance. The patient's symptoms before and after operation were collected to assess whether they had severe complications. Changes in hemoglobin and serum creatinine values were collected. Results: Data from a total of 15 patients with active bleeding after renal biopsy were collected, including data of 6 men and 9 women. After the operation, there were 11 cases of mild back pain; 1 case of chills, cold sweats, and back pain; 1 case of cold sweats and blood pressure reduction, and 2 cases with no obvious symptoms. No severe complications occurred in this study, and active bleeding was stopped in all patients. After the operation, compared with before the operation, there was no statistically significant difference in the hemoglobin value and serum creatinine value (p = 0.10 > 0.05, p = 0.78 > 0.05). Conclusion: Ultrasound-guided lauromacrogol injection is a relatively simple, safe and feasible method, which could be helpful in treating active bleeding in the immediate post-procedure period after renal biopsy.
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Affiliation(s)
- Weizong Liu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingshu Lian
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lifeng Xu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhanye Lin
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Abstract
The year 2021 was the last full year of Alberto Ortiz’s editorship at Clinical Kidney Journal (CKJ). On May 2022, Maria José Soler will start her term as the Editor-in-Chief. Over these years, CKJ obtained its first journal impact factor and has consolidated its position among the top journals in the field, consistently ranking among the top 25% (first quartile) journals in Urology and Nephrology. The 2020 journal impact factor rose to 4.45, becoming the top open access journal in Nephrology and the ninth ranked Nephrology journal overall. We now review the recent history of the journal and the most highly cited topics which include the epidemiology of kidney disease, chronic kidney disease topics, such as the assessment and treatment of chronic kidney disease, onconephrology, cardionephrology, glomerular disease, transplantation and coronavirus disease 2019 (COVID-19).
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Abstract
Rationale & Objective Although kidney biopsy is a useful tool, nephrologists' approach toward biopsies is inconsistent for reasons incompletely understood, including lack of established clinical guidelines. We examined contemporary clinical decision-making patterns among nephrologists to perform native kidney biopsy. Study Design Qualitative study using semistructured interviews. Setting & Participants Purposive sampling was used to select nephrologists from different regions in the United States. Semistructured interviews were continued until thematic saturation. Analytical Approach A modified grounded theory was used to identify dominant themes reflecting the nephrologists' decision-making styles about kidney biopsy. Results Twenty nephrologists were interviewed: 16 (80%) were from academic centers, 3 (15%) performed their own biopsies, and 7 (35%) had been in practice for less than 10 years. The median time of practice was 14 years. We found substantial variability among the nephrologists in their attitude toward using kidney biopsy, which reflected individual differences in weighing the risks and benefits of the procedure for an individual patient. Five overarching themes were identified: operator comfort with biopsy and availability of interventional radiologist, exposure to biopsy during training and years of experience, concerns about the invasiveness of biopsy and inflicting harm, perception of evidence base and limited treatment options, and patient characteristics and preference. Limitations Generalizability was limited because the nephrologists sampled may not have been broadly representative. Conclusions Multiple factors influence nephrologists' decision to pursue kidney biopsy, with substantial variability among nephrologists that can have meaningful clinical implications. This suggests the need to establish consensus guidelines to make biopsy practice more standardized.
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Quencer KB, Anand K. Kidney Tissue Biopsy. Tech Vasc Interv Radiol 2021; 24:100775. [PMID: 34895708 DOI: 10.1016/j.tvir.2021.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Kidney tissue biopsy is a commonly performed procedure which is valuable in the work-up for patients with medical renal disease and renal transplant. This article will review indications, contraindications, technique and potential complications of kidney biopsy.
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Affiliation(s)
- Keith B Quencer
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT.
| | - Keshav Anand
- Division of Interventional Radiology, University of Utah Department of Radiology, Salt Lake City, UT
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14
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Halimi JM. Complications after native kidney biopsy: definitive data. Curr Opin Nephrol Hypertens 2021; 30:555-558. [PMID: 34412087 DOI: 10.1097/mnh.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To assess the risk of complications associated with native kidney biopsies. This review will highlight recent advances on the risk factors for major bleeding and risk management in patients with native kidney biopsy. RECENT FINDINGS Recent studies provided new important data regarding the individualization of the risk of bleeding after kidney biopsy. A new bleeding risk score was proposed as a risk stratification tool, useful for shared decision making and procedure choice. SUMMARY The risk of complications is low (<1%) in most patients but varies widely. Risk factors include Charlson index, frailty index, female gender, dyslipidemia, anemia, thrombocytopenia, cancer, abnormal kidney function, glomerular disease, autoimmune disease, vasculitis, hematologic disease, and thrombotic microangiopathy. A new bleeding score can help physicians and patients to assess the risk of bleeding enabling informed consent, and decide to perform it or not, and to prefer transjugular vs percutaneous route.
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Affiliation(s)
- Jean-Michel Halimi
- Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, CHU Tours
- EA4245, University of Tours, Tours
- INI-CRCT, Vandœuvre-lès-Nancy, France
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15
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Asad RA, Valson AT, Kavitha V, Korula A, Eapen A, Rebekah G, Jacob S, Pathak H, Alexander S, Mohapatra A, David VG, Varughese S, Tamilarasi V, Basu G. Safety and utility of kidney biopsy in patients with estimated glomerular filtration rate < 30 ml/min/1.73 m 2. Nephrology (Carlton) 2021; 26:659-668. [PMID: 33779021 PMCID: PMC7615903 DOI: 10.1111/nep.13879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/20/2021] [Accepted: 03/20/2021] [Indexed: 01/28/2023]
Abstract
AIM Kidney biopsy (KBx) is the gold standard for evaluation of kidney disease, but is associated with a higher risk of complications in patients with reduced glomerular filtration rate (GFR). We studied the safety and utility of KBx in patients with eGFR <30 ml/min/1.73 m2 . METHODS Consecutive adult patients with eGFR <30 ml/min/1.73 m2 , who were planned for a KBx and consented to participate were prospectively enrolled. Patients with solitary/transplant kidney or acute kidney injury were excluded. Haemoglobin was checked on the day of KBx and repeated 18-24 h later along with a screening ultrasound. Post-KBx complications were noted and their risk-factors analysed. The utility of the KBx was graded as effecting significant, some, or no change to subsequent management. RESULTS Of the 126 patients included, 75% were male, 27.7% were diabetic, and the median eGFR was 13.5 ml/min/1.73m2 . Major complications occurred in 5.6%. Peri-renal haematomas were detected in 37.3%, and haematomas ≥2 cm were significantly more frequent in those with eGFR <15 ml/min/1.73 m2 (29.2% vs. 13%, p = .032). Dialysis was a risk factor, while pre KBx blood transfusion, diabetes and higher serum albumin were protective against any complication. KBx was more likely to make a significant difference in management in those with eGFR 15-29 ml/min/1.73m2 (44.1% vs. 11.1%, p < .001). Increasing age, lower serum creatinine and albumin were independently associated with KBx utility. CONCLUSION KBx is relatively safe in severe kidney disease but its risk to benefit balance needs to be carefully considered when eGFR is <15 ml/min/1.73m2 .
