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Yang JR, Wu S, Li J, Tian XJ, Xue ZX, Niu XY. Hemothorax caused by injury of musculophrenic artery after ultrasound-guided percutaneous liver biopsy: a case report. J Med Case Rep 2024; 18:303. [PMID: 38918846 PMCID: PMC11202318 DOI: 10.1186/s13256-024-04619-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/02/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Hemorrhage is the most common major complication after liver biopsy. Hemothorax is one type of bleeding and is very rare and dangerous. Several cases of hemothorax subsequent to liver biopsy have been documented, primarily attributed to injury of the intercostal artery or inferior phrenic artery and a few resulting from lung tissue damage; however, no previous case report of hemothorax caused by injury of musculophrenic artery after liver biopsy has been reported. CASE PRESENTATION A 45-year-old native Chinese woman diagnosed with primary biliary cirrhosis due to long-term redness in urination and abnormal blood test indicators was admitted to our hospital for an ultrasound-guided liver biopsy to clarify pathological characteristics and disease staging. A total of 2 hours after surgery, the patient complained of discomfort in the right chest and abdomen. Ultrasound revealed an effusion in the right thorax and hemothorax was strongly suspected. The patient was immediately referred to the interventional department for digital subtraction angiography. Super-selective angiography of the right internal thoracic artery was performed which revealed significant contrast medium extravasation from the right musculophrenic artery, the terminal branch of the internal thoracic artery. Embolization was performed successfully. The vital signs of the patient were stabilized after the transarterial embolization and supportive treatment. CONCLUSION This case draws attention to the musculophrenic artery as a potential source of hemorrhage after percutaneous liver biopsy.
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Affiliation(s)
- Jing-Ru Yang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Sai Wu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Jian Li
- Department of Interventional Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Xiao-Juan Tian
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Zhuo-Xi Xue
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Xiao-Yan Niu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
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Thongwitokomarn H, Noppakun K, Chaiwarith R, Chattipakorn SC, Chattipakorn N. Extracellular vesicles as potential diagnostic markers for kidney allograft rejection. Clin Transplant 2024; 38:e15314. [PMID: 38628057 DOI: 10.1111/ctr.15314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
Kidney transplantation is a highly effective treatment for end-stage kidney disease. However, allograft rejection remains a significant clinical challenge in kidney transplant patients. Although kidney allograft biopsy is the gold-standard diagnostic method, it is an invasive procedure. Since the current monitoring methods, including screening of serum creatinine and urinary protein, are not of sufficient sensitivity, there is a need for effective post-transplant monitoring to detect allograft rejection at an early stage. Extracellular vesicles are vesicles with a lipid bilayer that originate from different cell types in pathological and physiological conditions. The content of extracellular vesicles reflects the status of cells at the time of their production. This review comprehensively summarizes clinical, in vivo, and in vitro reports that highlight the potential of extracellular vesicles as diagnostic biomarkers for kidney allograft rejection. Clarification would facilitate differentiation between rejection and non-rejection and identification of the mechanisms involved in the allograft rejection. Despite increasing evidence, further research is necessary to establish the clinical utility of extracellular vesicles in the diagnosis and monitoring of allograft rejection in kidney transplant recipients. Using extracellular vesicles as non-invasive biomarkers for diagnosis of kidney allograft rejection could have tremendous benefits in improving patient outcomes and reduce the need for invasive procedures.
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Affiliation(s)
- Harit Thongwitokomarn
- Faculty of Medicine, Department of Internal Medicine, Division of Infectious Disease, Chiang Mai University, Chiang Mai, Thailand
| | - Kajohnsak Noppakun
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Faculty of Medicine, Department of Internal Medicine, Division of Infectious Disease, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Faculty of Medicine, Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Department of Physiology, Cardiac Electrophysiology Unit, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Faculty of Medicine, Cardiac Electrophysiology Research and Training Center, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Department of Physiology, Cardiac Electrophysiology Unit, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
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Strnad BS, Kristeva M, Itani M, Fetzer DT, O'Connor SD, Patel MD, Middleton WD. Percutaneous Core Biopsy Devices: A Detailed Review and Comparison of Different Needle Designs. Ultrasound Q 2024; 40:1-19. [PMID: 37918119 DOI: 10.1097/ruq.0000000000000664] [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: 11/04/2023]
Abstract
ABSTRACT Percutaneous core-needle biopsy (PCNB) plays a growing and essential role in many medical specialties. Proper and effective use of various PCNB devices requires basic understanding of how they function. Current literature lacks a detailed overview and illustration of needle function and design differences, a potentially valuable reference for users ranging from early trainees to experts who are less familiar with certain devices. This pictorial aims to provide such an overview, using diagrams and magnified photographs to illustrate the intricate components of these devices. Following a brief historical review of biopsy needle technology for context, we emphasize distinctions in design between 2 major classes of PCNB devices (side- and end-cutting devices), focusing on practical implications for how each device is most effectively used. We believe a nuanced understanding of biopsy device function sheds light on certain lingering ambiguities in biopsy practice, such as the optimal needle gauge in organ biopsy, the benefits and risks associated with coaxial technique, the impact of needle selection and technique on bleeding, and the risk of unsuccessful sampling. In a subsequent pictorial, we will draw on the concepts presented here to illustrate examples of biopsy needle failure and how unrecognized needle failure can be an important and often preventable cause of increased biopsy risk and lower tissue yield.
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Affiliation(s)
- Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Mariya Kristeva
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Stacy D O'Connor
- Department of Radiology, University of North Carolina Medical Center, Chapel Hill, NC
| | | | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
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Kavandi H, Itani M, Strnad B, Martin S, Ebrahimzadeh SA, Lubner MG, Noe-Kim V, Hinshaw JL, Bansal M, Karam AR, Khanna K, Hadied MO, Planz V, Glazer DI, Burgan CM, Galgano S, Brook A, Brook OR. A Multicenter Study of Needle Size and Safety for Splenic Biopsy. Radiology 2024; 310:e230453. [PMID: 38259204 DOI: 10.1148/radiol.230453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Splenic biopsy is rarely performed because of the perceived risk of hemorrhagic complications. Purpose To evaluate the safety of large bore (≥18 gauge) image-guided splenic biopsy. Materials and Methods This retrospective study included consecutive adult patients who underwent US- or CT-guided splenic biopsy between March 2001 and March 2022 at eight academic institutions in the United States. Biopsies were performed with needles that were 18 gauge or larger, with a comparison group of biopsies with needles smaller than 18 gauge. The primary outcome was significant bleeding after the procedure, defined by the presence of bleeding at CT performed within 30 days or angiography and/or surgery performed to manage the bleeding. Categorical variables were compared using the χ2 test and medians were compared using the Mann-Whitney test. Results A total of 239 patients (median age, 63 years; IQR, 50-71 years; 116 of 239 [48.5%] female patients) underwent splenic biopsy with an 18-gauge or smaller needle and 139 patients (median age, 58 years [IQR, 49-69 years]; 66 of 139 [47.5%] female patients) underwent biopsy with a needle larger than 18 gauge. Bleeding was detected in 20 of 239 (8.4%) patients in the 18-gauge or smaller group and 11 of 139 (7.9%) in the larger than 18-gauge group. Bleeding was treated in five of 239 (2.1%) patients in the 18-gauge or smaller group and one of 139 (1%) in the larger than 18-gauge group. No deaths related to the biopsy procedure were recorded during the study period. Patients with bleeding after biopsy had smaller lesions compared with patients without bleeding (median, 2.1 cm [IQR, 1.6-5.4 cm] vs 3.5 cm [IQR, 2-6.8 cm], respectively; P = .03). Patients with a history of lymphoma or leukemia showed a lower incidence of bleeding than patients without this history (three of 90 [3%] vs 28 of 288 [9.7%], respectively; P = .05). Conclusion Bleeding after splenic biopsy with a needle 18 gauge or larger was similar to biopsy with a needle smaller than 18 gauge and seen in 8% of procedures overall, with 2% overall requiring treatment. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Grant in this issue.
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Affiliation(s)
- Hadiseh Kavandi
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Malak Itani
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Benjamin Strnad
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Sooyoung Martin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Seyed Amir Ebrahimzadeh
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Meghan G Lubner
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Victoria Noe-Kim
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - J Louis Hinshaw
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohit Bansal
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Adib R Karam
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Kanika Khanna
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Mohamad Omar Hadied
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Virginia Planz
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Daniel I Glazer
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Constantine M Burgan
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Samuel Galgano
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
| | - Olga R Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (H.K., S.A.E., A.B., O.R.B.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.I., B.S., S.M.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., V.N.K., J.L.H.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (M.B., A.R.K.); Department of Radiology, Henry Ford Health, Detroit, Mich (K.K., M.O.H.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (V.P.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.I.G.); and Department of Radiology, University of Alabama at Birmingham, Birmingham, Ala (C.M.B., S.G.)
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Hou X, Tian C, Liu W, Li Y, Li W, Wang Z. Construction of artificial intelligence non-invasive diagnosis model for common glomerular diseases based on hyperspectral and urine analysis. Photodiagnosis Photodyn Ther 2023; 44:103736. [PMID: 37597684 DOI: 10.1016/j.pdpdt.2023.103736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To develop a non-invasive fluid biopsy assisted diagnosis model for glomerular diseases based on hyperspectral, so as to solve the problem of poor compliance of patients with invasive examination and improve the early diagnosis rate of glomerular diseases. METHODS A total of 65 urine samples from patients who underwent renal biopsy from November 2020 to January 2022 in Qianfoshan Hospital of Shandong Province were collected.By simultaneously capturing spectral information of the above urine samples in the 400-1000 nm range, more obvious differences were found in the spectra of urine from patients with glomerular diseases between 650 nm and 680 nm. We obtained the original hyperspectral images in this wavelength range through digital scanning, and sampled pixel points at intervals on the original images. The two-dimensional digital image generated from each pixel point served as a member of the subsequent training and test sets. . After manually labeling the images according to different biopsy pathological types, they were randomly divided into training set (n = 58,800) and test set (n = 25,200). The training set was used for training learning and parameter iteration of artificial intelligence non-invasive liquid diagnosis model, and the test set for model recognition and interpretation. The evaluation indexes such as accuracy, sensitivity and specificity were calculated to evaluate the performance of the diagnosis model. RESULTS The model has an accuracy rate of 96% for early diagnosis of four glomerular diseases. CONCLUSION The auxiliary diagnosis model system has high accuracy. It is expected to be used as a non-invasive diagnostic method for glomerular diseases in clinic.
