Abstract
Introduction: Renal biopsy is an integral part of clinical nephrology practice that helps in the diagnosis of various renal diseases. Across the globe, it is performed by nephrologists and/or surgeons under ultrasound guidance. Lately, this novel procedure has been performed more frequently by the interventional radiologist (IR) as compared to nephrologists and surgeons.Methods: We completed a retrospective review of 378 consecutive renal biopsies performed at our university hospital in the city center of Philadelphia, Pennsylvania, between September 2008 and June 2011 for various indications. Baseline characteristics were comparable except systolic blood pressure (SBP), prothrombin time (PT), and international normalized ratio (INR) which was higher. Hemoglobin was lower in patients who underwent biopsy by the IR compared to those who were biopsied by nephrologists and/or surgeons.Results: The primary outcome showed the average number of glomeruli obtained with each biopsy was significantly lower by nephrology or surgical teams, 9.09 ± 5.17 vs. 19.17 ± 11.11 obtained by the interventional radiology team, p-value <0.0001. The number of cores obtained with each biopsy was significantly lower by nephrologist or surgeon at the bedside, 1.57 ± 1.05 vs. 2.42 ± 1.26, p-value <0.0001. The average number of attempts to obtain one core was 2.00 ± 1.10 vs. 2.60 ± 1.17 by nephrologist and surgeon vs. IR, respectively, p-value <0.0001.Conclusion: Our study clearly shows the superior success of renal biopsy by the IR as compared to the nephrology and surgical teams. This calls for more robust training of nephrology fellows and surgery residents to obtain the renal biopsy to prevent the loss of this unique procedure skill by non-radiology clinicians.
Highlights
Renal biopsy is an integral part of clinical nephrology practice that helps in the diagnosis of various renal diseases
The primary outcome showed the average number of glomeruli obtained with each biopsy was significantly lower by nephrology or surgical teams, 9.09 ± 5.17 vs. 19.17 ± 11.11 obtained by the interventional radiology team, p-value
The primary outcome included the average number of glomerulus obtained with each biopsy was 9.09 ± 5.17 by the nephrologist or the surgical team in the bedside group compared to 19.17 ± 11.11 obtained by the interventional radiologist (IR) in the radiology department, p-value
Summary
Renal biopsy is an integral part of clinical nephrology practice that helps in the diagnosis of various renal diseases Across the globe, it is performed by nephrologists and/or surgeons under ultrasound guidance. Renal biopsies are increasingly being performed by interventional radiologists (IR) compared to the nephrologists in training and surgeons who use the bedside ultrasound-guided percutaneous technique [8,9,10]. This is due to the loss of follow-up care and lack of training skills by the nephrology fellows as compared to the IR [10]. This transition has occurred to limit the complications associated with the ultrasound-guided bedside technique and to increase the safety, diagnostic yield, and efficacy of the procedure
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