Comparison of yield and complications of craniocaudal versus caudocranial needle trajectory for kidney biopsy

Abstract

Background: Percutaneous renal biopsy can result in serious complications. The study is aimed to compare the safety and yield between the two approaches of biopsy techniques: the conventional craniocaudal and the caudocranial trajectory of the biopsy needle under real-time ultrasound guidance. Methods: In this prospective observational study, a total of 80 serial kidney biopsies were performed, 40 with craniocaudal angulation and 40 with caudocranial angulation of the biopsy needle on the random allocation of 1:1 in each group. In the craniocaudal approach, the patient must hold the breath in deep inspiration to make a lower pole of the kidney approachable during unloading the biopsy gun, which was not required in caudocranial trajectory as the lower pole was approachable without holding the breath in deep inspiration. All kidney biopsies were performed percutaneously under real-time ultrasonogram guidance with a 16-cm-long, 16- or 18-gauge needles with a penetration depth of 22 mm and a sample notch of 18 mm. The yield and complications between the two groups were analyzed. Results: Both the groups were comparable in essential demographic characteristics. The study found that the caudocranial position of renal biopsy is equally suitable concerning tissue yield without any increase in the risk of complications and a smaller number of passes to obtain adequate tissue. Conclusion: Caudocranial trajectory of the biopsy needle using a probe needle guide is as safe as the craniocaudal approach. Both approaches have similar yield and complications; however, the caudocranial approach provides ease to the patient during the procedure.

Glomeruli Count and Arterial Injury in Real-Time Ultrasound-Guided Needle Kidney Biopsy Specimens: Adequacy of Three Approaches for Pig Kidneys

“…In a previous study comparing the craniocaudal approach and the angled tangential approach (i.e., the vertical approach used in this study), the angled tangential approach collected significantly more glomeruli [20]. In several studies comparing the caudocranial and craniocaudal approaches, there was no significant difference in the number of glomeruli collected [16, 26]. Our study differed from previous reports in that all approaches were performed on the same kidney and our results were similar; there was no significant difference between the caudocranial and craniocaudal approaches, and the vertical approach yielded significantly more glomeruli than the other two approaches.…”

“…Three main approaches to kidney biopsy are commonly usednamely, puncturing the lower pole toward the cranial side, puncturing the lower pole toward the caudal side, and puncturing the surface cortex of the lower pole of the kidney. To date, several reports have presented the advantages of each approach [14][15][16][17] and have evaluated their postoperative bleeding risk. However, these studies were not performed on the same kidney; it is not ethical in clinical practice to use different approaches at the same time on a single individual.…”

Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial

“… 5 Other retrospective and prospective observational studies revealed the caudal angulation needle approach under real-time ultrasonogram guidance in obtaining cortical tissue from the lower pole of the native kidney as an effective technique with very few complications. 6 , 7 Hence, our study is the first human RCT that compared CD to CN in native kidney biopsy.…”

“…The key exclusion criteria were (1) patients who underwent a kidney transplant, (2) serum creatinine of >3.5 mg/dL for 3 months, (3) small-size kidneys (length of <8 cm, width of <3.5 cm), (4) coagulopathy and/or thrombocytopenia, (5) uncontrolled hypertension (>160/100 mmHg), ( 6) obesity (body mass index [BMI] of >35 kg/m 2 ), (7) single kidney, and (8) refusal to sign the inform consent. The full exclusion list was announced at the Thai Clinical Trial Registry (TCTR20170706001: https://www.thaiclinicaltrials.org/show/TCTR20170706001).…”

“… 5 Other retrospective and prospective observational studies revealed that the CD biopsy technique is safe and effective. 6 , 7 However, this was not confirmed by human randomized controlled trials (RCTs). Thus, this study aims to compare the efficacy and complications of CN versus CD biopsy techniques.…”