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Affiliation(s)
- Xiangyu Hou
- Department of Nephrology, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong 250014, China
| | - Chongxuan Tian
- Department of biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250016, China
| | - Wen Liu
- Department of Nephrology, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong 250014, China
| | - Yang Li
- Department of Nephrology, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong 250014, China
| | - Wei Li
- Department of biomedical Engineering Institute, School of Control Science and Engineering, Shandong University, Jinan, Shandong, 250016, China.
| | - Zunsong Wang
- Department of Nephrology, Shandong Institute of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong 250014, China.
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Yeon SK, Ahn Y, Shin JH, Oh SY, Kim GH. Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy. Diagn Interv Radiol 2023; 29:819-825. [PMID: 37650514 PMCID: PMC10679561 DOI: 10.4274/dir.2023.232253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB). METHODS A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality. RESULTS All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed. CONCLUSION The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.
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Affiliation(s)
- Su Kyeong Yeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Gun Ha Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Kaczmarek M, Halimi JM, de Fréminville JB, Gatault P, Gueguen J, Goin N, Longuet H, Barbet C, Bisson A, Sautenet B, Herbert J, Buchler M, Fauchier L. A Universal Bleeding Risk Score in Native and Allograft Kidney Biopsies: A French Nationwide Cohort Study. J Clin Med 2023; 12:jcm12103527. [PMID: 37240634 DOI: 10.3390/jcm12103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The risk of bleeding after percutaneous biopsy in kidney transplant recipients is usually low but may vary. A pre-procedure bleeding risk score in this population is lacking. METHODS We assessed the major bleeding rate (transfusion, angiographic intervention, nephrectomy, hemorrhage/hematoma) at 8 days in 28,034 kidney transplant recipients with a kidney biopsy during the 2010-2019 period in France and compared them to 55,026 patients with a native kidney biopsy as controls. RESULTS The rate of major bleeding was low (angiographic intervention: 0.2%, hemorrhage/hematoma: 0.4%, nephrectomy: 0.02%, blood transfusion: 4.0%). A new bleeding risk score was developed (anemia = 1, female gender = 1, heart failure = 1, acute kidney failure = 2 points). The rate of bleeding varied: 1.6%, 2.9%, 3.7%, 6.0%, 8.0%, and 9.2% for scores 0 to 5, respectively, in kidney transplant recipients. The ROC AUC was 0.649 (0.634-0.664) in kidney transplant recipients and 0.755 (0.746-0.763) in patients who had a native kidney biopsy (rate of bleeding: from 1.2% for score = 0 to 19.2% for score = 5). CONCLUSIONS The risk of major bleeding is low in most patients but indeed variable. A new universal risk score can be helpful to guide the decision concerning kidney biopsy and the choice of inpatient vs. outpatient procedure both in native and allograft kidney recipients.
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Affiliation(s)
- Mathieu Kaczmarek
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Jean-Baptiste de Fréminville
- Paris-Cardiovascular Research Center, INSERM, UMR970, Université de Paris, F-75006 Paris, France
- Unité Fonctionnelle d'Hypertension Artérielle, Centre de Référence des Maladies Rares de la Surrénale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, F-75015 Paris, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Juliette Gueguen
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Nicolas Goin
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
| | - Arnaud Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- INI-CRCT, F-54500 Nancy, France
| | - Julien Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
- Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, F-37000 Tours, France
- EA4245, University of Tours, F-37000 Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, F-37000 Tours, France
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Safety and Efficacy of CT-Guided Percutaneous Biopsy of Suspicious Subcentimeter Pelvic and Retroperitoneal Lymph Nodes Detected by 11C-Choline PET in Patients With Prostate Cancer. AJR Am J Roentgenol 2023; 220:718-725. [PMID: 36475814 DOI: 10.2214/ajr.22.28321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. In patients with prostate cancer, PET using targeted radiotracers can identify increased activity in small morphologically normal lymph nodes, facilitating earlier detection of metastatic disease. OBJECTIVE. The purpose of this article was to assess the efficacy and safety of CT-guided biopsy of suspicious pelvic and retroperitoneal lymph nodes measuring smaller than 1 cm detected by 11C-choline PET in patients with prostate cancer, with comparison with nodes measuring 1 cm or larger. METHODS. This retrospective study included patients with prostate cancer who underwent CT-guided percutaneous biopsy of suspicious pelvic or retroperitoneal lymph nodes detected by 11C-choline PET/CT or PET/MRI (performed because of rising or elevated PSA or known recurrent or metastatic disease) between June 1, 2012, and March 20, 2020. Patient, lymph node, and procedural characteristics, as well as biopsy outcomes and complications, were recorded. Biopsies of lymph nodes measuring smaller than 1 cm and of lymph nodes measuring 1 cm and larger were compared. RESULTS. A total of 269 patients (mean age, 68.7 ± 6.8 [SD] years) were included. A total of 156 patients underwent biopsy of lymph nodes measuring smaller than 1 cm (range, 3-9 mm); 113 patients underwent biopsy of lymph nodes measuring 1 cm or larger (range, 10-35 mm). Lymph nodes smaller than 1 cm and lymph nodes 1 cm and larger showed no significant difference in diagnostic yield (89.7% vs 92.9%; p = .40). Diagnostic yield was not significantly different between nodes smaller than 1 cm and nodes 1 cm and larger for any individual anatomic location within the pelvis or retroperitoneum (all p > .05). Malignant yield was lower for nodes smaller than 1 cm than for nodes 1 cm and larger (44.9% vs 63.7%; p = .003). The single biopsied 3-mm node had a nondiagnostic specimen. Diagnostic yield and malignant yield were 100.0% and 40.0%, respectively, for 4-mm nodes, and 95.5% and 45.5%, respectively, for 5-mm nodes. Patients with nodes smaller than 1 cm and nodes 1 cm and larger showed no significant difference in minor (12.8% vs 7.1%; p = .16) or major (0.6% vs 2.7%; p = .31) complication rate. CONCLUSION. The findings support the safety and efficacy of CT-guided biopsy of suspicious subcentimeter pelvic and retroperitoneal lymph nodes detected on 11C-choline PET in patients with prostate cancer. CLINICAL IMPACT. Earlier diagnosis of metastatic lymphadenopathy will impact prognostic assessment and management decisions in patients with recurrent prostate cancer.
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Guillaud O, Dumortier J, Couchonnal-Bedoya E, Ruiz M. Wilson Disease and Alpha1-Antitrypsin Deficiency: A Review of Non-Invasive Diagnostic Tests. Diagnostics (Basel) 2023; 13:diagnostics13020256. [PMID: 36673066 PMCID: PMC9857715 DOI: 10.3390/diagnostics13020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Wilson disease and alpha1-antitrypsin deficiency are two rare genetic diseases that may impact predominantly the liver and/or the brain, and the liver and/or the lung, respectively. The early diagnosis of these diseases is important in order to initiate a specific treatment, when available, ideally before irreversible organ damage, but also to initiate family screening. This review focuses on the non-invasive diagnostic tests available for clinicians in both diseases. These tests are crucial at diagnosis to reduce the potential diagnostic delay and assess organ involvement. They also play a pivotal role during follow-up to monitor disease progression and evaluate treatment efficacy of current or emerging therapies.
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Affiliation(s)
- Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Ramsay Générale de Santé, Clinique de la Sauvegarde, 69009 Lyon, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, 69003 Lyon, France
- Correspondence: ; Tel.: +33-4-72-11-95-19
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des Spécialités Digestives, 69003 Lyon, France
- Faculté de Médecine Lyon Est, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Eduardo Couchonnal-Bedoya
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour la Maladie de Wilson, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d’Hépatogastroentérologie et Nutrition Pédiatrique, 69500 Bron, France
| | - Mathias Ruiz
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d’Hépatogastroentérologie et Nutrition Pédiatrique, 69500 Bron, France
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Centre National de Référence pour l’Atrésie des Voies Biliaires et les Cholestases Génétiques, 69500 Bron, France
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Niroshan V, Balagobi B, Brammah T, Weerasinghe N, Gowribahan T. Surgically managed acute Page kidney following renal biopsy-A case report. Int J Surg Case Rep 2022; 99:107641. [PMID: 36122422 PMCID: PMC9568784 DOI: 10.1016/j.ijscr.2022.107641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Case presentation Clinical discussion Conclusion
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Affiliation(s)
- V Niroshan
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - B Balagobi
- University Surgical Unit, Teaching Hospital of Jaffna, Sri Lanka.
| | - T Brammah
- University Medical Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - N Weerasinghe
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
| | - T Gowribahan
- Urology Unit, Teaching Hospital of Jaffna, Sri Lanka
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11
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Singh S, Clemente LC, Parra ER, Tchakarov A, Yang C, Li Y, Long JP, Yee C, Lin JS. Urinary T cells are detected in patients with immune checkpoint inhibitor-associated immune nephritis that are clonotypically identical to kidney T cell infiltrates. Oncoimmunology 2022; 11:2124678. [PMID: 36185804 PMCID: PMC9519023 DOI: 10.1080/2162402x.2022.2124678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/31/2022] [Accepted: 09/11/2022] [Indexed: 10/28/2022] Open
Abstract
Acute kidney injury (AKI) occurs in ~20% of patients receiving immune checkpoint inhibitor (ICI) therapy; however, only 2-5% will develop ICI-mediated immune nephritis. Conventional tests are nonspecific in diagnosing disease pathology and invasive procedures (i.e. kidney biopsy) may not be feasible. In other autoimmune renal diseases, urinary immune cells correlated with the pathology or were predictive of disease activity. Corresponding evidence and analysis are absent for ICI-mediated immune nephritis. We report the first investigation analyzing immune cell profiles of matched kidney biopsies and urine of patients with ICI-AKI. We demonstrated the presence of urinary T cells in patients with immune nephritis by flow cytometry analysis. Clonotype analysis of T cell receptor (TCR) sequences confirmed enrichment of kidney TCRs in urine. As ICI therapies become standard of care for more cancers, noninvasively assessing urinary immune cells of ICI therapy recipients can facilitate clinical management and an opportunity to tailor ICI-nephritis treatment.