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Affiliation(s)
| | - Anna T. Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijayakumar Kavitha
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
- Metropolis Healthcare Ltd., Chennai, Tamil Nadu, India
| | - Anila Korula
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
- Department of Pathology, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Harish Pathak
- Nephrology, Nanavati Super Specialty Hospital, Mumbai, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Veerasamy Tamilarasi
- Institute of Kidney Disease, Medica Super Specialty Hospital, Kolkata, West Bengal, India
| | - Gopal Basu
- Renal Medicine, The Alfred Hospital, MONASH University (Central Clinical School), Melbourne, Victoria, Australia
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16
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Bonani M, Seeger H, Weber N, Lorenzen JM, Wüthrich RP, Kistler AD. Safety of Kidney Biopsy when Performed as an Outpatient Procedure. Kidney Blood Press Res 2021; 46:310-322. [PMID: 34077930 DOI: 10.1159/000515439] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/21/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Kidney biopsy remains the gold standard for the diagnosis of most renal diseases. A major obstacle to performing a biopsy is safety concerns. However, many safety measures are not evidence based and therefore vary widely between centers. We sought to determine the rate and timing of kidney biopsy complications in our center, to compare the complication rate between native and transplant kidney biopsies, to evaluate the feasibility of performing kidney biopsies as an outpatient procedure and the value of a postbiopsy ultrasound before discharge, and to identify risk factors for complications. METHODS We performed a single-center, retrospective, observational study at the Division of Nephrology of the University Hospital Zurich including all patients who underwent renal biopsy between January 2005 and December 2017. Major bleeding (primary outcome) and any other bleeding or nonbleeding complications (secondary outcomes) were compared between native and transplant kidney biopsies and between inpatient and outpatient procedures and correlated with clinical factors possibly affecting bleeding risk. RESULTS Overall, 2,239 biopsies were performed in 1,468 patients, 732 as inpatient and 1,507 as outpatient procedures. Major bleeding was observed in 28 (3.8%) inpatient and in 15 (1.0%) outpatient procedures, totaling to 43 (1.9%) of all biopsies. Major bleeding requiring intervention amounted to 1.0% (0.5% of outpatient procedures). Rate of major bleeding was similar between native and transplant kidneys. 13/15 (87%) bleeding episodes in planned outpatient procedures were detected during the 4-h surveillance period. Risk factors for bleeding were aspirin use, low eGFR, anemia, cirrhosis, and amyloidosis. Routine postbiopsy ultrasound did not change management. CONCLUSIONS Kidney biopsy is an overall safe procedure and can be performed as an outpatient procedure in most patients with an observation period as short as 4 h. The value of routine postbiopsy ultrasound is questionable.
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Affiliation(s)
- Marco Bonani
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Harald Seeger
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Nina Weber
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Johan M Lorenzen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Rudolf P Wüthrich
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas D Kistler
- Division of Nephrology, Department of Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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18
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Doughem K, Battisha A, Sheikh O, Konduru L, Madoukh B, Al-Sadawi M, Shaikh S. Hydralazine-Induced ANCA Associated Vasculitis (AAV) Presenting with Pulmonary-Renal Syndrome (PRS): A Case Report with Literature Review. Curr Cardiol Rev 2021; 17:182-187. [PMID: 32418528 PMCID: PMC8226194 DOI: 10.2174/1573403x16666200518092814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 01/26/2023] Open
Abstract
Hydralazine, an arterial vasodilator, is a widely used medication for the management of hypertension and heart failure, especially for patients who cannot tolerate the use of ACEIs or ARBs. It is generally well-tolerated and has a safe profile in pregnancy. However, hydralazine can induce immune-mediated side effects, such as hydralazine-induced lupus and less commonly hydralazine- induced ANCA vasculitis. The latter most commonly affects the kidneys with or without other organ involvement. There are several cases reported in the literature of hydralazine-induced ANCA associated vasculitis (AAV) that have pulmonary manifestations, also known as hydralazine- induced pulmonary-renal syndrome (PRS), a condition with a high risk of mortality. We are reporting a case of Hydralazine-induced ANCA associated glomerulonephritis with severe diffuse alveolar hemorrhage (DAH). In addition, we will review the current literature and discuss the importance of prompt diagnosis and early management to decrease mortality and morbidity associated with this serious condition.
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Affiliation(s)
- Karim Doughem
- Address correspondence to this author at University of Texas Health Science Center at Houston, Houston, TX 77030, United States; E-mail:
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Kajawo S, Ekrikpo U, Moloi MW, Noubiap JJ, Osman MA, Okpechi-Samuel US, Kengne AP, Bello AK, Okpechi IG. A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries. Kidney Int Rep 2020; 6:78-90. [PMID: 33426387 PMCID: PMC7783578 DOI: 10.1016/j.ekir.2020.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/22/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Kidney biopsy is an important tool for making diagnoses and for assessing the drug treatment requirements and disease prognosis in the management of kidney diseases. There are variations in the rate of complications associated with kidney biopsies across countries, and this depends on various clinical and technical factors. The aim of this study is to report on complications associated with kidney biopsy performed in low- and middle-income countries. Methods Two reviewers searched studies in MEDLINE, Embase, Cochrane Reviews, and African Journals Online. A random effects meta-analysis method was used to pool estimates of complications. Results We identified 39 studies reporting on 19,500 kidney biopsies with overall complications (major + minor) rate of 14.9% (95% confidence interval = 11.4%–18.7%). Fewer complications were reported in biopsies performed with real-time ultrasound scans compared to those pre-marked using ultrasound or blind procedures (12.4% vs. 14.9% vs. 24.5%; P = 0.037), respectively. Complications, albeit lower for procedures performed with automated needles (13.3%), were not significantly different from those performed with nonautomated needles (17.3%; P = 0.588). Major complications included macroscopic hematuria (1.48%), nephrectomy (0.04%), blood loss requiring red cell transfusion (0.24%), angiographic intervention (0.22%), and death (0.01%). Conclusion Complications associated with kidney biopsy in low- and middle-income countries are low, are comparable to those in other settings, and occur more sparingly when real-time ultrasound techniques or automated kidney biopsy needles are used. This suggests the need to expand the use of this procedure to improve diagnosis of kidney pathologies and choice of therapy when indicated.
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Affiliation(s)
- Shepherd Kajawo
- Department of Medicine, National University of Science and Technology, Bulawayo, Zimbabwe.,Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Renal Unit, Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Mothusi Walter Moloi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Mohamed A Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andre Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa.,Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa.,Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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20
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Liang D, Zhang H, Yang M, Ji H, Chen G, Yu N, Zhang X. Massive hemorrhage after percutaneous kidney biopsy caused by renal artery malformation: a case report and literature review. BMC Surg 2020; 20:256. [PMID: 33121464 PMCID: PMC7597045 DOI: 10.1186/s12893-020-00918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Accessory renal artery (ARA) is the most common site for anatomical variation of renal supply artery. Rare studies reported interventional embolization for the management of massive hemorrhage caused by ARA injury after percutaneous kidney biopsy (PKB). Case presentation We describe a 35-year-old man who developed massive hemorrhage after PKB leading to shock. Digital subtraction angiography (DSA) showed hemorrhage in the ARA at the inferior pole of the right kidney and hemostasis was noticed after renal artery embolization. Conclusions We proposed that much attention should be paid to the presence of ARA before PKB. In addition, digital subtraction angiography combined with superselective embolization is the best choice for the treatment of renal artery injury.
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Affiliation(s)
- Dong Liang
- Department of Nephrology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shangdong, P.R. China
| | - Hui Zhang
- Department of Nephrology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shangdong, P.R. China
| | - Min Yang
- Department of Nephrology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shangdong, P.R. China
| | - Hong Ji
- Department of Pathology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shandong, P.R. China
| | - Gang Chen
- Department of Vascular Intervention, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shandong, P.R. China
| | - Ning Yu
- Department of Pathology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shandong, P.R. China
| | - Xiaomin Zhang
- Department of Nephrology, Binzhou Medical University Hospital, No. 661 Huanghe Second Road, Binzhou, 256603, Shangdong, P.R. China.
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21
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Halimi JM, Gatault P, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Grammatico-Guillon L, Fauchier L. Major Bleeding and Risk of Death after Percutaneous Native Kidney Biopsies: A French Nationwide Cohort Study. Clin J Am Soc Nephrol 2020; 15:1587-1594. [PMID: 33060158 PMCID: PMC7646233 DOI: 10.2215/cjn.14721219] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The risk of major bleeding after percutaneous native kidney biopsy is usually considered low but remains poorly predictable. The aim of the study was to assess the risk of major bleeding and to build a preprocedure bleeding risk score. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our study was a retrospective cohort study in all 52,138 patients who had a percutaneous native kidney biopsy in France in the 2010-2018 period. Measurements included major bleeding (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, or nephrectomy) at day 8 after biopsy and risk of death at day 30. Exposures and outcomes were defined by diagnosis codes. RESULTS Major bleeding occurred in 2765 of 52,138 (5%) patients (blood transfusions: 5%; angiographic intervention: 0.4%; and nephrectomy: 0.1%). Nineteen diagnoses were associated with major bleeding. A bleeding risk score was calculated (Charlson index [2-4: +1; 5 and 6: +2; >6: +3]; frailty index [1.5-4.4: +1; 4.5-9.5: +2; >9.5: +3]; women: +1; dyslipidemia: -1; obesity: -1; anemia: +8; thrombocytopenia: +2; cancer: +2; abnormal kidney function: +4; glomerular disease: -1; vascular kidney disease: -1; diabetic kidney disease: -1; autoimmune disease: +2; vasculitis: +5; hematologic disease: +2; thrombotic microangiopathy: +4; amyloidosis: -2; other kidney diagnosis: -1) + a constant of 5. The risk of bleeding went from 0.4% (lowest score group =0-4 points) to 33% (highest score group ≥35 points). Major bleeding was an independent risk of death (500 of 52,138 deaths: bleeding: 81 of 2765 [3%]; no bleeding: 419 of 49,373 [0.9%]; odds ratio, 1.95; 95% confidence interval, 1.50 to 2.54; P<0.001). CONCLUSIONS The risk of major bleeding after percutaneous native kidney biopsy may be higher than generally thought and is associated with a twofold higher risk of death. It varies widely but can be estimated with a score useful for shared decision making and procedure choice.
