Percutaneous Native Renal Biopsy Adequacy: A Successful Interdepartmental Quality Improvement Activity

Abstract

BackgroundAn adequate renal biopsy is essential for diagnosis and treatment of medical renal disease.ObjectiveWe evaluated two initiatives to improve adequacy of renal biopsy samples at our centre.DesignRetrospective determination of renal biopsy adequacy.SettingQueen Elizabeth II Health Sciences Centre.PatientsPatients undergoing medical renal biopsies.MeasurementsRenal biopsy adequacy.MethodsThe first initiative was to restrict the performance of biopsies to a smaller group of radiologists and to include a comment on biopsy adequacy in every pathology report. The second initiative was to introduce on-site adequacy assessment by a medical laboratory technologist. Native renal and allograft biopsy adequacies were calculated for three periods: 1) baseline, October 2005 to September 2006; 2) after implementation of the first initiative, January 2007 to September 2011; and 3) after implementation of the second initiative, October 2011 to September 2012. A subset of native renal biopsies was examined to determine if there was a relationship between adequacy and number of passes.ResultsThe percentages of adequate native renal biopsies during the first, second, and third periods were 31%, 72% and 90%, respectively. This represents a significant increase (40%, p < 0.0001) in adequacy following the first initiative, and another significant increase (18%, p = 0.0003) following the second initiative. The percentages of adequate renal allograft biopsies during the first, second, and third periods were 75%, 56% and 69%, respectively. These changes in adequacy were not statistically significant. In the subset of native renal biopsies examined, a biopsy comprising more than three cores was not associated with increase in adequacy.LimitationsThe most important limitation is the lack of generally accepted and applied adequacy criteria limiting generalizability of our findings.ConclusionsRestricting the performance of biopsies to subspecialist operators, including an adequacy statement in the renal biopsy report and on-site adequacy assessment were effective in significantly improving native renal biopsy adequacy. This improvement appeared unrelated to an increase in the number of passes taken with a biopsy needle. Neither initiative improved the low adequacy of allograft biopsies.

Spectrum of glomerular diseases in native kidneys in patients attending Nepal Medical College Teaching Hospital

“…of glomeruli, it is said that for a good interpretation of renal tissue, a sample should have atleast 10 glomeruli. 17 Waldo B et al showed in their study that absence of perinephric bleeding within an hour of post biopsy was predictive of an uncomplicated course while the presence of a perinephric haematoma was not reliably predictive of a clinically significant complication post-renal biopsy. 18 We routinely did post renal biopsy USG to look for any complications but after 24 hrs of biopsy in our cases.…”

CT-guided Native Medical Renal Biopsy: Cortical Tangential versus Non-Tangential Approaches—A Comparison of Efficacy and Safety

“…For example, antiglomerular basement membrane disease (Goodpasture syndrome) and dense deposit disease are two diagnoses overlooked without IF and EM, respectively. As a result, the classification criteria previously described by Geldenhuys et al (12) theoretically may not directly correlate with whether a pathologic diagnosis can be rendered clinically. Practically, however, of the 10 patients who required a repeat biopsy, none satisfied the utilized numeric criteria of adequacy, a finding that lends credibility to said criteria.…”

“…Our study also differs in the pathologic criteria used to assess sample adequacy. Most previous studies base sample adequacy on whether the pathologist was able to render a diagnosis, a subjective standard (12). The numeric criterion utilized in our study is a more stringent and objective criterion, not dependent on an institution's pathology department.…”

“…The electronic medical record (EMR) and picture archiving and communication system (PACS) imaging data for each biopsy were reviewed, reporting in native medical renal biopsies (10,11). A criteria for defining the adequacy of medical renal biopsy based on the number of glomeruli have been previously described by Geldenhuys et al (12).…”

A retrospective analysis of the utility and safety of kidney transplant biopsies by nephrology trainees and consultants

“…Most of the biopsies contained glomeruli but using the relatively strict Banff criteria about a third of biopsies contained a technically inadequate number of glomeruli [ 10 ]. A quality improvement project aimed at improving transplant biopsy adequacy noted a biopsy inadequacy rate of about 25–30% that was not improved by restricting biopsies to a smaller number of radiologists, labelling biopsy reports with specimen adequacy or immediate examination of cores at the bedside by microscopy [ 13 ]. Another study of transplant biopsy adequacy attained a lower mean number of glomeruli per biopsy (9) with 70% of biopsy containing more than 7 glomeruli and 1 artery [ 9 ].…”