Renal biopsy: Comparative yield of cranial <i>versus</i> caudal needle trajectory. An <i>ex vivo</i> analysis

Karam, Adib R.; Vijayaraghavan, Gopal; Khan, Ashraf; Ustun, Berrin; Hussain, Sarwat

doi:10.1111/nep.12038

Cited by 7 publications

(15 citation statements)

References 5 publications

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“…In terms of needle direction, our study is in keeping with the findings of Caliskan et al who reported a low rate of complications with an ultrasound-guided “tangential” approach to renal biopsy in a pediatric population [11]. Karam et al reported on an ex vivo model comparing caudal to cranial angle of renal biopsies [12] and found that the number of glomeruli obtained depended on the biopsy direction. Another group proposed an equation to calculate the safe depth of renal biopsy [8], and this may allude to avoidance of the medulla.…”

Section: Discussionsupporting

confidence: 90%

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

et al. 2019

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Introduction Although medical factors such as hypertension and coagulopathy have been identified that are associated with hemorrhage after renal biopsy, little is known about the role of technical factors. The purpose of our study was to examine the effects of biopsy needle direction on renal biopsy specimen adequacy and bleeding complications. Methods Two hundred and forty-two patients who had undergone ultrasound-guided renal biopsies were included. A printout of the ultrasound picture taken at the time of the biopsy was used to measure the biopsy angle (“angle of attack” [AOA]) and to determine if the biopsy needle was aimed at the upper or lower pole and if the medulla was targeted or avoided. Results Of the 3 groups of biopsy angle, an AOA of between 50°–70° yielded the most glomeruli per core ( P = .001) and the fewest inadequate specimens (4% vs 15% for > 70°, and 9% for < 50°, P = .038). Biopsy directed at a pole vs an interpolar region resulted in fewer inadequate specimens (8% vs 23%, P = .005), while biopsies that were medulla-avoiding resulted in fewer inadequate specimens (5% vs 16%, P = .004) and markedly reduced bleeding complications (12% vs 46%, P < .001) compared to biopsies where the medulla was entered. Discussion An AOA of approximately 60°, aiming at the poles, and avoiding the medulla were each associated with fewer inadequate biopsies and bleeding complications. While biopsy of the medulla is necessary for some diagnoses, the increased bleeding risk emphasizes the need for communication between nephrologist, pathologist, and radiologist.

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Section: Discussionsupporting

confidence: 90%

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

et al. 2019

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“…The reason for the higher rate of complications during the first period may be the difficult needle coordination between radiologist and nephrologists without needle guide; needle guide reduces sliding of the ultrasound transducer on slippery gel which makes the complex task of coordination and alignment of transducer plane and biopsy needle plane easier to perform. A better yield of cortex was reported with caudal angulations when compared with cephalad angulations of the needle in a study on porcine kidney biopsies [ 19 ]. All native kidney biopsies were performed from the lower pole with caudal angulations and transplant kidney biopsies from the upper pole with cephalad angulations.…”

Section: Discussionmentioning

confidence: 99%

“…Various larger studies have reported minor complication rates varying from 7.5 to 58.6% and major complications from 0.3 to 4.3% [ 19 – 22 ]. We have observed minor complications in 5.4% and major complication in 5.1% of patients.…”

Section: Discussionmentioning

confidence: 99%

Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

Prasad

Kumar

Manjunath

et al. 2015

Clinical Kidney Journal

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BackgroundPercutaneous renal biopsy (PRB) can result in serious complications. The study is aimed to compare the biopsy yield and complications rate of the real-time ultrasonagram (USG)-guided PRB and needle tracking with and without needle guide in two different study periods.MethodsWe compared the yield and complications of 2138 kidney biopsies performed in two different periods, 1510 biopsies during the first period from April 2004–December 2010 and 628 biopsies during second period from January 2011–March 2013. All biopsies in both periods were performed by nephrologists. Radiologists provided the real-time image without needle guide during the first period while nephrologists performed both imaging and biopsy with needle guide during the second period.ResultsOf all the 2138 patients, 226 (10.5%) patients developed 118 minor and 108 major complications. Only 13 (2.1%) major complications occurred in the second period and 95 (6.7%) in the first period (P < 0.001). The relative risk of developing a major complication without guide was 3.04 times greater than that of the biopsies performed with use of the guide. The mean number of glomeruli per biopsy obtained during the second period (17.98 ± 6.75) was significantly greater than that of the first period (14.14 ± 6.01) (P = 0.004). The number of passes to acquire adequate tissue (P = 0.001) and percentage of cortex on biopsy (P = 0.001) were also significantly better in the second period. The optimal observation period post biopsy is 24 h.ConclusionsReal-time USG imaging supported by needle guide device is associated with better biopsy yield and fewer complications.

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“…In the current study in terms of major complications, we had only one case that needed blood transfusion (1.6%) and 2 cases (3.3%) with urinary bladder hematoma needing irrigation. While numerous larger reports have stated rates of minor complications ranged between 7.5 and 58.6% while major complications between 0.3 and 4.3% [17].…”

Section: Discussionmentioning

confidence: 92%

Predictive Value of Ultrasound in the Detection of Complications After 1 Hour of Renal Biopsy.

Salem

Kholeif

Haroun

et al. 2022

GEGET

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Introduction: Renal biopsy became a standard technique in diagnosing renal diseases. It had many complications in the past being performed blindly. But since the presentation of ultrasound-directed renal biopsy in the field, the procedure became much safer with less complication rate and better yield. Aim of the study: In this work, we aim to assess the capability of ultrasound examination to detect early complications after one hour of renal biopsy and predict the course of cases. Methods: This is a prospective study performed during the period from October 2017 to the end of March 2018, and included cases experiencing Percutaneous Renal Biopsy in the Pediatric Nephrology Unit at Cairo University Children's Hospital. Results: The present work enrolled 60 patients; 29-male (48.3%) and 31-female (51.7%); their mean weight was 24.2 kg, with a mean age of 89.3 months. Out of 60 patients who performed the biopsy, only 21.6% had complications. We detected two cases with subcapsular hematomas (3.3%), another 2 cases with bladder hematoma (3.3%), 9 cases with back pain (15%) and gross hematuria (as a complication, not related to original disease) occurred in 6 cases (10%). We found that the sensitivity of ultrasound is 66.6% in the first hour after renal biopsy with 98.3 % specificity to possible bleeding complications with 66.6% positive predictive value (PPV) and 98.2% negative predictive value (NPV). However clinical presentation was the only predictor in one case for complication which was detected late by ultrasound. Conclusion:Our study suggests that combined ultrasound and clinical examination in the first hour after renal biopsy is the best indicator of postrenal biopsy complications.

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Renal biopsy: Comparative yield of cranial versus caudal needle trajectory. An ex vivo analysis

Abstract: The proportion of cortical tissue in the core biopsy specimen using the caudad angle approach was statistically significantly higher, compared with the cephalad needle trajectory.

Cited by 7 publications

References 5 publications

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

Direction of the Biopsy Needle in Ultrasound-Guided Renal Biopsy Impacts Specimen Adequacy and Risk of Bleeding

Real-time ultrasound-guided percutaneous renal biopsy with needle guide by nephrologists decreases post-biopsy complications

Predictive Value of Ultrasound in the Detection of Complications After 1 Hour of Renal Biopsy.

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