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Affiliation(s)
- Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France .,Equipe d'Accueil 4245, University of Tours, Tours, France.,Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, Vandœuvre-lès-Nancy, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Equipe d'Accueil 4245, University of Tours, Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Investigation Network Initiative - Cardiovascular and Renal Clinical Trialists, Vandœuvre-lès-Nancy, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France.,Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, Centre Hospitalier Universitaire Tours, Tours, France.,Equipe d'Accueil 4245, University of Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Service d'information médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, Equipe d'Accueil 7505, University of Tours, Tours, France
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Helvacı Ö, Korucu B, Gonul Iİ, Arınsoy T, Guz G, Derici U. Kidney biopsy in the elderly: diagnostic adequacy and yield. Int Urol Nephrol 2020; 53:105-109. [PMID: 32940813 DOI: 10.1007/s11255-020-02640-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The number of kidney biopsies (KB) performed in elderly patients has been increasing. Safety and usefulness of elderly KB have been well established, whereas much less is known about diagnostic adequacy and yield in this patient population. METHODS We performed a retrospective study of KBs in 428 patients from April 2015 to December 2017 at an academic institution. We compared KB from 50 patients aged over 64 (elderly) with KB from 378 patients aged between 18 and 64. RESULTS Gender ratio, body mass index, systolic and diastolic BP, creatinine values, incidences of AKI at the time of biopsy, INR/aptt values, and platelets were similar between the two groups. eGFR and number of transplant biopsies were lower in the elderly biopsy group. The glomerular yield was similar between the two groups (22 ± 14 vs. 22 ± 13, p = 0.869). The likelihood of obtaining more than ten glomeruli was 87% and 88%, respectively, without a significant difference. Inadequate samples were encountered in 6% of the elderly and 5.6% of the non-elderly KB, again without a significant difference. Samples taken by nephrologist had higher glomerular yield for both groups (25 ± 13 vs. 18 ± 12 overall, 26 ± 14 vs. 18 ± 14 for elderly, p < 0.001 both). Inadequate biopsies were lower in the nephrologist group when all patients were considered (3% vs. 9%, p = 0.025). Results were numerically similar for the elderly patients, but the difference was not statistically significant (2% vs. 8%, p = 0.322). No deaths occurred in both arms. Minor complications were not different for each group (4.5% vs. 4%). There were no major complications in elderly patients. However, the difference did not reach statistical significance. CONCLUSION The world is aging, leading to an increased number of KB in older patients. KB in the elderly is a safe, effective, and an indispensable tool for the nephrologist. This study suggests there is no need to fear lower diagnostic adequacy in the decision making of a KB for an elderly patient.
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Affiliation(s)
- Özant Helvacı
- Department of Nephrology, Yıldırım Beyazıt University Yenimahalle Training and Research Hospital, Ankara, Turkey.
| | - Berfu Korucu
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ipek İsik Gonul
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Turgay Arınsoy
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Galip Guz
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ulver Derici
- Department of Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
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23
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Nance ME, Tarim AO, Nguyen V, Malhotra K, Davis RM, Bhat AP. Risk Factors for Major Hemorrhage Following Percutaneous Image-Guided Renal Biopsy: What is the "core" of the Problem? A Retrospective Case-control Study. J Clin Imaging Sci 2020; 10:54. [PMID: 33024609 PMCID: PMC7533095 DOI: 10.25259/jcis_87_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: Percutaneous renal biopsy (PRB) plays a critical role in the work-up of renal parenchymal disease. Although it is considered a low-risk procedure, additional interventions may be required in about 7% of the cases following biopsy. The purpose of this study was to identify risk factors for major hemorrhage by microscopic analysis of the cores obtained following PRB, with an intent to enhance the sensitivity and specificity of the risk stratification process, especially in patients undergoing this procedure in an outpatient setting. Material and Methods: A retrospective review identified 17 of 179 patients (9.50%) with major hemorrhage following PRB between July 2014 and June 2019. Using propensity score matching, 26 controls (without major hemorrhage) were matched to 17 cases (with major hemorrhage). The biopsy cores obtained from the cases and controls were analyzed by a single pathologist for medullary, cortical, total (medullary + cortical) lengths, and the number of arcuate arteries (AAs). Medullary:cortical (M:C), cortical:total (C:T), and medullary:total (M:T) length ratios were then calculated. Results: A stratified version of logistic regression was used to test for an association between each of the variables identified on the cores and the probability of a major hemorrhage. The analysis revealed that there was a statistically significant association between the number of AAs per specimen with the risk of major hemorrhage (P = 0.0006). When 0, 1, or >2 AAs were identified, the frequency of major hemorrhage was 13.04%, 66.67%, and 75.00%, respectively. The odds of major hemorrhage were 6 times higher with one AA and (95% CI, 1.28–32.30) and 15 times higher with >2 AAs (95% CI, 1.41–169.57). No significant association was found between medullary length (P = 0.228), medulla:cortex (M:C) (P = 0.089), medulla:total (M:T) (P = 0.108), or cortex:total (C:T) (P = 0.112) length ratios and major hemorrhage. Conclusion: There was a strong and incremental correlation between major renal hemorrhage following PRB and the number of AAs per core specimen. Identification of AAs by the pathologist, while assessing for sample adequacy, in the US suite can help predict major hemorrhage in patients undergoing PRBs.
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Affiliation(s)
- Michael E Nance
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Andrew O Tarim
- Departments of Radiology, University of Missouri, Columbia, Missouri, United States
| | - Van Nguyen
- Departments of Pathology, University of Missouri, Columbia, Missouri, United States
| | - Kunal Malhotra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, Missouri, United States
| | - Ryan M Davis
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri, Columbia, Missouri, United States
| | - Ambarish P Bhat
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Missouri, Columbia, Missouri, United States
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Gagnon MH, Lin MF, Lancia S, Salter A, Yano M. A Color Flow Tract in Ultrasound-Guided Random Renal Core Biopsy Predicts Complications. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1335-1342. [PMID: 31995242 DOI: 10.1002/jum.15227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To determine patient and procedural risk factors for major complications in ultrasound (US)-guided random renal core biopsy. METHODS Random renal biopsies performed by radiologists in the US department at a single institution between 2014 and 2018 were retrospectively reviewed. The patient's age, sex, race, and estimated glomerular filtration rate (eGFR) were recorded. The biopsy approach, needle gauge, length of cores, number of throws, and presence of a color flow tract were recorded. Outcome data included minor and major complications. Associations between variables were tested with χ2 analyses and univariable/multivariable logistic regression models. RESULTS A total of 231 biopsies (167 native and 64 allografts) were reviewed. There was no significant difference in the sex, age, race, or eGFR between native and allograft groups. The overall rate for any complication was 18.2%, with a 4.3% rate of major complications, which was significantly greater in native compared to allograft biopsies (6% versus 0%; P = .045). A risk analysis in native biopsies only showed that major complications were significantly associated with a low eGFR such that patients with stage 4 or 5 kidney disease had higher odds of complications (odds ratio [95% confidence interval]: stage 4, 9.405 [1.995-44.338]; P = .0393; stage 5, 10.749 [2.218-52.080]; P = .0203) than patients with normal function (eGFR >60 mL/min). The presence of a color flow tract portended a 10.7 times greater risk of having any complication (95% confidence interval, 4.595-24.994; P < .001). Other procedural factors were not significantly associated with complications. CONCLUSIONS There is an increased risk of major complications in US-guided random native kidney biopsy in patients with a low eGFR (<30 mL/min) and a patent color flow tract in the immediate postbiopsy setting.
