Ultrasonic Localization for Renal Biopsy

Abstract

B-scan ultrasound was used in 30 patients to localize the kidney prior to renal biopsy. The lower pole of the kidney was outlined in the longitudinal and transverase planes and the depth of the kidney was easily obtained from the ultrasonic tracings. The puncture site was marked on the skin and the angle of the needle pathway determined. Renal biopsy was performed successfully in 28 patients, which compares favorably with the results of other localization methods.

Percutaneous Renal Biopsy with the Use of Real-Time Ultrasound

“…This accuracy is favorable when compared with the other methods for localization previously described which had success rates ranging from 80 to 95% [3,8,12,13]. Similarly, in other series that looked at ultrasound guidance [4,7,11,14], suffi cient tissue for diagnosis was obtained in 93-94% of patients.…”

“…In 1975, Goldberg et al [7] described the usefulness of ultrasound in performing percutaneous renal biopsies by outlining the lower pole of the kidney, demonstrating the depth of kidney, and permitting the optimal angle necessary for the biopsy needle to strike the kidney sur face perpendicularly. Although other methods of imag ing have been used for kidney localization, they have their limitations.…”

“…Although other methods of imag ing have been used for kidney localization, they have their limitations. The accuracy of radiography with in travenous pyelography is limited by the geometric dis tortion that occurs if the patient's kidney and the x-ray beam are not properly aligned [7,8], In addition, the patient is given intravenous contrast with all of its poten tial complications, including allergic reactions that range from a mild skin rash to anaphylaxis, to the precipitation of acute tubular necrosis. Fluoroscopy is accurate at localizing the kidney, especially when used in combina tion with excretory urography.…”

“…Radionuclide imaging is a safe and reliable localization technique. Its major disadvantage is the inadequate counts accumulated in patients with renal insufficiency in up to 20% of subjects [7,8], Computed tomography (CT) has not been studied extensively as a primary tool. Its major use is in the case of technical interference with ultrasound.…”

“…Its major disadvantages include its expense and radiation exposure [10]. The advantages of ultra sound over these other methods are in its lack of radia tion exposure for both the physician and the patient (es pecially useful in pregnant patients), the avoidance of contrast media, the fact that its use is not dependent upon renal function (as in radionuclide or intravenous contrast methods), the portable nature of the ultrasound machine, and its cost (ultrasound $ 350, CT $ 836, fluo roscopy $ 626 and radionuclide $ 450 at our institution) [4,7,8,11], In our experience, ultrasound has proved to be an accurate and safe tool. What is noteworthy is the yield of tissue obtained by localization of the kidney under ultra sound guidance.…”