Percutaneous Renal Biopsy of Native Kidneys: A Single-Center Experience of 1,055 Biopsies

Abstract

Background: Percutaneous renal biopsy (PRB) of native kidneys is an essential tool in the diagnosis and management of renal disease. We report one of the largest single-center experiences on the success and safety of the procedure. Methods: From June 1983 to March 2012, 1,055 adults underwent PRB using real-time ultrasound guidance and 14-gauge biopsy needles. Data were collected prospectively for 826 biopsies (78%). Statistical analysis was performed using the Mann-Whitney test, Wilcoxon matched pairs test and Kruskal-Wallis test for continuous data or the Fisher's exact test and χ² test for categorical data. Multivariate analysis using logistic regression was performed to determine which feature at baseline was predictive of a complication following renal biopsy. Results: Patients were aged 46 ± 17 years; 38% were male, 40% were white and 43% were African-American. Serum creatinine (SCr) was 2.3 ± 2.3 mg/dl (>1.5 mg/dl in 47%). The pre-PRB hemoglobin was 12 ± 2 g/dl (<11.0 g/dl in 35%). Adequate tissue for diagnosis was obtained in 99% of biopsies. Minor complications occurred in 8.1% of biopsies (mainly gross hematuria, in 4.5%). Major complications occurred in 6.6% of biopsies, with transfusions required in 5.3%. Only 1 death (0.09%) resulted from post-PRB bleeding. By multivariate analysis, baseline features predictive of a complication were systolic blood pressure >170 mm Hg (OR 4.2, 95% CI 1.8-9.8), bleeding time >7.5 min (OR 1.7, CI 1.2-2.5) and SCr >3.5 mg/dl (OR 1.8, CI 1.2-2.9). Conclusions: PRB of native kidneys using real-time ultrasound with a 14-gauge automated needle remains a successful and safe procedure.

Safety and Utility of Kidney Biopsy in Elderly Patients: A Single-Center Cohort Study

“…In fact, the absolute incidence of major complications in the elderly of 4.0% was lower than that reported by Korbet et al (the rate of major complications after KBx under real-time ultrasound guidance and with the use of a 14-gauge needle was 6.6%) 10) . However, Yang et al reported that the elderly patients they studied did not experience major complications, and only 8.3% of their patients experienced minor complications 8) .…”

The Native Kidney Biopsy

“…Although the overall incidence of requiring a blood transfusion in this meta-analysis was 0.9% (95% confidence interval, 0.4% to 1.5%), transfusion rates as high as 5%-9% have been described in large single-center case series from major academic centers (7,12,(35)(36)(37). This may be because of some PRBs being performed by nephrology trainees and more high-risk patients undergoing PRBs at large academic centers.…”

“…Korbet et al (35) found no difference in complication rates when stratified by the number of passes or cores taken, and another study found no difference in complications (pain requiring analgesics or bleeding risk) with 2 versus 7 hours of strict bed rest after kidney biopsy (53). No data exist to guide how long manual compression should be applied after kidney biopsy.…”

Renal biopsy: Still a landmark for the nephrologist

“…July 6, 2016|Volume 5|Issue 4| WJN|www.wjgnet.com Fenerberg et al [24] 1998 1081 9.6 1.11 0.09 Prasad et al [28] 1998 1090 3 0.36 0 Preda et al [20] 2003 515 9.5 2.7 0 Whittier et al [51] 2004 750 6.7 6.4 0.13 Atwell et al [44] 2010 5832 -0.7 0 Stratta et al [29] 2007 1137 24.2 0.36 0 Korbet et al [23] 2014 1055 8.1 6.6 0.09 Mai et al [21] 2013 934 5.9 0.86 0 Tøndel et al [13] 2012 9288 1.9 0.9 0 Prasad et al [28] 2015 2138…”