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Affiliation(s)
| | | | - Samantha Lancia
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Amber Salter
- Department of Biostatistics, Washington University School of Medicine, St Louis, Missouri, USA
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Schorr M, Roshanov PS, Weir MA, House AA. Frequency, Timing, and Prediction of Major Bleeding Complications From Percutaneous Renal Biopsy. Can J Kidney Health Dis 2020; 7:2054358120923527. [PMID: 32547772 PMCID: PMC7251654 DOI: 10.1177/2054358120923527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/27/2020] [Indexed: 12/22/2022] Open
Abstract
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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Affiliation(s)
- Melissa Schorr
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,London Health Sciences Centre, Victoria Hospital, London, Ontario, Canada
| | - Pavel S Roshanov
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
| | - Matthew A Weir
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew A House
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
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Abstract
Vasculitis is characterized by inflammation of the vascular wall. It reaches vessels of different sizes and locations, conditioning multisystem and complex manifestations that require a holistic approach. Antineutrophil cytoplasmic antibody-associated vasculitis has an annual incidence rate of 20 per million inhabitants. It is the result of the interaction of infectious, genetic and environmental factors and manifest itself with varied and unspecific symptoms, often reaching the general state, respiratory and renal systems. The combination of clinical, laboratory, imaging and fundamentally histological changes allows the diagnosis and classification of the extent / severity of the disease necessary for the decision of the therapeutics to be taken. Glucocorticoids are generally used; with methotrexate being considered when localized disease and cyclophosphamide, rituximab or azathioprine when generalized disease. A systematized approach can increase survival rates from 12% to 70% over a 5-year span.
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Affiliation(s)
- Fernando Salvador
- Autoimmune Diseases Unit, Internal Medicine Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, 5000-508 Vila Real, Portugal; NEDAI/SPMI Autoimmune Diseases Group/Portuguese Society of Internal Medicine, Portugal.
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A nationwide survey on clinical practice patterns and bleeding complications of percutaneous native kidney biopsy in Japan. Clin Exp Nephrol 2020; 24:389-401. [PMID: 32189101 PMCID: PMC7174253 DOI: 10.1007/s10157-020-01869-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/01/2020] [Indexed: 12/29/2022]
Abstract
Background Practice patterns and bleeding complications of percutaneous native kidney biopsy (PNKB) have not recently been investigated and the Japanese Society of Nephrology performed a nationwide questionnaire survey in 2018. Methods The survey consisted of nine sections about PNKB: (1) general indications; (2) indications for high-risk patients; (3) informed consent; (4) pre-biopsy evaluation; (5) procedures; (6) sedation; (7) post-biopsy hemostasis, bed rest, and examinations; (8) bleeding complications; and (9) specimen processing. A supplementary survey examined bleeding requiring transcatheter arterial embolization (TAE). Results Overall, 220 directors of facilities (nephrology facility [NF], 168; pediatric nephrology facility [PF], 52) completed the survey. Indications, procedures, and monitoring protocols varied across facilities. Median lengths of hospital stay were 5 days in NFs and 6 days in PFs. Gauge 14, 16, 18 needles were used in 5%, 56%, 33% in NFs and 0%, 63%, 64% in PFs. Mean limits of needle passes were 5 in NFs and 4 in PFs. The bed rest period was 16–24 h in 60% of NFs and 65% of PFs. Based on 17,342 PNKBs, incidence rates of macroscopic hematuria, erythrocyte transfusion, and TAE were 3.1% (NF, 2.8%; PF, 6.2%), 0.7% (NF, 0.8%; PF, 0%), and 0.2% (NF, 0.2%; PF, 0.06%), respectively. Forty-six percent of facilities processed specimens all for light microscopy, immunofluorescence, and electron microscopy, and 21% processed for light microscopy only. Timing of bleeding requiring TAE varied among PNKB cases. Conclusion Wide variations in practice patterns of PNKB existed among facilities, while PNKBs were performed as safely as previously reported. Electronic supplementary material The online version of this article (10.1007/s10157-020-01869-w) contains supplementary material, which is available to authorized users.
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Pombas B, Rodríguez E, Sánchez J, Radosevic A, Gimeno J, Busto M, Barrios C, Sans L, Pascual J, Soler MJ. Risk Factors Associated with Major Complications after Ultrasound-Guided Percutaneous Renal Biopsy of Native Kidneys. Kidney Blood Press Res 2019; 45:122-130. [PMID: 31822004 DOI: 10.1159/000504544] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Percutaneous renal biopsy (PRB) of native kidneys is an important tool for diagnosis and management of renal disease. In this study, we analyzed the success, safety, and risk complications of PRB in our center. METHODS A retrospective review of ultrasound-guided PRB done at our institution from January 1998 to December 2017 was performed. Clinical and laboratory data were collected for 661 PRBs. Statistical analysis was performed using the Mann-Whitney U test for continuous variable and chi-square test for categorical variables. Multivariate analysis using logistic regression was performed to assess factors associated with increased risk of complications after PRB. RESULTS The median age was 56 (42-68) years old, the majority were male (64%) and white (82%). Ten glomeruli were present in 63.5% of PRBs. Overall, the rate of complications was 16.6%, where 15.1% of them were minor complications and 1.5% were major complications. Perinephritic hematoma accounted for the minor complication that occurred most frequently, whereas the need of a blood transfusion was the prevalent for major complications. By multivariate analysis, increased activated partial thromboplastin time (aPTT; OR 1.11, 95% CI 1.035-1.180) and prebiopsy lower hemoglobin (Hgb; OR 1.61, 95% CI 1.086-2.304) were identified as independent risk factors for major complications. In addition, older patients (OR 1.057, 95% CI 1.001-1.117) were identified as an independent risk factor for blood transfusion requirement. CONCLUSION The current risk of complications after native PRB is low. Major complications are most common in case of increased aPTT and decreased Hgb baseline level.
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Affiliation(s)
- Beatriz Pombas
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eva Rodríguez
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan Sánchez
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Aleksandar Radosevic
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Javier Gimeno
- Department of Pathology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Marcos Busto
- Department of Radiology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Clara Barrios
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laia Sans
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - María José Soler
- Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain, .,Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain,
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Connor H, Connor A. Who made what? The Ross renal biopsy needle. JOURNAL OF MEDICAL BIOGRAPHY 2019; 27:244-245. [PMID: 30646818 DOI: 10.1177/0967772018818051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Wampler K, Bartenhagen L, Sayles H, Michael K. Lightly Embalmed Cadavers in Sonography Education: A Novel Approach to Improving Students’ Perceived Competence in Renal Biopsy Procedures. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319875451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if a simulation lab using lightly embalmed cadavers would improve diagnostic medical sonography (DMS) students’ perceived competence in ultrasound-guided native renal biopsy examinations. Methods: Subjects included DMS students (n = 49) enrolled in academic years 2012 to 2018. Each DMS student performed a native renal biopsy with a nephrology fellow. Skills practiced included machine setup, inferior renal pole localization, biopsy guide preparation, needle visualization, and communication skills. Pre- and postlab surveys assessed DMS students’ perceived competence. Results: Prelab, 12% (n = 6) of students felt competent to assist in the procedure. Postlab, 61% (n = 35) of students felt competent, a statistically significant ( P < .001) change. All students viewed the lab as a valuable experience. Hands-on experience (53%), student/physician collaboration (33%), and low-stress environment (13%) were reported themes. Additional resources (50%) and scheduling (22%) were areas for improvement. Conclusion: A renal biopsy simulation lab using lightly embalmed cadavers is an effective method to improve DMS students’ perceived competence in this procedure.