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Affiliation(s)
- Shailbala Singh
- Department of Melanoma Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leticia C. Clemente
- Department of Translational Molecular Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Edwin R. Parra
- Department of Translational Molecular Pathology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Tchakarov
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Chao Yang
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yisheng Li
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James P. Long
- Department of Biostatistics, Division of Basic Sciences, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cassian Yee
- Department of Melanoma Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Immunology, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jamie S. Lin
- Section of Nephrology, Division of Internal Medicine, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
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12
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Strnad BS, Itani M, Middleton WD. Detection and management of bleeding in the setting of image-guided percutaneous needle biopsy. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2681-2696. [PMID: 34882270 DOI: 10.1007/s00261-021-03357-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/18/2023]
Abstract
Image-guided percutaneous needle biopsy (PNB) is an important and increasingly utilized method of minimally invasive tissue sampling for a broad variety of disease processes. While infrequent, major bleeding is a potential complication of PNB and can be life-threatening, especially when unrecognized. On the other hand, prompt recognition and treatment of major bleeding in this setting can prevent significant morbidity or mortality. It is therefore crucial for anyone performing PNB to be familiar with the diagnosis and management of bleeding complications. This article reviews the risk factors for major bleeding in the setting of PNB, the presentation and imaging findings of a spectrum of bleeding complications encountered during and following PNB, and the management of those findings based on experience at a single, high volume, biopsy center.
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Affiliation(s)
- Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA.
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Box 8131, Saint Louis, MO, 63110, USA
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13
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Comparison of clinical efficacy, subjective user experience, and safety for two different core biopsy needles, the Achieve® and Marquee®. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2632-2639. [PMID: 34181039 DOI: 10.1007/s00261-021-03187-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare clinical efficacy, subjective radiologist preference, and complication rates for two different core biopsy needles, the Achieve® and Marquee®. METHODS Retrospective review included consecutive patients who underwent 18 gauge non-targeted core liver biopsy, 30 with Achieve® (Merit Medical) and 30 with Marquee® (BD Bard) Pathologist (blinded to needle type) reviewed specimen total length, maximum width, and portal triad count. Sixteen radiologists subjectively rated (1 to 5(best)) each needle for cocking, firing, recoil, chamber exposure, handling, and overall. A medical records search of all (targeted and non-targeted) core liver biopsies 1/1/17-9/30/2020 compared rates of major (requiring transfusion and/or embolization) and minor (self-limited bleeding) hemorrhagic complications. Comparison between needle types was performed using t-test. RESULTS For Achieve® and Marquee® needles, the respective mean (SD) for total length(mm) was 29.7(7.0) and 31.9(4.6), p = 0.1; max width(mm) was 0.78(0.1) and 0.85(0.1), p < 0.01; and number of portal triads was 15.3(5.3) and 17.3(5.3), p = 0.2. Radiologists subjectively preferred the Marquee® for several measures including cocking, chamber exposure, and overall (p < 0.02 for each), while the needles were rated similarly for firing, recoil, and handling. Review of 800 cases showed no difference in major (1.0% Achieve®, 1.9% Marquee®, p = 0.5) or minor (1.5% Achieve®, 0.5% Marquee®, p = 0.3) rates of hemorrhagic complications. CONCLUSION Liver biopsy specimens were significantly wider with Marquee® compared to Achieve®. Radiologists preferred the Marquee® for multiple tactile measures, while the major complication rate was not significantly different. While both needles have a similar side-notch design, the Marquee® needle demonstrates better sample quality and higher user preference, without compromising safety.
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14
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Kelly L, Simon P, Nash A, Thompson J, Affronti ML. Reducing Recovery Times in Outpatient Liver Biopsies: Role of the GI Nurse. Gastroenterol Nurs 2022; 45:238-243. [PMID: 35833740 DOI: 10.1097/sga.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/31/2021] [Indexed: 11/26/2022] Open
Abstract
This project is aimed to identify whether recovery times could be reduced in patients undergoing an outpatient liver biopsy. Liver biopsies are typically performed in a hospital setting, and many facilities require patients to recover for multiple hours, sometimes ranging from 4 to 6 hours. This can discourage the patient from undergoing the biopsy. Multiple studies have examined recovery times and determined patients can safely recover and be discharged within 1-2 hours post-liver biopsy. In this retrospective review, the data of 60 outpatients who underwent a liver biopsy from June to December 2020 were analyzed. Analysis included comparing vital signs and symptoms at the 2-hour recovery period and 4-hour discharge time also to see whether there were any hospital admissions 1 week post-liver biopsy. Descriptive statistics were utilized for the data collected in this study. Results demonstrated that after 2 hours, 55 (91.7%) patients had vital signs within safe parameters, pain less than 5 on a 10-point pain scale and denied any other symptoms. The remaining five patients (8.3%) did not meet discharge criteria at the 2-hour mark because of pain greater than 5 on the pain scale yet were still discharged safely at the 4-hour mark.
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Affiliation(s)
- Lisa Kelly
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Peter Simon
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Angela Nash
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Julie Thompson
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
| | - Mary Lou Affronti
- Lisa Kelly, FNP-C, RN-MSN, is Doctoral Student at Duke University School of Nursing, Durham, North Carolina; Nurse Practitioner, Interventional Radiology at Atrium Health Cabarrus in Concord, North Carolina
- Peter Simon, MD, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Angela Nash, DHA, MSPAS, is Committee Member, Charlotte Radiology, Concord, North Carolina
- Julie Thompson, PhD, is Committee Member, Duke University, Durham, North Carolina
- Mary Lou Affronti, DNP, RN, MHSc, ANP, FAAN, is DNP Project Chair, Duke University, Durham, North Carolina
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Robson PC, Pardini P, O’Connor D, Akard TF, Dietrich MS, Ebstein AMM, Solomon SB. Patient and Procedure-related Characteristics Correlated with Severity of Hemoptysis Following Percutaneous Transthoracic Needle Biopsy: Results of a 10-year Retrospective Review. JOURNAL OF RADIOLOGY NURSING 2022; 41:82-88. [PMID: 37799819 PMCID: PMC10552674 DOI: 10.1016/j.jradnu.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Purpose A risk of percutaneous transthoracic needle biopsy (PTNB) is hemoptysis which can range from mild to life-threatening. The reported occurrence of hemoptysis is 1.7-14.5% and the demographic, patient, and procedure characteristics have not been extensively described. The purpose of this study was to assess the associations of demographic, patient, and procedure characteristics with the severity of hemoptysis. Materials and Methods A single-institution, single group, retrospective, electronic medical record (EMR) review was performed on all hemoptysis events occurring between 2008 and 2018. Demographic, clinical, and procedure variables were extracted from EMRs. Outcome of hemoptysis events was graded using Common Terminology Criteria for Adverse Events (CT-CAE). Mild-moderate and severe hemoptysis were defined as CT-CAE classifications of 1-2 and 3-5, respectively. Associations were generated using logistic regressions and Likelihood Ratio Chi-Square tests. Results In ten years, 14,665 PTNB resulted in 231 hemoptysis events occurring in 229 patients; 12.7% (n=29) of those were severe. The strongest and statistically significant variables associated with an increased likelihood of a severe event, if an event occurred, were cigarette pack years (OR=1.02, 95% C.I.=1.01-1.04, P=.020); history of chronic obstructive pulmonary disease (COPD) (OR=3.68, 95% C.I. = 1.53-8.82, P=.003); core biopsy technique (OR=8.13, 95% CI=1.07, 61.40, P=.042), and larger diameter needle (20g vs. 18g: OR= 2.60 (1.09, 6.17), P=.031). Conclusions PTNB-associated hemoptysis was an uncommon event that was rarely life-threatening. The extent of the patient's smoking history, the diagnosis of COPD, and core biopsy technique were associated with an increased likelihood of severe hemoptysis.
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Affiliation(s)
- Piera C. Robson
- Memorial Sloan Kettering Cancer Center Department of Nursing and Vanderbilt University School of Nursing
| | - Perri Pardini
- Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M2 D-desk, New York, NY 10065
| | - David O’Connor
- Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-613D, New York, NY 10065, 212-639-5360
| | - Terrah F. Akard
- Vanderbilt University School of Nursing, 461 21 Ave South, 514 Godchaux Hall, Nashville, TN 37240, 615-343-6025
| | - Mary S. Dietrich
- Vanderbilt University School of Nursing and School of Medicine, (Biostatistics, VICC, Hearing & Speech), 461 21 Ave South, 410 Godchaux Hall, Nashville, TN 37240, 615-343-7788
| | - Ann M Mazzella Ebstein
- Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, 917-952-6877
| | - Stephen B. Solomon
- Memorial Sloan Kettering Cancer Center Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065, 212-639-5012
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16
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Fecher LA, Bishu S, Fontana RJ, Hayek SS, Schneider BJ. The Role of Tissue Biopsy in the Management of Immune Checkpoint Inhibitor Toxicity. J Natl Compr Canc Netw 2022; 20:417-425. [PMID: 35390763 DOI: 10.6004/jnccn.2022.7011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022]
Abstract
Immune checkpoint inhibitors have revolutionized the treatment of cancer and are now omnipresent. However, immune-related adverse events can present with varying phenotypes and timing, which can pose diagnostic and therapeutic challenges for the treating oncologist as well as subspecialty consultants. Biopsies of affected organs may provide insight into biologic mechanisms as well as potentially guide management in certain circumstances.
