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