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Affiliation(s)
- Kathryn Wampler
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lisa Bartenhagen
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Harlan Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kimberly Michael
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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Prasad N, Shukla R, Behera M, Yachha M, Bhadauria D, Kaul A, Lal H, Gupta A. Comparison of yield and complications of craniocaudal versus caudocranial needle trajectory for kidney biopsy. J Vasc Access 2019; 21:73-78. [PMID: 31204556 DOI: 10.1177/1129729819854009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Percutaneous renal biopsy can result in serious complications. The study is aimed to compare the safety and yield between the two approaches of biopsy techniques: the conventional craniocaudal and the caudocranial trajectory of the biopsy needle under real-time ultrasound guidance. METHODS In this prospective observational study, a total of 80 serial kidney biopsies were performed, 40 with craniocaudal angulation and 40 with caudocranial angulation of the biopsy needle on the random allocation of 1:1 in each group. In the craniocaudal approach, the patient must hold the breath in deep inspiration to make a lower pole of the kidney approachable during unloading the biopsy gun, which was not required in caudocranial trajectory as the lower pole was approachable without holding the breath in deep inspiration. All kidney biopsies were performed percutaneously under real-time ultrasonogram guidance with a 16-cm-long, 16- or 18-gauge needles with a penetration depth of 22 mm and a sample notch of 18 mm. The yield and complications between the two groups were analyzed. RESULTS Both the groups were comparable in essential demographic characteristics. The study found that the caudocranial position of renal biopsy is equally suitable concerning tissue yield without any increase in the risk of complications and a smaller number of passes to obtain adequate tissue. CONCLUSION Caudocranial trajectory of the biopsy needle using a probe needle guide is as safe as the craniocaudal approach. Both approaches have similar yield and complications; however, the caudocranial approach provides ease to the patient during the procedure.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Shukla
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manas Behera
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Monika Yachha
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Heera Lal
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Bakdash K, Schramm KM, Annam A, Brown M, Kondo K, Lindquist JD. Complications of Percutaneous Renal Biopsy. Semin Intervent Radiol 2019; 36:97-103. [PMID: 31123379 DOI: 10.1055/s-0039-1688422] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Percutaneous renal biopsy is widely used for diagnosis, prognosis, and management of nephropathies. Complications may arise after renal biopsy, most commonly in the form of bleeding. Efforts should be taken to optimize modifiable risk factors such as hypertension, thrombocytopenia, and coagulopathy prior to the procedure. Unmodifiable risk factors such as poor renal function, gender, and underlying histologic diagnosis may be used to identify high-risk patients. Delayed presentation of bleeding complications is common, and close clinical follow-up is crucial.
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Affiliation(s)
- Kenaz Bakdash
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kristofer M Schramm
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Aparna Annam
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Matthew Brown
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Kimi Kondo
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
| | - Jonathan D Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Center, Aurora, Colorado
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Hayatghaibi SE, Ashton DJ, Orth RC. Pediatric percutaneous renal biopsies: comparison of complications between real-time ultrasound guidance and pre-procedure ultrasound-aided skin-marking techniques. Pediatr Radiol 2019; 49:626-631. [PMID: 30552437 DOI: 10.1007/s00247-018-4321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/16/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous renal biopsy is a commonly performed procedure that guides decision-making for children with renal disease. OBJECTIVE To compare complications from renal biopsies using real-time ultrasound (US) guidance versus pre-procedure US-aided skin-marking in children. MATERIALS AND METHODS We conducted a priori power analysis using a risk-adjusted model, which indicated we needed a sample size of 643-714 procedures (effect size: 0.8). Then we retrospectively identified consecutive patients who underwent a percutaneous renal biopsy from Jan. 1, 2012, to Dec. 31, 2016. We categorized complications according to the Society of Interventional Radiology (SIR) criteria and compared rates using the Fisher exact test. We analyzed complication predictors using multivariate regression. RESULTS The study consisted of 701 percutaneous renal biopsies in 553 patients: 313 used real-time US guidance and 388 used pre-procedure US-aided skin-marking. Among the 254/701 (36%) complications, 56/313 (18%) resulted from real-time US guidance and 198/388 (51%) from pre-procedure US-aided skin-marking (P<0.001). In the US real-time guidance group, 39/56 (70%) complications were SIR A, 8/56 (14%) SIR B, 6/56 (11%) SIR C and 3/56 (5%) SIR D. Among the pre-procedure US-aided skin-marking group, 139/198 (70%) complications were SIR A, 47/198 (24%) SIR B, 11/198 (6%) SIR C and 1/198 (1%) SIR D. Complications between the two groups were significantly different regarding SIR A (P<0.001) and SIR B complications (P<0.001) but not major complications. Multivariate regression demonstrated that complications were higher using US-aided pre-procedure skin-marking (odds ratio [OR]=6.30; 95% confidence interval [CI]=3.86, 10.27) than with US real-time guidance. CONCLUSION Children and young adults who underwent real-time US-guided percutaneous renal biopsies had significantly fewer minor complications, including those requiring follow-up medical care, compared to those who underwent percutaneous renal biopsies with pre-procedure US-aided skin-marking. No difference was detected in the incidence of major complications.
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Affiliation(s)
- Shireen E Hayatghaibi
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., #470, Houston, TX, 77030, USA.
| | - Daniel J Ashton
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., #470, Houston, TX, 77030, USA
| | - Robert C Orth
- Department of Radiology, Texas Children's Hospital, 6701 Fannin St., #470, Houston, TX, 77030, USA
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Non-Coding RNAs as New Therapeutic Targets in the Context of Renal Fibrosis. Int J Mol Sci 2019; 20:ijms20081977. [PMID: 31018516 PMCID: PMC6515288 DOI: 10.3390/ijms20081977] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 12/15/2022] Open
Abstract
Fibrosis, or tissue scarring, is defined as the excessive, persistent and destructive accumulation of extracellular matrix components in response to chronic tissue injury. Renal fibrosis represents the final stage of most chronic kidney diseases and contributes to the progressive and irreversible decline in kidney function. Limited therapeutic options are available and the molecular mechanisms governing the renal fibrosis process are complex and remain poorly understood. Recently, the role of non-coding RNAs, and in particular microRNAs (miRNAs), has been described in kidney fibrosis. Seminal studies have highlighted their potential importance as new therapeutic targets and innovative diagnostic and/or prognostic biomarkers. This review will summarize recent scientific advances and will discuss potential clinical applications as well as future research directions.
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Pantoja Peralta C, Badenes Gallardo A, García Vidal R, Rodríguez Espinosa N, Pañella Agustí F, Gómez Moya B. Our experience in emergency treatment of renal haemorrhage. Nefrologia 2019; 39:301-308. [PMID: 30808522 DOI: 10.1016/j.nefro.2018.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Renal haemorrhage is a potentially life-threatening event requiring emergency surgery. Endovascular therapy is currently the first-line treatment option. OBJECTIVES Review patients with renal haemorrhage who required emergency endovascular therapy at our center. Evaluate the causes of the bleeding, the treatment performed and the clinical outcomes. MATERIAL AND METHODS We performed a retrospective analysis of consecutive patients with renal bleeding who underwent endovascular therapy from June 2012 to June 2017 at Hospital Universitari Joan XXIII (Tarragona, Spain). Demographic data (age, gender and comorbidity) and other related variables were collected (mechanism of injury, haemodynamic stability and anticoagulant therapy). We also studied the CT angiography findings, time from diagnosis to surgery, endovascular technique and materials used, extent of tissue embolised and outcomes. RESULTS Twenty-two (22) patients were included with a mean age of 63 (range 19-85). The aetiology of injuries included: renal biopsy (n=7, 31.8%), bleeding from malignant kidney tumour (n=5, 22.7%), trauma (n=4, 18.2%), angiomyolipoma (n=2, 9.1%), spontaneous bleeding (n=2, 9.1%) and surgical complications (n=2, 9.1%). The endovascular therapy technique was embolisation in all cases. The following materials were used: spheres (9.1%); coils (63.6%); spheres + coils (18.2%); and spheres + plug (9.1%). In 17 cases (77.3%), selective embolisation was performed and in five cases (22.7%), embolisation of the whole kidney. Clinical and technical success rates of 100% were recorded. The 30-day mortality rate was 9.1%. CONCLUSION We believe that endovascular therapy is an effective modality for the management of renal bleeding which, in many cases, enables a large part of the renal tissue to be preserved.