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Affiliation(s)
| | | | | | - Salim S Hayek
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
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17
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Bhadauria D, Jose L, Kushwaha R, Kaul A, Nandan R, Singh V, Prasad N. Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed? Acta Radiol 2022; 63:261-267. [PMID: 33497275 DOI: 10.1177/0284185120988812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. PURPOSE To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. MATERIAL AND METHODS We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. RESULTS Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. CONCLUSION A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.
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Affiliation(s)
- Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Leena Jose
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Raghu Nandan
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vivek Singh
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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18
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Habibi HA, Cevener M, Yilmaz S. Image-guided percutaneous cutting needle biopsy in difficult locations. Jpn J Radiol 2022; 40:560-567. [DOI: 10.1007/s11604-021-01238-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/09/2021] [Indexed: 12/01/2022]
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19
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Hoegger MJ, Middleton WD. Ultrasound-Guided Thrombin Injection for the Treatment of Bleeding Following Kidney and Liver Biopsies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:247-253. [PMID: 33780029 DOI: 10.1002/jum.15699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to describe the technique and outcomes of percutaneous thrombin injection into the superficial aspect of actively bleeding liver and kidney biopsy tracks identified with color Doppler ultrasound with the aim of hemorrhage termination. After percutaneous thrombin injection, 15/16 (94%) patients did not require further intervention. Ultrasound-guided thrombin injection into the superficial site of active bleeding is an effective technique for terminating bleeding in the immediate post-procedure period following kidney and liver biopsies and should be considered if active bleeding persists on color Doppler after ≥30 minutes of compression and observation.
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Affiliation(s)
- Mark J Hoegger
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
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20
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Navin PJ, Eickstaedt NL, Atwell TD, Young JR, Eiken PW, Welch BT, Schmitz JJ, Schmit GD, Johnson MP, Moynagh MR. Safety and Efficacy of Percutaneous Image-Guided Mediastinal Mass Core-Needle Biopsy. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1100-1108. [PMID: 34877475 PMCID: PMC8633817 DOI: 10.1016/j.mayocpiqo.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To retrospectively evaluate the safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy. Patients and Methods Retrospective review of an institutionally maintained biopsy registry identified 337 computed tomography- or ultrasound-guided percutaneous mediastinal mass core needle biopsies between October 2002 and August 2017 in a single quaternary referral center. Mean patient age was 51 (range, 18 to 93) years. Procedural techniques, anticoagulation/antiplatelet therapy, and tumor anatomical characteristics were reviewed. Classification and gradation of complications was based on the Clavien-Dindo system. Diagnostic yield was defined as the ratio of diagnostic biopsy to all biopsies performed. Results Mean tumor size was 59.2 (range, 10 to 180) mm with 89.9% (n=303) of lesions located in the prevascular (anterior) mediastinum. There was a single major complication (0.3%) of a symptomatic pneumothorax requiring intervention. There were seven (2.1%) minor complications, including three bleeding complications. A transpleural approach was the only variable associated with an increased complication rate (P<.01). Forty-one (12.2%) patients had a biopsy performed while taking an antiplatelet/anticoagulant agent within the therapeutic window, with a single case (0.3%) associated with a minor bleeding complication. Of 18 (5.3%) procedures performed without cessation of anticoagulant/antiplatelet therapy, there were no bleeding complications. Of all 337 biopsies, 322 (95.5%) were diagnostic. None of the analyzed variables were significantly associated with a nondiagnostic biopsy. Conclusion Image-guided percutaneous core-needle biopsy of mediastinal masses is a safe procedure with high diagnostic yield. Further prospective studies are required to assess the complication profile in higher risk patients.
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21
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Abstract
Membranous nephropathy (MN) is a glomerular disease that can occur at all ages. In adults, it is the most frequent cause of nephrotic syndrome. In ~80% of patients, there is no underlying cause of MN (primary MN) and the remaining cases are associated with medications or other diseases such as systemic lupus erythematosus, hepatitis virus infection or malignancies. MN is an autoimmune disease characterized by a thickening of the glomerular capillary walls due to immune complex deposition. Identification of the phospholipase A2 receptor (PLA2R) as the major antigen in adults in 2009 induced a paradigm shift in disease diagnosis and monitoring and several other antigens have since been characterized. Disease outcome is difficult to predict and around one-third of patients will undergo spontaneous remission. In those at high risk of progression, immunosuppressive therapy with cyclophosphamide plus corticosteroids has substantially reduced the need for kidney replacement therapy. Owing to carcinogenic risk, other treatments (calcineurin inhibitors and CD20-targeted B cell depletion therapy (rituximab)) have been developed. However, disease relapses are frequent when calcineurin inhibitors are stopped and the remission rate with rituximab is lower than with cyclophosphamide, particularly in patients with high PLA2R antibody titres. Other new drugs are already available and antigen-specific immunotherapies are being developed.
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22
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Robson PC, O’Connor D, Pardini P, Akard TF, Dietrich MS, Kotin A, Solomon A, Chawla M, Kennedy M, Solomon SB. Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes. JOURNAL OF RADIOLOGY NURSING 2021; 40:221-226. [PMID: 34483778 PMCID: PMC8409504 DOI: 10.1016/j.jradnu.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management. METHODS In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice. RESULTS There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001). DISCUSSION Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
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Affiliation(s)
- Piera C. Robson
- Memorial Sloan Kettering Cancer Center Department of Nursing and, Vanderbilt University School of Nursing, 1275 York Avenue, S121, New York, NY 10065
| | - David O’Connor
- Memorial Sloan Kettering Cancer Center Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-613D, New York, NY 10065
| | - Perri Pardini
- Memorial Sloan Kettering Cancer Center Department of Nursing, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M2 D-desk, New York, NY 10065
| | - Terrah F. Akard
- Vanderbilt University School of Nursing, 461 21 Ave South, 514 Godchaux Hall, Nashville, TN 37240
| | - Mary S. Dietrich
- Vanderbilt University School of Nursing and School of Medicine (Biostatistics, VICC, Psychiatry), 461 21 Ave South, 410 Godchaux Hall, Nashville, TN 37240
| | - Alan Kotin
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, 1275 York Avenue, C330A, New York, NY
| | - Alexandra Solomon
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Mohit Chawla
- Memorial Sloan Kettering Cancer Center, Department of Medicine, 1275 York Avenue, New York, NY
| | - Matthew Kennedy
- Memorial Sloan Kettering Cancer Center, Department of Nursing, 1275 York Avenue, New York, NY
| | - Stephen B. Solomon
- Memorial Sloan Kettering Cancer Center, Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065
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23
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Preservation of Renal Function after Major Bleeding Events due to Ultrasound-Guided Parenchymal Renal Biopsy. J Vasc Interv Radiol 2021; 32:1227-1230. [PMID: 33961989 DOI: 10.1016/j.jvir.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022] Open
Abstract
The clinical outcomes of major bleeding events following ultrasound-guided native and allograft parenchymal renal biopsy were evaluated. Forty-eight bleeding complications after biopsy (Society of Interventional Radiology adverse event grade ≥ 2) from 2002 to 2018 were identified. The primary outcome assessed was renal function. The clinical outcomes and interventions performed, including blood transfusion, angiography with or without embolization, nephrostomy tube placement, surgery, nephrectomy, hospitalization, intensive care unit admission, dialysis, and survival, were noted. Renal function may be moderately diminished in the short-term periprocedural setting. None of the patients studied died or required nephrectomy or the initiation of dialysis as a result of a major bleeding complication after the renal biopsy.
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24
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Feng S, Gao Y, Yin D, Lv L, Wen Y, Li Z, Wang B, Wu M, Liu B. Identification of Lumican and Fibromodulin as Hub Genes Associated with Accumulation of Extracellular Matrix in Diabetic Nephropathy. Kidney Blood Press Res 2021; 46:275-285. [PMID: 33887734 DOI: 10.1159/000514013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/22/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy (DN) remains a major cause of end-stage renal disease. The development of novel biomarkers and early diagnosis of DN are of great clinical importance. The goal of this study was to identify hub genes with diagnostic potential for DN by weighted gene co-expression network analysis (WGCNA). METHODS Gene Expression Omnibus database was searched for microarray data including distinct types of CKD. Gene co-expression network was constructed, and modules specific for DN were identified by WGCNA. Gene ontology (GO) analysis was performed, and the hub genes were screened out within the selected gene modules. In addition, cross-validation was performed in an independent dataset and in samples of renal biopsies with DN and other types of glomerular diseases. RESULTS Dataset GSE99339 was selected, and a total of 179 microdissected glomeruli samples were analyzed, including DN, normal control, and 7 groups of other glomerular diseases. Twenty-three modules of the total 10,947 genes were grouped by WGCNA, and a module was specifically correlated with DN (r = 0.54, p = 9e-15). GO analysis showed that module genes were mainly enriched in the accumulation of extracellular matrix (ECM). LUM, ELN, FBLN1, MMP2, FBLN5, and FMOD were identified as hub genes. Cross verification showed LUM and FMOD were higher in the DN group and were negatively correlated with estimated glomerular filtration rate (eGFR). In renal biopsies, expression levels of LUM and FMOD were higher in DN than IgA nephropathy, membranous nephropathy, and normal controls. CONCLUSION By using WGCNA approach, we identified LUM and FMOD related to ECM accumulation and were specific for DN. These 2 genes may represent potential candidate diagnostic biomarkers of DN.
