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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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

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          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.

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          Bleeding complications of native kidney biopsy: a systematic review and meta-analysis.

          Ann E. Gordon, Ethan Balk, L. Chen … (2012)
          Kidney biopsy provides important information for nephrologists, but the risk of complications has not been systematically described. Meta-analysis of randomized controlled trials and prospective or retrospective observational studies. Adults undergoing native kidney biopsy in an inpatient or outpatient setting. MEDLINE indexed studies from January 1980 through June 2011; sample size of 50 or more. Native kidney biopsy with automated biopsy device and real-time ultrasonographic guidance. Macroscopic hematuria and erythrocyte transfusion rates and factors associated with these outcomes. 34 studies of 9,474 biopsies met inclusion criteria. The rate of macroscopic hematuria was 3.5% (95% CI, 2.2%-5.1%), and erythrocyte transfusion was 0.9% (95% CI, 0.4%-1.5%). Significantly higher rates of transfusion were seen with the following: 14-gauge compared with smaller needles (2.1% vs 0.5%; P = 0.009), studies with mean serum creatinine level ≥2.0 mg/dL (2.1% vs 0.4%; P = 0.02), ≥50% women (1.9% vs 0.6%; P = 0.03), and ≥10% of biopsies for acute kidney injury (1.1% vs 0.04%; P < 0.001). Higher transfusion rates also were observed in studies with a mean age of 40 years or older (1.0% vs 0.2%; P = 0.2) and mean systolic blood pressure ≥130 mm Hg (1.4% vs 0.1%; P = 0.09). Similar relationships were noted for the macroscopic hematuria rate with the same predictors, but none was statistically significant. Publication bias, few randomized controlled trials, and missing data. Native kidney biopsy using automated biopsy devices and real-time ultrasonography is associated with a relatively small risk of macroscopic hematuria and erythrocyte transfusion requirement. Using smaller gauge needles may lower complication rates. Patient selection may affect outcome because studies with higher serum creatinine levels, more women, and higher rates of acute kidney injury had higher complication rates. Future studies should further evaluate risk factors for complications. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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            Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy.

            Giovanni Strippoli, Loredana Arnesano, Carlo Manno … (2004)
            The risks associated with performing a percutaneous renal biopsy have substantially decreased in the past two decades because of technical advances in the method. However, bleeding complications still occur, resulting in increased hospital stay and treatment costs. We investigated the predictive value of demographics (age, gender), clinical data (blood pressure), baseline chemistry (hemoglobin/hematocrit, prothrombin time, partial thromboplastin time, bleeding time, serum creatinine, daily proteinuria), and needle size for the risk of major (need for blood transfusion, nephrectomy, or angiography) or minor (no need for any intervention) postrenal biopsy bleeding complications. This was a prospective cohort study of 471 patients who underwent ultrasound-guided biopsy of native kidney by automated needle in a single center; all biopsies were performed by two experienced nephrologists. Patients with transplant kidneys were excluded from the study. Predictors of postbiopsy bleeding were assessed by multiple linear and multivariate logistic regression analysis. Data are presented as unadjusted (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI). The study cohort consisted of 471 (277 males, 194 females) patients. Of these, 161 (34.1%) experienced postbiopsy bleeding [157 (33.3%) hematomas, 2 (0.4%) gross hematuria, 2 (0.4%) arteriovenous fistula]. Major complications were seen in 6 (1.2%) patients (blood transfusion, N= 2; angiography, N= 3; nephrectomy, N= 1), but no deaths occurred. The risk of postbiopsy bleeding was higher in women (39.7% women, 30.3% men, AOR 2.05, 95% CI 1.26 to 3.31, P= 0.004), younger subjects (35.0 +/- 14.5 years vs. 40.3 + 15.4, AOR 0.80, CI 0.68 to 0.94, P= 0.006), and patients with higher baseline partial thromboplastin time (102.7 + 11.8% vs. 100.1 + 10.0%, AOR 1.26, CI 1.02 to 1.54, P= 0.032). These findings were independent of size of hematoma. Although the methods for performing a percutaneous renal biopsy have improved in the past two decades, renal biopsy is still not a risk-free procedure. Of the data routinely collected for potential predictors of postbiopsy bleeding complications, only gender, age, and baseline partial thromboplastin time show a significant predictive value. The other variables investigated do not have any predictive value.
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              Risk factors for bleeding complications in percutaneous renal biopsy.

              T Katoh, Tsuyoshi Watanabe, Masaaki Eiro (2005)
              Among the complications in percutaneous renal biopsy, bleeding is the most frequent and sometimes becomes fatal. We prospectively studied 394 consecutive percutaneous renal biopsies in 359 patients (male/female = 188/171). The mean age of the patients was 44.0 +/- 17.2 years. Percutaneous renal biopsies were performed on native kidneys under direct visualization by ultrasound, using an automated spring-loaded biopsy device and a 16-cm 18 G needle. The most common complication was hematoma (n = 149, 37.8%). "De novo macrohematuria" was observed in 29 patients (7.4%). Other complications included pain (n = 27, 6.9%), loss of blood (n = 17, 4.3%), and renal dysfunction (increase of serum creatinine more than 0.2 mg/dl, n = 9, 2.2%). Although there were no severe complications such as loss of blood requiring a blood transfusion, loss of kidney function, or death, 10 patients had an extended rest period in bed because of moderate complications. Hypertension and amyloidosis had significant influence on the complications. For those who are clinically suspected of having amyloidosis or hypertension, more careful biopsy procedures and observations are necessary.
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                Author and article information

                Journal
                Journal ID (publisher-id): AJN
                Journal ID (nlm-ta): Am J Nephrol
                Journal ID (doi): 10.1159/issn.0250-8095
                Title: American Journal of Nephrology
                Publisher: S. Karger AG
                ISSN (Print): 0250-8095
                ISSN (Electronic): 1421-9670
                Publication date Subscription-year: 2013
                Publication date (Print): April 2013
                Publication date (Electronic): 09 March 2013
                Volume: 37
                Issue: 3
                Pages: 249-254
                Affiliations
                Departments of aPathology and bMedicine, and cComprehensive Transplant Center, The Ohio State University, Columbus, Ohio, and dDepartment of Radiology, Westchester Medical Center, Valhalla, N.Y., USA
                Author notes
                *Sergey V. Brodsky, MD, PhD, Department of Pathology, The Ohio State University, 333 W 10th Ave, Graves Hall, B078, Columbus, OH 43210 (USA), E-Mail sergey.brodsky@osumc.edu
                Article
                Publisher ID: 347219 Other ID: Am J Nephrol 2013;37:249-254
                DOI: 10.1159/000347219
                PubMed ID: 23485619
                SO-VID: 41a8f135-92f2-483f-ac2e-b551cde0f61d
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 28 November 2012
                Date accepted : 15 January 2013
                Page count
                Figures: 2, Tables: 2, Pages: 6
                Categories
                Subject: Original Report: Laboratory Investigation

                ScienceOpen disciplines: Cardiovascular Medicine,Nephrology
                Keywords: Pathology,Tubulointerstitial fibrosis,Kidney disease
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine, Nephrology
                Keywords: Pathology, Tubulointerstitial fibrosis, Kidney disease

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