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Affiliation(s)
- Cristina Pantoja Peralta
- Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, España.
| | | | - Raúl García Vidal
- Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, España
| | - Natalia Rodríguez Espinosa
- Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, España
| | - Francesc Pañella Agustí
- Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, España
| | - Benet Gómez Moya
- Servei d'Angiologia, Cirurgia Vascular i Endovascular, Hospital Universitari Joan XXIII, Tarragona, España
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Haochen W, Jian W, Li S, Tianshi L, Xiaoqiang T, Yinghua Z. Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience. J Int Med Res 2019; 47:1649-1659. [PMID: 30760109 PMCID: PMC6460605 DOI: 10.1177/0300060519828528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy. METHODS From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization. RESULTS Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization. CONCLUSIONS Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.
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Affiliation(s)
- Wang Haochen
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Wang Jian
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Song Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Lv Tianshi
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Tong Xiaoqiang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Zou Yinghua
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
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Li Q, Lin X, Zhang X, Samir AE, Arellano RS. Imaging-Related Risk Factors for Bleeding Complications of US-Guided Native Renal Biopsy: A Propensity Score Matching Analysis. J Vasc Interv Radiol 2018; 30:87-94. [PMID: 30527649 DOI: 10.1016/j.jvir.2018.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate imaging-related hemorrhagic risk factors for ultrasound (US)-guided native kidney biopsy. MATERIALS AND METHODS A retrospective review was conducted of adult patients who underwent US-guided native kidney biopsy at a single center between January 2006 and March 2016 and identified 37 of 551 patients (6.72%) with postbiopsy bleeding complications, including 11 major complications (2.00%; n = 11) and 26 minor complications (4.72%; n = 26). Ten patients with major complications and 20 with minor complications were matched with 20 control subjects each by propensity score matching based on age, needle size, number of cores, blood pressure, partial thromboplastin time, prothrombin time, platelet count, and estimated glomerular filtration rate. RESULTS Biopsy needle passing through the renal sinus was identified in the patients with major (6 of 10; 60%) and minor complications (8 of 20; 40.0%) but not in the control groups. For patients with major complications, the needle-sinus distance was significantly shorter (5.11 mm ± 7.32 vs 11.14 mm ± 3.54; P = .023) and the needle-capsule distance was significantly longer (17.52 mm ± 8.04 vs 9.28 mm ± 3.29; P = .0004) than in control subjects. The bimodal distribution of cortical tangential angles (< 30° or ≥ 60°) in minor complication cases (17 of 20; 85.0%) was significantly greater than in the control group (8 of 20; 40.0%; odds ratio = 8.50; P = .004). CONCLUSIONS This study identifies imaging risk factors in US-guided native kidney biopsy and recommends an algorithm to manage them, including appropriate needle path position between the renal capsule and sinus and proper needle cortical tangential angle.
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Affiliation(s)
- Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114
| | - Xueying Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114; Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114.
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Mejía-Vilet JM, Márquez-Martínez MA, Cordova-Sanchez BM, Ibargüengoitia MC, Correa-Rotter R, Morales-Buenrostro LE. Simple risk score for prediction of haemorrhagic complications after a percutaneous renal biopsy. Nephrology (Carlton) 2018; 23:523-529. [PMID: 28419667 DOI: 10.1111/nep.13055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/02/2017] [Accepted: 04/09/2017] [Indexed: 01/26/2023]
Abstract
AIM To derive a simple risk score to predict the individual risk of major complications for patients undergoing a percutaneous renal biopsy procedure of native kidneys. METHODS The risk score was derived from a cohort of 1205 adult patients subjected to percutaneous renal biopsy and assigned to training and validation datasets. Factors associated with major complications were derived from univariate analysis and then modelled by stepwise multivariate logistic regression. Based on the odds ratio, independent predictors were assigned a weighted integer. The risk score is calculated from the sum of the integers. RESULTS The overall incidence of major complications was 3.2%. Independent factors associated with MC were lower pre-biopsy haemoglobin, lower platelets, higher blood urea nitrogen, documented chronic kidney disease features in pre-biopsy ultrasound (US) and the presence of haematoma in the post-biopsy US. A score for pre-biopsy evaluation included the first four predictors and stratified patients in three categories with increasing risk at higher scores (low-risk 0.1%, moderate-risk 3.0% and high-risk 26.1%). The score demonstrated good discriminative power (AUC = 0.872). The addition of post-biopsy US findings increased the discriminative power (AUC = 0.938). A higher post-biopsy risk score was also associated with a higher incidence of MC (low-risk 0.2%, moderate-risk 2.7%, high-risk 16.9%). CONCLUSION The risk of major complications after a percutaneous renal biopsy can be assessed by a simple risk score calculated from readily available information.
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Affiliation(s)
- Juan M Mejía-Vilet
- Department of Nephrology and Mineral Metabolism, National Sciences and Nutrition Institute Salvador Zubiran, México
| | - Manuel A Márquez-Martínez
- Department of Nephrology and Mineral Metabolism, National Sciences and Nutrition Institute Salvador Zubiran, México
| | - Bertha M Cordova-Sanchez
- Department of Nephrology and Mineral Metabolism, National Sciences and Nutrition Institute Salvador Zubiran, México
| | - Mónica Chapa Ibargüengoitia
- Department of Radiology and Image "Dr. Adan Pitol Croda", National Sciences and Nutrition Institute Salvador Zubiran, México
| | - Ricardo Correa-Rotter
- Department of Nephrology and Mineral Metabolism, National Sciences and Nutrition Institute Salvador Zubiran, México
| | - Luis E Morales-Buenrostro
- Department of Nephrology and Mineral Metabolism, National Sciences and Nutrition Institute Salvador Zubiran, México
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Lees JS, McQuarrie EP, Mackinnon B. Renal biopsy: it is time for pragmatism and consensus. Clin Kidney J 2018; 11:605-609. [PMID: 30289128 PMCID: PMC6165764 DOI: 10.1093/ckj/sfy075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 01/29/2023] Open
Abstract
To obtain truly informed consent, we must be able to advise our patients accurately about the relative risk and benefit of any treatment plan. Percutaneous renal biopsy remains the gold standard investigation in the evaluation of intrinsic renal disease. There have been significant improvements in practice over the past decades with regards to percutaneous renal biopsy. Across centres, we appear now to have reached agreement on many aspects of this procedure, such as the need for blood pressure control, avoidance of coagulopathy, use of spring-loaded needles under direct imaging guidance and a need to monitor for complications. The authors from Rush University Medical Centre provide reassurance that renal biopsy in the modern era remains a safe procedure with a low rate of significant bleeding. There remain areas of divergence in practice that may have unintended and deleterious consequences: administration of desmopressin and discontinuation of aspirin, for example, both carry a risk of thrombosis. It is our opinion that it is time to reach consensus on our interpretation of the available data and to draw up guidelines to standardize our biopsy practice internationally.
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Affiliation(s)
- Jennifer S Lees
- Glasgow Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily P McQuarrie
- Glasgow Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bruce Mackinnon
- Glasgow Renal and Transplant Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
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Paterson C, Ghaemi J, Alashkham A, Biyani CS, Coles B, Baker L, Szewczyk-Bieda M, Nabi G. Diagnostic accuracy of image-guided biopsies in small (<4 cm) renal masses with implications for active surveillance: a systematic review of the evidence. Br J Radiol 2018; 91:20170761. [PMID: 29888978 DOI: 10.1259/bjr.20170761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE: To determine the safety and diagnostic accuracy of renal tumour biopsies in a defined population of small renal masses (SRMs) only <4 cm using 3 × 2 table, intention to diagnose approach. 3 × 2 table approach examines indeterminate results as a separate category rather than pushing these through traditional 2 × 2 table (four-cell matrix) approach. METHODS: A highly sensitive search was performed in the Cochrane Library, Database of Abstracts of Reviews of Effects; MEDLINE and MEDLINE in Process, EMBASE and conference proceedings (1966-2016) for the acquisition of data on the diagnostic accuracy and complications of RTB in patients with SRM <4 cm. Methodological quality and risk of bias was assessed using QUADAS-2. Test characteristics were calculated using conventional 2 × 2 contingency table analysis excluding non-diagnostic biopsies, and an intention-to-diagnose approach with a 3 × 2 table for pooled estimates of the sensitivity and specificity. RESULTS: A total of 20 studies were included with a total sample size of 974. The pooled estimates for sensitivity and specificity of RTB based upon univariate analysis using 2 × 2 table observed sensitivity 0.952 [confidence interval (CI) 0.908-0.979] and specificity 0.824 (CI 0.566-0.962). Using the 3 × 2 table and intention-to-diagnose principle, sensitivity 0.947 (CI 0.925-0.965) and specificity 0.609 (CI 0.385-0.803) decreased. CONCLUSION: RTB in SRMs (<4 cm) is associated with a high diagnostic sensitivity but poor specificity when non-diagnostic results are included by a 3 × 2 table for analysis (intention to diagnose approach). Risk of non-diagnostic results and poor quality of research need addressing through future studies, preferably by a well-designed prospective study appropriately powered for diagnostic accuracy using valid reference standards. ADVANCES IN KNOWLEDGE: A comprehensive synthesis of literature on image-guided biopsies in SRMs using a different methodology and study design.