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Affiliation(s)
- Songtao Feng
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yueming Gao
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Di Yin
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Linli Lv
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Yi Wen
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Zuolin Li
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Bin Wang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Min Wu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Bicheng Liu
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
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25
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Özdemir-Şimşek Ö, Kasap-Demir B, Erfidan G, Arslansoyu-Çamlar S, Soyaltın E, Alaygut D, Mutlubaş F. Severe abdominal pain in a case with lupus nephritis: Answers. Pediatr Nephrol 2021; 36:875-879. [PMID: 32749540 DOI: 10.1007/s00467-020-04675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Özgür Özdemir-Şimşek
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Belde Kasap-Demir
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
- Department of Pediatrics, Division of Pediatric Nephrology and Rheumatology, İzmir Katip Çelebi University, Izmir, Turkey.
| | - Gökçen Erfidan
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Seçil Arslansoyu-Çamlar
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Eren Soyaltın
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Demet Alaygut
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatrics, Division of Nephrology, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey
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Matsumoto T, Yanagihara T, Yoshizaki K, Tsuchiya M, Terasaki M, Nagahama K, Shimizu A, Kunishima S, Maeda M. Renal Biopsy-induced Hematoma and Infection in a Patient with Asymptomatic May-Hegglin Anomaly. J NIPPON MED SCH 2021; 88:579-584. [PMID: 33692298 DOI: 10.1272/jnms.jnms.2021_88-609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The May-Hegglin anomaly is characterized by inherited thrombocytopenia, giant platelets, and leukocyte cytoplasmic inclusion bodies. The Fechtner, Sebastian, and Epstein syndromes are associated with mutations of the MYH9-coding nonmuscle myosin heavy chain ⅡA, similar to the May-Hegglin anomaly, and are together classified as MYH9 disorders. MYH9 disorders may include symptoms of Alport syndrome, including nephritis and auditory and ocular disorders. A 6-year-old boy was diagnosed with an MYH9 disorder after incidental discovery of hematuria and proteinuria. Focal segmental glomerulosclerosis was detected on renal biopsy. However, despite no prior bleeding diatheses, he developed a large post-biopsy hematoma despite a preprocedural platelet transfusion calculated to increase the platelet count from 54,000/μL to >150,000/μL. Idiopathic thrombocytopenic purpura is a major cause of pediatric thrombocytopenia following acute infection or vaccination, and patients with MYH9 disorders may be misdiagnosed with idiopathic thrombocytopenic purpura and inappropriately treated with corticosteroids. Careful differential diagnosis is important in thrombocytopenic patients with hematuria and proteinuria for the early detection of thrombocytopenia. Patients with MYH9 disorders require close follow-up and treatment with angiotensin Ⅱ receptor blockers to prevent the onset of progressive nephritis, which may necessitate hemodialysis or renal transplantation. The need for renal biopsy in patients with MYH9 disorders should be carefully considered because there could be adverse outcomes even after platelet transfusion.
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Affiliation(s)
- Tae Matsumoto
- Department of Pediatrics, Graduate School of Medicine, Nippon Medical School
| | - Takeshi Yanagihara
- Department of Pediatrics, Graduate School of Medicine, Nippon Medical School
| | - Kaoru Yoshizaki
- Department of Pediatrics, Graduate School of Medicine, Nippon Medical School
| | - Masami Tsuchiya
- Department of Pediatrics, Graduate School of Medicine, Nippon Medical School
| | - Mika Terasaki
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School
| | - Kiyotaka Nagahama
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School
| | - Akira Shimizu
- Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School
| | - Shinji Kunishima
- Department of Advanced Diagnosis, Clinical Research Center, National Hospital Organization Nagoya Medical Center
| | - Miho Maeda
- Department of Pediatrics, Graduate School of Medicine, Nippon Medical School
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27
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Ateş ÖF, Taydaş O, Kara AB, Göktepeli M, Özdemir M. A new predictor of bleeding based on ultrasonographic features in percutaneous liver mass biopsy. Turk J Med Sci 2020; 50:1970-1975. [PMID: 33078606 PMCID: PMC7775694 DOI: 10.3906/sag-2005-338] [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: 11/03/2022] Open
Abstract
Background/aim An ultrasound-guided liver mass biopsy is a method frequently used in determining the diagnosis and treatment plan.The aim of this study was to evaluate the potential new predictors of bleedingbased on ultrasonographic features in liver mass biopsies, which are frequently applied in routine clinical practice. Materials and methods The images and data of patients aged over 18years,who underwent an imaging-guided percutaneous liver mass biopsy between January 2018 and December 2019 with various indications, were retrospectively reviewed. Liver size, liver steatosis status, parenchyma appearance, and mass vascularity on Doppler ultrasonography before the procedure, and hemoglobin (Hb) values before and after the procedure were recorded. Results A total of 176 patients were included in the study. Ninety-six patients were male (54.5%) and 80 were female (45.5%). The mean age of the patients was 64 ± 12.3 years. The mean hemoglobin values of the patients were 11.5 ± 1.9 gr/dL before the procedure and 11.4 ± 1.5 gr/dL after the procedure. While 144 of the patients had less than 10% hemoglobin decrease (81.8%), 32 had more than 10% decrease (8.2%). In 56 patients, a heterogeneous and coarse granular pattern was observed in the liver parenchyma (31.8%). The decrease in the Hb rate was significantly higher in patients with heterogeneous and coarse granular liver parenchyma (8.7%) than in patients with normal parenchyma (6.6%) (P = 0.036). Conclusion In our study, it was shown for the first time in the literature that the ultrasonographic appearance of the liver (heterogeneous and coarse granular parenchyma) may also be one of the parameters that can help to predict the risk of bleeding.
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Affiliation(s)
- Ömer Faruk Ateş
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Onur Taydaş
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ahmet Burak Kara
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Mehmet Göktepeli
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mustafa Özdemir
- Department of Radiology, Kayseri City Hospital, Kayseri, Turkey
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Reece J, Pavlick M, Penninck DG, Webster CRL. Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs. J Vet Intern Med 2020; 34:2398-2404. [PMID: 33125175 PMCID: PMC7694835 DOI: 10.1111/jvim.15942] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).
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Affiliation(s)
- Jonjo Reece
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Michelle Pavlick
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Dominique G Penninck
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
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Bobart SA, Fervenza FC. Kidney Biopsy Is Required for Nephrotic Syndrome with PLA2R+ and Normal Kidney Function: The Con View. KIDNEY360 2020; 1:890-893. [PMID: 35369550 PMCID: PMC8815595 DOI: 10.34067/kid.0003262020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/04/2020] [Indexed: 06/14/2023]
Affiliation(s)
- Shane A. Bobart
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Low Utility of Screening Hematologic Testing for Image-Guided Biopsies in Patients Without Bleeding Risks. AJR Am J Roentgenol 2020; 215:1279-1285. [PMID: 32901565 DOI: 10.2214/ajr.19.22414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This study evaluates the prevalence of an abnormal international normalized ratio (INR) and platelet count before image-guided percutaneous needle biopsies over a 10-year period, comparing data from patients with and those without known conditions predisposing to coagulopathy. MATERIALS AND METHODS. A review of electronic medical records identified patients who were scheduled for a biopsy in a single institution's radiology department for the period of 2007-2016. The following information was recorded: demographic data, patient history of conditions that predispose to bleeding (e.g., liver disease, anticoagulant therapy, history of coagulopathy), and INR and platelet values within 30 days before biopsy. Data were stratified by biopsies that were performed versus those that were cancelled. RESULTS. Over 10 years, 3864 percutaneous biopsies were performed, and 6371 were cancelled. Approximately half of the biopsies (48.2%) were performed in patients without a predisposing condition; of those patients, 0.8% and 0.1% had an INR greater than 1.5 and greater than 1.8, respectively, and 0.4% had a platelet count of 50,000/μL or less (≤ 50 × 109/L). In patients with no known predisposing condition, 0.6% and 0.0% of biopsies cancelled were in patients who had an INR greater than 1.5 and greater than 1.8, respectively, and 0.1% of biopsies cancelled were in patients who had a platelet count of 50,000/μL or less. Ordering prebiopsy testing of patients with no predisposing conditions for the 1864 percutaneous biopsies performed over the 10-year study period resulted in more than $850,000 in laboratory-related health care costs. Our results suggest that the cost of identifying one abnormal INR is nearly $700,000. CONCLUSION. For patients without any known bleeding risks who are scheduled to undergo image-guided percutaneous biopsies, identifying an abnormal INR or abnormal platelet count is rare. Eliminating this testing in patients without predisposing conditions has the potential to create savings in costs and time for both physicians and patients.
