When Size Matters: Diagnostic Value of Kidney Biopsy according to the Gauge of the Biopsy Needle

Abstract

Background: Kidney biopsy is a vital tool in the diagnosis of kidney disease. Although it has become a routine procedure, it is not complication-free. Some serious complications of percutaneous kidney biopsy include retroperitoneal hemorrhage and death. There is an increased belief that smaller biopsy needle size results in a lower complication rate. As renal pathologists, we witness an increased number of kidney biopsies performed with a small needle size (as low as gauge 22), which results in inadequate tissue sampling and often non-diagnostic biopsy results. Herein we report the diagnostic value of kidney biopsies according to the size of the biopsy needles. Methods: We performed kidney biopsies from nephrectomy specimens using biopsy needles of different sizes. Morphologic parameters were analyzed. Results: We found that biopsies performed by small needles (gauges 20 and 22) contain significantly lower numbers of glomeruli and blood vessels, which limits pathologic evaluation. Data from our institution do not show differences in kidney biopsy complication rates between 16- and 18-gauge needles. Conclusions: Our data indicate that small biopsy needles do not provide sufficient material for diagnosis, and they increase the likelihood for a repeat biopsy.

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

“…The reason for the higher major complication and transfusion rates in our study compared to others may have to do with many factors, including the prospective nature of our study, the patient mix and the fact that as an academic institution the majority of biopsies are performed by supervised fellows in training. It is therefore of interest that our transfusion rate of 5.3% is similar to rates (5.4-8%) recently reported in a number of biopsy studies from other major academic institutions that used smaller-gauged needles [22,45,46]. Roth et al [45] evaluated 149 native PRBs performed over a 1-year period using 16- and 18-gauge automated needles and found the post-PRB transfusion rate to be 5.4% overall and not different between the needles (4.9 and 6.0%, respectively).…”

“…However, in the prospective trial by Nicholson et al [37], no differences in complication rates were found for biopsies performed with 14-, 16- or 18-gauge automated needles. Similarly, a number of other studies have found no differences in complication rates or transfusion requirements based on needle size [4,8,11,21,32,44,45], including the 2013 report of the Norwegian Kidney Biopsy Registry [21] of 9,288 PRBs. However, in a recent meta-analysis by Corapi et al [12], the rate of transfusion was greater in patients biopsied with a 14-gauge automated needle compared to 16- and 18-gauge needles (2.1 vs. 0.5%, p = 0.009), and this led to the recommendation that the use of 14-gauge needles be discouraged.…”

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.…”

“…The diagnostic yield does not seem to differ significantly when comparing 14-and 16-gauge needles, but some (although not all) studies indicate lower yield with smaller (18-gauge) needles (6)(7)(8)(9)(10)(11)(12). Other factors, such as patient characteristics (e.g., kidney size) and operator experience, may also affect diagnostic yield.…”

Comments and extensions to EFSUMB guidelines on renal interventional ultrasound (INVUS).

“…Overall, 14-gauge needles did not improve histological assessment, yet tended to create more complications. Smaller sized needles (16-18 gauge) are sufficient with lower complication rates, while further size reduction compromises histological assessment [29][30][31][32].…”