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Affiliation(s)
- Catherine Paterson
- 1 School of Nursing and Midwifery, Robert Gordon University , Garthdee, Aberdeen , UK
| | - Joseph Ghaemi
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
| | - Abduelmenem Alashkham
- 3 Centre for Human Anatomy, School of Biomedical Sciences, University of Edinburgh , Edinburgh , UK
| | - Chandra Shekhar Biyani
- 4 Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust , Leeds, West Yorkshire , UK
| | - Bernadette Coles
- 5 Site Librarian, University Library Service, Cardiff University, Cancer Research Wales Library, Velindre Cancer Centre , Cardiff , Wales
| | - Lee Baker
- 6 Chi-Squared Innovations , Dundee , UK
| | - Magdalena Szewczyk-Bieda
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
| | - Ghulam Nabi
- 2 Academic Section of Urology, Division of Cancer, School of Medicine, Ninewells Hospital , Dundee , UK
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Ferguson C, Winters S, Jackson S, McToal M, Low G. A retrospective analysis of complication and adequacy rates of ultrasound-guided native and transplant non-focal renal biopsies. Abdom Radiol (NY) 2018; 43:2183-2189. [PMID: 29159524 DOI: 10.1007/s00261-017-1405-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess non-focal ultrasound (US)-guided renal biopsy complication and adequacy rates at our institution. METHODS A retrospective analysis of 1067 non-focal renal biopsy cases between 2012 and 2015. Information collected including type of US-guided procedure (US-localized by nephrology vs. real-time US-guided by radiology), sample adequacy, complications, blood work, and histologic data. RESULTS 602 biopsies were performed by radiology (56.4%) and 465 (43.6%) by nephrology. The overall adequacy rate was 96.1%, with an US-localized rate of 95.7% and real-time US-guided rate of 96.3% (p = 0.58). A lower adequacy rate was noted for 1 biopsy core but there were no differences between 2 and 6 cores (p = 0.001). A lower adequacy rate was found for transplant biopsies vs. native biopsies (p = 0.03). Complication rates were as follows-minor 5.9%, major 4.3%, and life-threatening 0.8%. There were no differences in complication rates between the US-localized and real-time US-guided techniques (p = 0.63). Complications were more likely in patients with a lower hemoglobin, higher serum creatinine, and lower albumin (p < 0.05). No differences were found between the number of cores performed and the complication rates. The complication rate was similar between transplant biopsies vs. native biopsies (p = 0.2). The adequacy rate was lower in trainees (p = 0.01) than experienced radiologists. CONCLUSIONS No significant differences were found between US-localized vs. real-time US-guided techniques. A lower adequacy rate was found for trainee radiologists and for transplant biopsies. A lower adequacy rate was also observed when only 1 biopsy pass was performed.
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Affiliation(s)
- Craig Ferguson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada.
| | - Sean Winters
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Stuart Jackson
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Marina McToal
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, WMC 2B2.41 8440-112 ST, Edmonton, AB, T6G2B7, Canada
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Ultrasonographic Reference Values of Kidney Dimensions and Clinicopathological Findings Associating the Transcutaneous Ultrasound-Guided Renal Biopsy in Donkeys (Equus asinus). J Equine Vet Sci 2018; 68:1-11. [PMID: 31256879 DOI: 10.1016/j.jevs.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 11/23/2022]
Abstract
This study aimed to establish normal ultrasonographic reference values of kidney dimensions in donkeys (Equus asinus) and to describe and evaluate the clinicopathological variations associated with ultrasound-guided renal biopsy. The ultrasonographic dimensions of the right and left kidneys were conducted on 16 donkeys, which were then divided into two groups; eight each for biopsy of the right kidney (RK) and left kidney (LK). Three ultrasonographic cineloops were obtained at 17th intercostal space daily for 3 consecutive days. Renal length, width, and dimensions of the cortex, medulla, and pelvis for both the kidneys in each donkey were recorded. Maximal dimensions were obtained for the RK (length 10 ± 8 cm, width 4.9 ± 1 cm, thickness 4.2 ± 0.4 cm) and LK (length 8.9 ± 0.9 cm, width 4.7 ± 0.8 cm, thickness 3.5 ± 0.7 cm) with good-to-excellent repeatability for all measurements. Follow-up ultrasonography revealed development of postbiopsy subcapsular hematomas, which were confirmed postmortem, of mild (volume < 20 mL), moderate (volume from 20 to 40 mL), and severe degrees (volume > 40 mL). Gross hematuria had been observed till 24 hours after biopsy, and then microscopic hematuria was noticed thereafter. Variable clinicopathological changes were noticed in blood and urine. All the biopsy specimens were adequate for histopathological assessment. Postmortem histopathological examination revealed various kidney changes. In conclusion, kidney dimensions can be used by veterinarians for accurate diagnosis and management of renal diseases. Ultrasound-guided renal biopsy is a relatively safe procedure; however, some complications may develop. Renal biopsy is commonly associated with clinicopathological variations; thus, caution should be taken during interpretation of these variables.
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Rao NS, Chandra A. Needle guides enhance tissue adequacy and safety of ultrasound-guided renal biopsies. Kidney Res Clin Pract 2018; 37:41-48. [PMID: 29629276 PMCID: PMC5875575 DOI: 10.23876/j.krcp.2018.37.1.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 01/03/2023] Open
Abstract
Background Needle guides have recently come into use for ultrasound-guided percutaneous renal biopsies; however, it is not yet clear if the use of needle guides leads to decreased post-biopsy complication rates and improved tissue yields. Thus, we conducted a retrospective single center study comparing biopsy yield, adequacy, and rates of complications before and after utilization of a needle guide device. Methods A retrospective analysis was performed on all native kidney biopsies performed before and after June 2015 corresponding to the start of needle guide use. All biopsies in the latter period of the study were performed by a single operator. We compared clinical characteristics, indications, type of investigation, tissue yield, adequacy of procedure, and rates of major and minor complications. Results A total of 343 biopsies were analyzed, 140 in the pre-needle guide use period (Period I) and 203 in the needle guide use period (Period II). Biopsy yields were similar, irrespective of the use of needle guides. Tissue adequacy was better in Period II (93.7% vs. 84%, P < 0.001, with respect to pathologist-reported inconclusive biopsies. There were no differences in terms of major complications (1.7%) for the two periods; however, the rate of minor complications (8.4%) was significantly reduced in Period II (P = 0.006). According to multiple logistic regression analysis, not using a needle guide (odds ratio, 3.70; P < 0.001) along with low hemoglobin level, higher pre-dialysis serum creatinine level, and high urinary red blood cell count were significant predictors of biopsy complications. Conclusion Use of a needle guide improves biopsy adequacy and is associated with reduced rates of minor complications in native renal biopsies. Therefore, needle guides may be recommended in percutaneous renal biopsies, especially when transitioning to single-operator performed procedures.