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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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A new complication registration system for errors in radiology: Initial 5-year experience in a tertiary care radiology department. Eur J Radiol 2020; 130:109167. [PMID: 32682253 DOI: 10.1016/j.ejrad.2020.109167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/12/2020] [Accepted: 07/05/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe and evaluate our initial 5-year experience with a new complication registration system for errors in radiology. MATERIALS AND METHODS This study reviewed all cases that were submitted to a new complication registration system of a tertiary care radiology department between 2015-2019. RESULTS Sixty-seven cases were included. In the group of diagnostic complications/errors (n = 34), there were 21 perceptual errors and 13 cognitive errors. This 61.8 % (21/34) perceptual error rate was not significantly different (P = 0.297) from the 70 % perceptual error rate known from previous literature. In the group of interventional complications (n=19), most cases (47.4 % [9/19]) concerned symptomatic or major hemorrhage. In the group of organizational complications/errors (n=14), the leading incident type according to the International Classification System for Patient Safety was clinical process/procedure with wrong body part/side/site as subclassification (35.7 % [5/14]). Harm severities were none (n=35), mild (n=10), moderate (n=10), severe (n=6), death (n=5), and unknown (n=1). Harm severity of interventional complications was significantly higher (P < 0.05) than that of organizational complications, while there were no significant differences in harm severities between other groups of complications. CONCLUSION It is feasible to implement the radiologic complication registration system that was described in this study. Perceptual mistakes, hemorrhage, and procedures on the wrong body part/side/site dominated in the categories of diagnostic, interventional, and organizational complications/errors, respectively, and these should be the topic of vigilance in clinical practice and further research. Future studies are also required to determine whether this complication registration system reduces radiologic errors and improves healthcare quality.
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Gal-Oz A, Papushado A, Kirgner I, Meirsdorf S, Schwartz D, Schwartz IF, Zubkov A, Grupper A. Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy. Ren Fail 2020; 42:10-18. [PMID: 31842662 PMCID: PMC6968702 DOI: 10.1080/0886022x.2019.1700805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Introduction The risk of bleeding has led to screening of the primary hemostasis before renal biopsy. A bleeding time test (BT) is considered standard practice, but reliance on this test is controversial and its benefits remain questionable. A possible alternative is thromboelastography (TEG). However, data regarding TEG in patients with renal dysfunction is limited. Objectives To determine TEG abnormalities and their consequences in patients who underwent a native kidney biopsy. Methods A retrospective study of 417 consecutive percutaneous native renal biopsies performed in our Center. If serum creatinine >1.5 mg/dL, the patient underwent either a BT test (period A, January 2015–31 December 2016) or TEG (period B, January 2017–August 2018). In patients with prolonged BT, or an abnormal low maximal amplitude (MA) parameter of TEG, or suspected clinical uremic thrombopathy, the use of desmopressin acetate (DDAVP) was considered. Results Most biopsies (90.6%) were done by the same dedicated radiologist. Fifty-one patients had a BT test, which was normal in all tested patients. Seventy-one patients underwent TEG, and it was abnormal in 34 of them, most patients had combined abnormalities. The only parameter related to abnormal TEG was older age (Odds Ratio 1.21 [95% CI 1.09–2.38] p = 0.04 for abnormal Kinetics; OR 1.37 (1.05–1.96) p = 0.037 for abnormal MA). Twenty-six patients (6.23%) had bleeding complications. Risk of bleeding was significantly related to age (1.4 [1.11–7.48] p = 0.04), systolic blood pressure (1.85 [1.258–9.65] p = 0.02), and serum creatinine (1.21 [1.06–3.134] p = 0.048). Conclusions TEG abnormalities in patients with renal dysfunction are variable and fail to predict bleeding during kidney biopsy. The decision to administer DDAVP as a preventive measure during these procedures should be based on clinical judgment only.
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Affiliation(s)
- Amir Gal-Oz
- ICU Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amitay Papushado
- Department of Internal Medicine "B", Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilya Kirgner
- Hematology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Meirsdorf
- Radiology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Idit Francesca Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Asia Zubkov
- Pathology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Grupper
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Nelson SM, Hoskins JD, Lisanti C, Chaudhuri J. Ultrasound Fatty Liver Indicator: A Simple Tool for Differentiating Steatosis From Nonalcoholic Steatohepatitis: Validity in the Average Obese Population. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:749-759. [PMID: 31647137 DOI: 10.1002/jum.15154] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis/cirrhosis represent a spectrum of fatty liver disease. The ultrasound fatty liver indicator (US-FLI) evaluates ultrasound (US) features to identify stages of fatty liver disease. We hypothesized that US features could be independent predictors of NASH and that the US-FLI differentiates steatosis from NASH in the average obese population. METHODS A retrospective analysis of 208 patients with normal (n = 14), steatotic (n = 89), and NASH (n = 105) livers was performed. Liver/biliary disease and a history of alcohol intake were excluded. Ultrasound metrics included liver-kidney contrast, posterior attenuation, vessel blurring, difficulty visualizing the gallbladder wall, difficulty visualizing the diaphragm, and areas of focal fatty sparing. A statistical comparison of the 3 groups as well as fibrosis stage I and II/III NASH groups was performed. Logistic regression identified independent predictors of NASH. RESULTS Gallbladder wall visualization and vessel blurring were different between the steatosis and NASH groups (P ≤ .01). Gallbladder wall visualization was specific for NASH (89%), and vessel blurring was sensitive for NASH (93%). A US-FLI score of 4 or lower suggested the absence of NASH (negative predictive value, 88%; sensitivity, 91%). Logistic regression revealed vessel blurring as the only US predictor of NASH (P ≤ .01). However, the area under the curve (0.649) showed poor performance in differentiating steatosis from NASH when the US-FLI score was 5 or higher. CONCLUSIONS Our data suggest that the US-FLI may differentiate steatosis from NASH in the average obese population. Vessel blurring and poor gallbladder wall visualization were the most important metrics. Identification of NASH was enhanced by including the US-FLI score with vessel blurring.
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Affiliation(s)
- Steve M Nelson
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Jason D Hoskins
- Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- David Grant Medical Center, Travis Air Force Base, Fairfield, California, USA
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Çildağ MB, Gök M, Abdullayev O. Pre-procedural shear wave elastography on prediction of hemorrhage after percutaneous real-time ultrasound-guided renal biopsy. Radiol Med 2020; 125:784-789. [PMID: 32200456 DOI: 10.1007/s11547-020-01176-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/16/2020] [Indexed: 03/30/2024]
Abstract
PURPOSE To evaluate the relationship between renal elasticity which was determined with shear wave elastography (SWE) and hemorrhage in patients who undergone percutaneous renal parenchyma biopsy (PRB). MATERIALS AND METHODS In total, 60 patients who were performed ultrasound-guided PRB after the B-mode ultrasonography and SWE assessment were recruited in this study. All patients' serum creatinine, blood urea nitrogen and coagulation tests before PRB were obtained from medical records. The patients were divided into two groups who did and did not develop hemorrhage after PRB. We investigated whether there was any statistically significant difference between the two groups in terms of laboratory findings, B-mode ultrasonographic measurements and SWE measurements. RESULTS Of the 60 patients, 23 (38.3%) had post-procedure hemorrhage and 37 (61.7%) had not. Mean hemorrhage size was 17.04 mm (7-50 mm). The mean value of renal cortical shear wave velocity of all patients was 1.91 m/s (0.96-3.57 m/sn). Patients with post-procedure hemorrhage had significantly lower mean shear wave velocity compared with patients with no hemorrhage (p < 0.05). ROC curve analysis suggested that the optimum SWV cutoff point for hemorrhage presence was 1.21 m/sn, with 39.1% sensitivity and 97.3% specificity. There was no other statistically significant demographic, ultrasonographic or laboratory value differences between two groups. CONCLUSION Although shear wave velocities have low sensitivity for hemorrhage after renal biopsy, high specificity and statistically significant difference in hemorrhage and non-hemorrhage group suggest that patients who have lower renal cortical shear wave velocity have a tendency to hemorrhage after PRB.
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Affiliation(s)
- Mehmet Burak Çildağ
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey.
| | - Mustafa Gök
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey
| | - Oguz Abdullayev
- Department of Diagnostic and Interventional Radiology, Adnan Menderes University, Aydın, 09100, Turkey
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McDonald J, Amirabadi A, Farhat Z, Temple M, Parra D, Amaral J, Connolly B. Experience with Compressed Gelfoam Plugs in Children during Liver Biopsies and Other IR Procedures: A Retrospective Single-Center Case Series. J Vasc Interv Radiol 2019; 30:1855-1862. [DOI: 10.1016/j.jvir.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/09/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022] Open
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Lewis JI, Patel NJ, Williams EA, Bowman AW. Prophylactic Intravenous Access: Is It Necessary for Renal Transplant Biopsies? Curr Probl Diagn Radiol 2019; 50:156-158. [PMID: 31611010 DOI: 10.1067/j.cpradiol.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Percutaneous renal transplant biopsies have long been a safe and effective procedure with bleeding being the most common significant complication. Only a few studies, however, have addressed the need for intravenous access prior to the procedure. OBJECTIVES We postulate that the number of patients requiring intravenous resuscitation after a routine renal transplant biopsy is sufficiently low enough to prove that eliminating pre-procedural peripheral IV placement will have no negative impact on patient safety and could improve departmental efficiency. METHODS This is a retrospective analysis of complications that occurred in patients who underwent routine percutaneous renal transplant biopsies at an academic center. Patients were divided into two groups: the IV cohort that had peripheral IV access placed before the procedure (n=1318) and the no-IV cohort that did not (n=492). RESULTS This is a retrospective analysis of complications that occurred in patients who underwent routine percutaneous renal transplant biopsies at an academic center. Patients were divided into two groups: the IV cohort that had peripheral IV access placed before the procedure (n=1318) and the no-IV cohort that did not (n=492). CONCLUSIONS Placement of prophylactic peripheral IV access in patients undergoing routine renal transplant biopsies does not significantly impact the rate of biopsy complications.
