Original Article

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

Authors: Tibor Fülöp, MD, Bereket Alemu, MD, Neville R. Dossabhoy, MD, Justin H. Bain, DO, David E. Pruett, MD, Anita Szombathelyi, PhD, Albert W. Dreisbach, MD, Mihály Tapolyai, MD

Abstract

Objectives: The safety and efficacy of percutaneous renal biopsy (PKB) are relatively little studied in a training setting. We sought to review our recent experience with bedside PKB in our training program.

Methods: We performed a retrospective cohort review of our consecutive 2.5-year renal biopsy experience (May 2007–November 2009) at the University of Mississippi Nephrology Fellowship. All of the biopsies were performed exclusively by renal fellows using real-time ultrasound (US) visualization within the framework of a structured US-PKB training course.

Results: A total of 64 patients underwent PKB during the index period; 50 (78.1%) of these procedures were performed on native kidneys. Participant age was 39.8 ± 13.7 years, blood pressures measured 140.1/85.3 ± 21.5/14.9 mm Hg, serum creatinine was 3.05 ± 3.15 mg/dL, and median random urine protein:creatinine ratio was 2.38 (25%–75% interquartile range 0.49–7.32). The biopsied kidneys measured 11.8 (±1.6) cm. We recovered 18.8 ± 11.5 glomeruli per procedure; two biopsies were unsuccessful. Focal glomerular sclerosis and lupus nephritis (22% and 25%, respectively) predominated among the specimens. Only three specimens returned with no diagnostic changes. There was a close correlation between preceding history and recovered diagnoses of diabetic changes and lupus nephritis ( r 0.605 and 0.842; P < 0.0001 for both). Initial hemoglobin of 10.8 ± 1.8 g/dL dropped to 10.2 (1.9) g/dL after the procedure ( P < 0.0001). Five (7.8%) patients needed transfusion; one patient experienced persistent urine leakage; however, none of the patients needed surgical or radiological intervention or died.

Conclusions: In the setting of a well-structured training environment, US-guided PKB is a reasonably safe and valuable component of renal fellowship training.

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References

1. Weigert AL, Schafer AI. Uremic bleeding: pathogenesis and therapy. Am J Med Sci 1998;316:94-104.
 
2. Shidham GB, Siddiqi N, Beres JA, et al. Clinical risk factors associated with bleeding after native kidney biopsy. Nephrology (Carlton) 2005;10:305-310.
 
3. Whittier WL, Korbet SM. Renal biopsy: update. Curr Opin Nephrol Hypertens 2004;13:661-665.
 
4. Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012;19:179-187.
 
5. Maya ID, Maddela P, Barker J, et al. Percutaneous renal biopsy: comparison of blind and real-time ultrasound-guided technique. Semin Dial 2007;20:355-358.
 
6. Cozens NJA, Murchison JT, Allan PL, et al. Conventional 15 G needle technique for renal biopsy compared with ultrasound-guided spring-loaded 18 G needle biopsy. Br J Radiol 1992;65:594-597.
 
7. Hergesell O, Felten H, Andrassy K, et al. Safety of ultrasound-guided percutaneous renal biopsy-retrospective analysis of 1090 consecutive cases. Nephrol Dial Transplant 1998;13:975-977.
 
8. Kovalik EC, Schwab SJ, Gunnells JC, et al. No change in complication rate using spring-loaded gun compared to traditional percutaneous renal allograft biopsy techniques. Clin Nephrol 1996;45:383-385.
 
9. Honma M, Toyoda M, Umezono T, et al. An investigation of 2,093 renal biopsies performed at Tokai University Hospital between 1976 and 2000. Clin Nephrol 2008;69:18-23.
 
10. Fuiano G, Mazza G, Comi N, et al. Current indications for renal biopsy: a questionnaire-based survey. Am J Kidney Dis 2000;35:448-457.
 
11. Burstein DM, Schwartz MM, Korbet SM. Percutaneous renal biopsy with the use of real-time ultrasound. Am J Nephrol 1991;11:195-200.
 
12. Maya ID, Allon M. Percutaneous renal biopsy: outpatient observation without hospitalization is safe. Semin Dial 2009;22:458-461.
 
13. Clark EG, Schachter ME, Palumbo A, et al. Temporary hemodialysis catheter placement by nephrology fellows: implications for nephrology training. Am J Kidney Dis 2013;62:474-480.
 
14. Korbet SM. Nephrology and the percutaneous renal biopsy: a procedure in jeopardy of being lost along the way. Clin J Am Soc Nephrol 2012;7:1545-1547.
 
15. Islam N, Fulop T, Zsom L, et al. Do platelet function analyzer-100 testing results correlate with bleeding events after percutaneous renal biopsy? Clin Nephrol 2010;73:229-237.
 
16. 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.
 
17. Tøndel C, Vikse BE, Bostad L, et al. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol 2012;7:1591-1597.
 
18. Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int 2004;66:1570-1577.
 
19. Bataille S, Jourde N, Daniel L, et al. Comparative safety and efficiency of five percutaneous kidney biopsy approaches of native kidneys: a multicenter study. Am J Nephrol 2012;35:387-393.
 
20. Margaryan A, Perazella M, Mahnensmith R, et al. Experience with outpatient computed tomographic-guided renal biopsy. Clin Nephrol 2010;74:440-445.
 
21. Peters B, Andersson Y, Stegmayr B, et al. A study of clinical complications and risk factors in 1001 native and transplant kidney biopsies in Sweden. Acta Radiol 2013. [Epub ahead of print]
 
22. Tang S, Li JH, Lui SL, et al. Free-hand, ultrasound-guided percutaneous renal biopsy: experience from a single operator. Eur J Radiol 2002;41:65-69.
 
23. Augusto JF, Lassalle V, Fillatre P, et al. Safety and diagnostic yield of renal biopsy in the intensive care unit. Intensive Care Med 2012;38:1826-1833.
 
24. Whittier WL, Korbet SM. Timing of complications in percutaneous renal biopsy. J Am Soc Nephrol 2004;15:142-147.
 
25. Lin WC, Yang Y, Wen YK, et al. Outpatient versus inpatient renal biopsy: a retrospective study. Clin Nephrol 2006;66:17-24.
 
26. Tavares MB, Chagas de Almeida Mda C, Martins RT, et al. Cute tubular necrosis and renal failure in patients with glomerular disease. Ren Fail 2012;34:1252-1257.
 
27. Stiles KP, Hill C, LeBrun CJ, et al. The impact of bleeding times on major complication rates after percutaneous real-time ultrasound-guided renal biopsies. J Nephrol 2001;14:275-279.
 
28. Waldo B, Korbet SM, Freimanis MG, et al. The value of post-biopsy ultrasound in predicting complications after percutaneous renal biopsy of native kidneys. Nephrol Dial Transplant 2009;24:2433-2439.