Invited Commentary

Commentary on "Safety and Efficacy of Percutaneous Renal Biopsy by Physicians-in-Training in an Academic Teaching Setting"

Authors: Chunmei Huang, MD, MS

Abstract

Percutaneous renal biopsy (PRB) is an important procedure in nephrology practice, and pathology studies of the kidney tissue obtained by PRB can provide important diagnostic and prognostic information. Because the kidneys contain numerous vascular structures, the major complications of PRB are associated with hemorrhage. Although most complications resolve spontaneously, up to 5% of renal biopsies result in complications severe enough to require intervention, primarily red blood cell transfusions.1 Nephrologists have traditionally performed this procedure; however, PRB procedures are increasingly referred to interventional radiologists. Concern is growing that training for PRB has become less adequate in renal fellowship programs, although there is also debate whether to allow inexperienced nephrology fellows to perform the procedure because of patient safety concerns. Advances in medical technology have increased the safety and yield of PRB. When PRB was first performed in 1951 using an aspiration needle and intravenous pyelography for guidance, the procedure yielded kidney tissue in <40% of biopsies.2 The application of automated spring-loaded biopsy needles and real-time renal ultrasound for needle tracking has improved the tissue yield to >95%. The life threatening complication rate also has decreased to <0.1%.3 These statistics, however, are drawn from studies documenting procedures performed mostly by experienced nephrologists. There are few studies reporting the success and complication rates of procedures performed by in-training fellows.

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References

1. Corapi KM, Chen JL, Balk EM, et al. Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 2012;60:62-73.
 
2. Iversen P, Brun C. Aspiration biopsy of the kidney. Am J Med 1951;11:324-330.
 
3. Korbet SM, Volpini KC, Whittier WL. Percutaneous renal biopsy of native kidneys: a single-center experience of 1,055 biopsies. Am J Nephrol 2014;39:153-162.
 
4. Fülöp T, Alemu B, Dossabhoy NR, et al. Safety and efficacy of percutaneous renal biopsy by physicians-in-training in an academic teaching setting. South Med J 2014;107:520-525.
 
5. Tøndel C, Vikse BE, Bostad L, et al. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988Y2010. Clin J Am Soc Nephrol 2012;7:1591-1597.
 
6. Dawe SR, Windsor JA, Broeders JA, et al. A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg 2014;259:236-248.