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Affiliation(s)
- Jacob I Lewis
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | - Neema J Patel
- Department of Radiology, Mayo Clinic, Jacksonville, FL
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Percutaneous Kidney Biopsy and the Utilization of Blood Transfusion and Renal Angiography Among Hospitalized Adults. Kidney Int Rep 2019; 4:1435-1445. [PMID: 31701053 PMCID: PMC6829181 DOI: 10.1016/j.ekir.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Data on percutaneous kidney biopsy (KBx) incidence and frequencies of hemorrhagic complications among inpatients are limited. Methods Using nationally representative US hospitalization discharge data, we report temporal trends in inpatient KBx rates from 2007 to 2014 and estimate frequencies of, and risk factors for, utilization of packed red blood cell (pRBC) transfusion and renal angiography. Results From 2007 to 2014, rates of native KBx among adult inpatients increased from 8.2 to 10.0 per 100,000, while transplant KBx rates declined from 3.6 to 3.1 per 100,000. We studied 35,183 and 14,266 discharge records with native and transplant KBx. We found that 5.7% (95% confidence interval [CI]: 5.3%–6.0%) of inpatients undergoing native KBx and 4.9% (4.2%–5.5%) of those undergoing transplant KBx received a pRBC transfusion within 2 days of biopsy. Similarly, 0.6% (0.5%–0.7%) of inpatients undergoing native KBx and 0.4% (0.2%–0.5%) undergoing transplant KBx received a renal angiogram within 2 days of KBx. For inpatient native KBx, female sex, older age, higher chronic kidney disease stage, acute renal failure, lupus, vasculitis, cirrhosis, multiple myeloma/paraproteinemia, and anemia of chronic disease were independently associated with increased odds of pRBC transfusion; cirrhosis and end-stage renal disease (ESRD) were associated with increased odds, and nephrotic syndrome was associated with decreased odds, of renal angiography. Conclusions In this large population-based study of inpatient KBx practices, we demonstrate increasing rates of inpatient native KBx among US adults and provide accurate estimates of the frequencies of, and risk factors for, pRBC transfusion and renal angiography following inpatient KBx.
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Pavlick M, Webster CRL, Penninck DG. Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats. J Feline Med Surg 2019; 21:529-536. [PMID: 30099964 PMCID: PMC10814532 DOI: 10.1177/1098612x18788883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. METHODS The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. RESULTS All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. CONCLUSIONS AND RELEVANCE PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.
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Affiliation(s)
- Michelle Pavlick
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Cynthia RL Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Dominique G Penninck
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
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Bräsen JH, Mederacke YS, Schmitz J, Diahovets K, Khalifa A, Hartleben B, Person F, Wiech T, Steenbergen E, Großhennig A, Manns MP, Schmitt R, Mederacke I. Cholemic Nephropathy Causes Acute Kidney Injury and Is Accompanied by Loss of Aquaporin 2 in Collecting Ducts. Hepatology 2019; 69:2107-2119. [PMID: 30633816 DOI: 10.1002/hep.30499] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/22/2018] [Indexed: 02/07/2023]
Abstract
Impairment of renal function often occurs in patients with liver disease. Hepatorenal syndrome is a significant cause of acute kidney injury (AKI) in patients with cirrhosis (HRS-AKI, type 1). Causes of non-HRS-AKI include cholemic nephropathy (CN), a disease that is characterized by intratubular bile casts and tubular injury. As data on patients with CN are obtained primarily from case reports or autopsy studies, we aimed to investigate the frequency and clinical course of CN. We identified 149 patients who underwent kidney biopsy between 2000 and 2016 at the Department of Gastroenterology, Hepatology and Endocrinology at Hannover Medical School. Of these, 79 had a history of liver disease and deterioration of renal function. When applying recent European Association for the Study of the Liver criteria, 45 of 79 patients (57%) presented with AKI, whereas 34 patients (43%) had chronic kidney disease (CKD). Renal biopsy revealed the diagnosis of CN in 8 of 45 patients with AKI (17.8%), whereas none of the patients with CKD was diagnosed with CN. Univariate analysis identified serum bilirubin, alkaline phosphatase, and urinary bilirubin and urobilinogen as predictive factors for the diagnosis of CN. Histological analysis of AKI patients with normal bilirubin, elevated bilirubin, and the diagnosis of CN revealed loss of aquaporin 2 (AQP2) expression in collecting ducts in patients with elevated bilirubin and CN. Biopsy-related complications requiring medical intervention occurred in 4 of 79 patients (5.1%). Conclusion: CN is a common finding in patients with liver disease, AKI, and highly elevated bilirubin. Loss of AQP2 in AKI patients with elevated bilirubin and CN might be the result of toxic effects of cholestasis and in part be responsible for the impairment of renal function.
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Affiliation(s)
- Jan Hinrich Bräsen
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Young-Seon Mederacke
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Jessica Schmitz
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Kateryna Diahovets
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Abedalrazag Khalifa
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Björn Hartleben
- Institute of Pathology, Nephropathology Unit, Hannover Medical School, Hannover, Germany
| | - Fermín Person
- Institute of Pathology and Nephropathology Section, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Thorsten Wiech
- Institute of Pathology and Nephropathology Section, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Eric Steenbergen
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anika Großhennig
- Institute for Biostatistics, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Roland Schmitt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Ingmar Mederacke
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
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41
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Hasegawa J, Hoshino J, Sekine A, Hayami N, Suwabe T, Sumida K, Mise K, Ueno T, Yamanouchi M, Hazue R, Sawa N, Ohashi K, Fujii T, Takaichi K, Ubara Y. Clinical and pathological features of anti-neutrophil cytoplasmic antibody-associated vasculitis in patients with minor urinary abnormalities. Nephrology (Carlton) 2019; 23:1007-1012. [PMID: 28834647 DOI: 10.1111/nep.13157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2017] [Indexed: 12/01/2022]
Abstract
AIM Kidney biopsy is the gold standard for diagnosis of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), but it is unknown whether vasculitis can be detected from AAV patients with minor urinary abnormalities. METHODS Ninety ANCA-positive patients undergoing kidney biopsy were evaluated retrospectively after being divided into two groups, which were group A (minor urinary abnormalities with both proteinuria <0.5 g/day and red blood cells ≤5/high power field) and group B (major urinary abnormalities except group A). RESULTS Thirteen patients were included in group A and 77 patients were in group B. Crescentic glomeruli were detected less frequently in group A than in group B (61.5% vs. 92.2%, P < 0.01). The percentage of crescentic glomeruli relative to total glomeruli was significantly lower in group A than in group B (median [interquartile range]; 2.7% [0-5.2%] vs. 27.3% [8.1-56.1%], P < 0.01). Vasculitis of the small renal arteries was detected more frequently in group A than in group B without significant difference (30.8% vs. 19.5%, P = 0.46). Overall renal vasculitis (crescentic glomeruli and/or small renal artery vasculitis) was detected less frequently in group A than in group B (69.2% vs. 92.2%, P = 0.03). CONCLUSIONS These findings indicate that renal biopsy can be a useful tool for histological diagnosis of ANCA-associated vasculitis in ANCA-positive patients with minor urinary abnormalities, even though the rate of renal vasculitis to the total number of glomeruli sampled is lower in patients with minor urinary abnormalities than patients with major abnormalities.
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Affiliation(s)
- Jumpei Hasegawa
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan.,Department of Nephrology, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, Japan
| | | | | | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | | | | | - Koki Mise
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | | | | | - Ryo Hazue
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Kanagawa, Japan.,Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Kanagawa, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Kanagawa, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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42
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Welch BT, Packard AT, Atwell TD, Johnson GB, Lowe VJ, Karnes RJ, Mynderse LA, Gunderson TM, Park SS, Stish BJ, Evans JD, Kwon ED, Davis BJ, Nathan MA. Percutaneous Image-Guided Nodal Biopsy After 11C-Choline PET/CT for Biochemically Recurrent Prostate Cancer: Imaging Predictors of Disease and Clinical Implications. Adv Radiat Oncol 2019; 4:79-89. [PMID: 30706014 PMCID: PMC6349661 DOI: 10.1016/j.adro.2018.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose Management of recurrent prostate cancer necessitates timely diagnosis and accurate localization of the sites of recurrent disease. The purpose of this study was to assess predictors of histologic outcomes after 11C-choline positron emission tomography/computed tomography (CholPET) to increase the positive predictive value and specificity of CholPET in identifying imaging predictors of malignant and benign nodal disease to better inform clinical decision making regarding local therapy planning. Materials and Methods Retrospective review of patients undergoing CholPET followed by percutaneous core needle biopsy between January 1, 2010 and January 1, 2016. A total of 153 patients were identified who underwent 166 biopsy procedures. Patient, CholPET, procedural, and pathologic characteristics were recorded. Results A total of 157 biopsies were technically successful, and 110 (70.1%; 95% confidence interval, 62.2-77.1) yielded histologic results abnormal for metastatic prostate cancer. Lesion location, lesion maximum standardized uptake value (SUVmax), SUV ratio (calculated as the ratio of SUVmax to SUV mean in the right atrium), prostate-specific antigen, lesion short axis length, total Gleason score, and castration resistance were all associated with abnormal biopsy results (P values <.001, <.001, <.001, .02, .02, .02, and .015, respectively). External iliac, common iliac, and inguinal sites were associated with much lower rates of histologic positivity (mean [95% confidence interval], 51.2% [35.1-67.1], 46.2% [19.2-74.9], and 33.3% [7.5-70.1]), respectively. Conclusions In a cohort of patients in whom core needle biopsy was performed after CholPET, characteristics of choline localization including node location, SUVmax, lesion–to–blood pool SUV ratio, prostate-specific antigen, total Gleason score, and castration resistance were significantly associated with abnormal biopsy results for metastatic disease on CholPET. Relatively high false positive rates were found in common iliac, external iliac, and inguinal lymph node locations. Histologic confirmation of these sites should be strongly considered in the appropriate clinical scenario before designing additional local therapy plans.