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Affiliation(s)
- Namrata S Rao
- Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Abhilash Chandra
- Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees. BMC Nephrol 2018; 19:14. [PMID: 29334930 PMCID: PMC5769494 DOI: 10.1186/s12882-017-0796-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recently there has been a progressive loss of specialty related skills for nephrologists. Among the skills we find the kidney biopsy that has a central role in diagnosis of renal parenchymal disease. One of the causes might be the belief that the kidney biopsy should be performed only in larger Centers which can rely on the presence of a renal pathologist and on nephrologists with a large experience. This trend may increase in the short term procedural safety but may limit the chance of in training nephrologists to become confident with the technique. METHODS We evaluated renal biopsies performed from May 2002 to October 2016 in our Hospital, a mid-sized facility to determine whether the occurrence of complications would be comparable to those reported in literature and whether the increase in the number of biopsy performing physicians including nephrology fellows which took place since January 2012, after our Nephrology Unit became academic, would be associated to an increase of complications or a reduction of diagnostic power of renal biopsies. Three hundred thirty seven biopsies were evaluated. Patients underwent ultrasound guided percutaneous renal biopsy using a 14 G core needle loaded on a biopsy gun. Observation lasted for 24 h, we evaluated hemoglobin levels 6 and 24 h and kidney ultrasound 24 h after the biopsy. RESULTS Complications occurred in 18.7% of patients, of these only 1,2% were major complications. Complications were more common in female (28%) compared to male patients (14,8%) (p = 0.004). We found no correlation between diagnosis, kidney function and complication rates; hypertension was not associated to a higher risk in complications. The increase of biopsy performing personnel was not associated to an increase in complication rates (18,7% both pre and post 2012) or with an increase of major complications (1.2% vs 1,2%). CONCLUSIONS Kidney biopsy can be safely performed in mid-sized hospitals. Safety and adequacy are guaranteed even if the procedure is performed by a larger number of less experienced nephrologists as long as under tutor supervision, thus kidney biopsy should become an integral part of a nephrology fellow training allowing more widespread diffusion of this technique.
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Mwikirize C, Nosher JL, Hacihaliloglu I. Signal attenuation maps for needle enhancement and localization in 2D ultrasound. Int J Comput Assist Radiol Surg 2018; 13:363-374. [PMID: 29294213 DOI: 10.1007/s11548-017-1698-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We propose a novel framework for enhancement and localization of steeply inserted hand-held needles under in-plane 2D ultrasound guidance. METHODS Depth-dependent attenuation and non-axial specular reflection hinder visibility of steeply inserted needles. Here, we model signal transmission maps representative of the attenuation probability within the image domain. The maps are employed in a contextual regularization framework to recover needle shaft and tip information. The needle tip is automatically localized by line-fitting along the local-phase-directed trajectory, followed by statistical optimization. RESULTS The proposed method was tested on 300 ex vivo ultrasound scans collected during insertion of an epidural needle into freshly excised porcine and bovine tissue. A tip localization accuracy of [Formula: see text] was achieved. CONCLUSION The proposed method could be useful in challenging procedures where needle shaft and tip are inconspicuous. Improved needle localization results compared to previously proposed methods suggest that the proposed method is promising for further clinical evaluation.
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Affiliation(s)
- Cosmas Mwikirize
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, 08854, USA.
| | - John L Nosher
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
| | - Ilker Hacihaliloglu
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ, 08854, USA.,Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, 08901, USA
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Bleeding complications post ultrasound guided renal biopsy - A single centre experience from Pakistan. Ann Med Surg (Lond) 2017; 21:85-88. [PMID: 28794871 PMCID: PMC5536385 DOI: 10.1016/j.amsu.2017.06.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/20/2017] [Accepted: 06/20/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Renal biopsy is the diagnostic modality of choice for the diagnosis of renal parenchymal diseases. The advent of improved imaging techniques and biopsy needles over the years has increased the safety of the procedure and the ability to obtain adequate renal tissue for diagnosis. However, there is paucity of data in this regard from Pakistan. This study shall help in establishing the local perspective of the frequency of bleeding complications in percutaneous ultrasound guided renal biopsy. MATERIALS AND METHODS This is a prospective case series of hospitalized patients from January till December 2015 at Nephrology Department, Aga Khan University Hospital, Karachi, Pakistan. After enrolment, each participant was followed for 24 h after renal biopsy. RESULTS A total of 220 patients were included. Mean age was 41.65 ± 8.627 years, 82 (37.2%) were male and 138 (62.8%) were female. Pre and post biopsy haemoglobin, pre and post biopsy haematocrit were 10.92 ± 1.25 and 10.60 ± 1.22, and 30.82 ± 4.73 and 30.49 ± 4.68 respectively. Out of 220 patients, 16 (7.27%) developed major complications and 26 (11.8%) developed minor complications in 24 h after renal biopsy. CONCLUSIONS Percutaneous kidney biopsy is a relatively safe procedure. Complication rates following the procedure are minimal. It is important that all nephrology programs train the trainees in performing biopsies, so that there is a wider clinical use of this important investigation even in underprivileged & developing countries.
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Lees JS, McQuarrie EP, Mordi N, Geddes CC, Fox JG, Mackinnon B. Risk factors for bleeding complications after nephrologist-performed native renal biopsy. Clin Kidney J 2017; 10:573-577. [PMID: 28852497 PMCID: PMC5570080 DOI: 10.1093/ckj/sfx012] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Indexed: 01/27/2023] Open
Abstract
Background Bleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding. Methods We identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding. Results There were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P < 0.001). Aspirin was being taken at the time of biopsy in 327 of 1509 patients, with no significant increase in the risk of major bleeding (P = 0.93). Body mass index (BMI) data were available for 546 patients, with no increased risk of major bleeding in 207 patients classified as obese (BMI >30). Conclusions The risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.
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Affiliation(s)
- Jennifer S Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emily P McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Natalie Mordi
- Renal Unit, Ninewells Hospital, James Arnott Drive, Dundee, UK
| | - Colin C Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jonathan G Fox
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Mackinnon
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
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Xu DM, Chen M, Zhou FD, Zhao MH. Risk Factors for Severe Bleeding Complications in Percutaneous Renal Biopsy. Am J Med Sci 2017; 353:230-235. [DOI: 10.1016/j.amjms.2016.12.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/25/2016] [Accepted: 12/29/2016] [Indexed: 01/19/2023]
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Lubas A, Wojtecka A, Smoszna J, Koziński P, Frankowska E, Niemczyk S. Hemodynamic characteristics and the occurrence of renal biopsy-related arteriovenous fistulas in native kidneys. Int Urol Nephrol 2016; 48:1667-73. [PMID: 27580732 PMCID: PMC5031753 DOI: 10.1007/s11255-016-1411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
Abstract
Purpose Renal biopsy-related arteriovenous fistula (RB-AVF), although usually asymptomatic, may sometimes result in serious clinical implications. The aim of the study was to prospectively evaluate the incidence of RB-AVF in native kidneys, together with the assessment of hemodynamic characteristics and the impact of the histopathological results of biopsy. Methods The study included 138 patients (age 46.2 ± 15.2; 70 F, 68 M), who underwent percutaneous renal biopsy (PRB) of the native kidney. In all patients, 2D and color Doppler ultrasound was performed 24 h after PRB in order to exclude RB-AVF. Results Bleeding complications in the form of hematomas were found in 136 patients (98.55 %), and 23 cases of RB-AVF were observed (16.67 %). RB-AVF group had an increased maximal hematoma diameter and reduced number of glomeruli in PRB. The segmental arteries supplying the fistulas are characterized by higher maximum flow velocity (FV) and a lower resistance index (RI) compared to the normal segmental arteries (difference 45.9 ± 20.0 cm/s and 0.252 ± 0.104, respectively). In the ROC analysis, RI ≤ 0.524 allowed to detect RB-AVF with a sensitivity of 91 % and specificity of 100 % (AUC 0.998, p < 0.001). In approximately 39 % of RB-AVF cases, 2D ultrasound detected a hyperechogenic ischemic area between the fistula and the renal capsule. Conclusions Arteriovenous fistula is a quite frequent complication of native renal biopsy and can cause ischemia in the renal parenchyma detected by ultrasound. The arteries supplying the fistula are characterized by an increased flow velocity and reduced resistance index.
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Affiliation(s)
- Arkadiusz Lubas
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
| | - Anna Wojtecka
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Koziński
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Emilia Frankowska
- Department of Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
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Visconti L, Cernaro V, Ricciardi CA, Lacava V, Pellicanò V, Lacquaniti A, Buemi M, Santoro D. Renal biopsy: Still a landmark for the nephrologist. World J Nephrol 2016; 5:321-327. [PMID: 27458561 PMCID: PMC4936339 DOI: 10.5527/wjn.v5.i4.321] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/14/2016] [Accepted: 04/06/2016] [Indexed: 02/06/2023] Open
Abstract
Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefits must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.
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