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Affiliation(s)
- Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Ann T Packard
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jaden D Evans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Mark A Nathan
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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43
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Guillaud O, Dumortier J, Traclet J, Restier L, Joly P, Chapuis-Cellier C, Lachaux A, Mornex JF. Assessment of liver fibrosis by transient elastography (Fibroscan ®) in patients with A1AT deficiency. Clin Res Hepatol Gastroenterol 2019; 43:77-81. [PMID: 30612958 DOI: 10.1016/j.clinre.2018.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alpha-1-antitrypsin deficiency (A1ATD) is a common genetic condition which predisposes to emphysema and liver disorders. It is estimated that 10-15% of homozygous individuals for the Z allele (PiZZ) may develop liver fibrosis. The optimal modalities to detect liver disease in PiZZ adult patients need to be defined. The aim of this prospective study was to perform a systematic non-invasive evaluation of the liver fibrosis by elastometry using Fibroscan® in a cohort of A1ATD patients with emphysema. METHODS Patients followed in our respiratory unit were enrolled in this prospective study and underwent on the same day a physical examination, a biochemical profiling, an abdominal ultrasound (US) and a Fibroscan®. RESULTS Twenty-nine PiZZ adults (19 male) were included. Median age was 50.4 yrs (21.5-67.2). Median serum A1AT level was 0.20 g/L (0.15-0.33). Liver Function Tests (LFT) were not normal in 2 patients and US was abnormal in 6 patients. Two patients had both abdnormal LFT and US. Fibroscan® was technically feasible in 28/29 (97%) patients. Median liver stiffness was 4.5 kPa (2.8-32.8), and was > 7.2 kPa in 5/28 (18%) and > 14 kPa in 2/28 (7%) patients. Liver stiffness was increased in 2/2 (100%) patients with abnormal LFT and US, in 1/4 (25%) with abnormal LFT or US and in 2/22 (10%) patients with normal LFT and US. CONCLUSIONS Fibroscan® is an easy and repeatable tool which can be used in PiZZ patients to screen for the presence of significant liver fibrosis and to identify patients at higher risk to develop liver complications in the future and who may benefit from a closer surveillance.
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Affiliation(s)
- Olivier Guillaud
- Service d'hépato-gastro-entérologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
| | - Jérôme Dumortier
- Service d'hépato-gastro-entérologie, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - Julie Traclet
- Service de pneumologie, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France.
| | - Lioara Restier
- Service de gastro-entérologie, hépatologie et nutrition pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
| | - Philippe Joly
- Unité de pathologie moléculaire du globule rouge, laboratoire de biochimie et de biologie moléculaire, hôpital Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France.
| | - Colette Chapuis-Cellier
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Laboratoire d'immunologie, centre de biologie Sud, centre hospitalier Lyon-Sud, hospices civils, 69310 Pierre-Bénite, France.
| | - Alain Lachaux
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Service de gastro-entérologie, hépatologie et nutrition pédiatriques, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron, France.
| | - Jean François Mornex
- Service de pneumologie, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France; Université de Lyon, Inra, UMR754, 69007, Lyon, France.
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44
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Bobart SA, De Vriese AS, Pawar AS, Zand L, Sethi S, Giesen C, Lieske JC, Fervenza FC. Noninvasive diagnosis of primary membranous nephropathy using phospholipase A2 receptor antibodies. Kidney Int 2019; 95:429-438. [DOI: 10.1016/j.kint.2018.10.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 01/23/2023]
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45
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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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46
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Takeuchi Y, Ojima Y, Kagaya S, Aoki S, Nagasawa T. Manual compression and reflex syncope in native renal biopsy. Clin Exp Nephrol 2018; 22:1100-1107. [PMID: 29542049 PMCID: PMC6154117 DOI: 10.1007/s10157-018-1560-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/05/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Complications associated with diagnostic native percutaneous renal biopsy (PRB) must be minimized. While life threatening major complications has been extensively investigated, there is little discussion regarding minor bleeding complications, such as a transient hypotension, which directly affect patients' quality of life. There is also little evidence supporting the need for conventional manual compression following PRB. Therefore, this study evaluated the relationship between minor and major complications incidence in patients following PRB with or without compression. METHODS This single-center, retrospective study included 456 patients (compression group: n = 71; observation group: n = 385). The compression group completed 15 min of manual compression and 4 h of subsequent strict bed rest with abdominal bandage. The observation group completed 2 h of strict bed rest only. The primary outcome of interest was transient symptomatic hypotension (minor event). RESULTS Of the 456 patients, 26 patients encountered intraoperative and postoperative transient hypotension, which were considered reflex syncope without tachycardia. Univariate analysis showed that symptomatic transient hypotension was significantly associated with compression. This association remained significant, even after adjustment of covariates using multivariate logistic regression analysis (adjusted odds ratio 3.27; 95% confidential interval 1.36-7.82; P = 0.0078). CONCLUSION Manual compression and abdominal bandage significantly increased the frequency of reflex syncope during native PRB. It is necessary to consider the potential benefit and risk of compression maneuvers for each patient undergoing this procedure.
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Affiliation(s)
- Yoichi Takeuchi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, Nishimichishita-71 Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
| | - Yoshie Ojima
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, Nishimichishita-71 Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Saeko Kagaya
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, Nishimichishita-71 Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Satoshi Aoki
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, Nishimichishita-71 Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Tasuku Nagasawa
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, Nishimichishita-71 Hebita, Ishinomaki, Miyagi, 986-8522, Japan
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47
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Bleeding Complications After Percutaneous Liver Biopsy: Do Subcapsular Lesions Pose a Higher Risk? AJR Am J Roentgenol 2018; 211:204-210. [DOI: 10.2214/ajr.17.18726] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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48
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Winfree S, Dagher PC, Dunn KW, Eadon MT, Ferkowicz M, Barwinska D, Kelly KJ, Sutton TA, El-Achkar TM. Quantitative Large-Scale Three-Dimensional Imaging of Human Kidney Biopsies: A Bridge to Precision Medicine in Kidney Disease. Nephron Clin Pract 2018; 140:134-139. [PMID: 29870980 DOI: 10.1159/000490006] [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: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022] Open
Abstract
Kidney biopsy remains the gold standard for uncovering the pathogenesis of acute and chronic kidney diseases. However, the ability to perform high resolution, quantitative, molecular and cellular interrogation of this precious tissue is still at a developing stage compared to other fields such as oncology. Here, we discuss recent advances in performing large-scale, three-dimensional (3D), multi-fluorescence imaging of kidney biopsies and quantitative analysis referred to as 3D tissue cytometry. This approach allows the accurate measurement of specific cell types and their spatial distribution in a thick section spanning the entire length of the biopsy. By uncovering specific disease signatures, including rare occurrences, and linking them to the biology in situ, this approach will enhance our understanding of disease pathogenesis. Furthermore, by providing accurate quantitation of cellular events, 3D cytometry may improve the accuracy of prognosticating the clinical course and response to therapy. Therefore, large-scale 3D imaging and cytometry of kidney biopsy is poised to become a bridge towards personalized medicine for patients with kidney disease.
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Affiliation(s)
- Seth Winfree
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Integrative and Cellular Physiology, Indiana University, Indianapolis, Indiana, USA
| | - Pierre C Dagher
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Integrative and Cellular Physiology, Indiana University, Indianapolis, Indiana, USA.,Indianapolis VA Medical Center, Indianapolis, Indiana, USA
| | - Kenneth W Dunn
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael T Eadon
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Ferkowicz
- Department of Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Daria Barwinska
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Katherine J Kelly
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Timothy A Sutton
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tarek M El-Achkar
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Integrative and Cellular Physiology, Indiana University, Indianapolis, Indiana, USA.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Indianapolis VA Medical Center, Indianapolis, Indiana, USA
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49
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Kriegshauser JS, Osborn HH, Naidu SG, Huettl EA, Patel MD. Developing Interventional Radiology Anticoagulation Guidelines: Process and Benefits †. J Clin Med 2018; 7:jcm7040085. [PMID: 29677117 PMCID: PMC5920459 DOI: 10.3390/jcm7040085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 03/30/2018] [Accepted: 04/17/2018] [Indexed: 01/22/2023] Open
Abstract
We created, posted, and updated radiology department anticoagulation guidelines and identified various steps in the process, including triggering events, consensus building, legal analysis, education, and distribution of the guidelines to nurses and clinicians. Supporting data collected retrospectively, before and after implementation, included nursing satisfaction survey results and the number of procedure cancellations. After the guidelines were developed and posted, significantly fewer procedures were cancelled, nursing satisfaction was higher, and radiologists performed procedures with less variability. Anecdotally, radiologists had fewer queries about anticoagulation. The development and dissemination of radiologic procedure anticoagulation guidelines should be considered as a departmental quality improvement project.
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Affiliation(s)
- J Scott Kriegshauser
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Howard H Osborn
- Department of Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
| | - Sailen G Naidu
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Eric A Huettl
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
| | - Maitray D Patel
- Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
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50
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Takeuchi Y, Ojima Y, Kagaya S, Aoki S, Nagasawa T. Unexpected delayed bleeding after native renal biopsy: a case report. CEN Case Rep 2017; 7:9-12. [PMID: 29127651 DOI: 10.1007/s13730-017-0280-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022] Open
Abstract
Percutaneous native renal biopsy is recognized as a safe procedure. The majority of bleeding events occur within 24 h after the procedure, and reports of delayed major complications are very limited. We report a patient presenting with sudden flank pain 7 days after renal biopsy, in whom abdominal computed tomography showed increased hematoma size with extravasation and who was treated with radiological intervention. Careful attention should be paid to diagnose and treat delayed major complications in patients undergoing native renal biopsy.
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Affiliation(s)
- Yoichi Takeuchi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan.
| | - Yoshie Ojima
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Saeko Kagaya
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Satoshi Aoki
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan
| | - Tasuku Nagasawa
- Division of Nephrology, Department of Medicine, Japanese Red Cross Ishinomaki Hospital, 71 Nishimichishita, Hebita, Ishinomaki, Miyagi, 986-8522, Japan
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