MO148: CT-Guided Native Kidney Biopsy by Interventional Nephrologists

Abstract

Abstract BACKGROUND AND AIMS Histopathology of renal parenchyma is the key diagnostic in the treatment of kidney diseases by nephrologists. Most nephrologists perform renal biopsy using percutaneous ultrasound-guided technic. Generally, this act is very simple for the majority of patients, but when the kidney size is small or the patient has an extreme obesity, this act could be a real challenge with more risk of complications. In Annonay Hospital (North Ardeche, France) all percutaneous renal biopsies are performed by a CT guidance technic. We report a retrospective study of 123 patients who have had a CT-guided kidney biopsies by interventional nephrologists. METHOD Between January 2016 and June 2021, 123 CT-guided native kidney biopsies were performed by interventional nephrologists at Annonay Hospital in North Ardeche in France. A total of 77 men and 46 women were introduced in this retrospective study. The mean age was 64 years (1933–1990); the mean BMI was 26.54 (47–129 kg). In our facility, all renal biopsies were performed by CT guidance technique. The patient was installed in the prone position. Preliminary CT images at 5-mm axial slices covering the entire length of the kidney are obtained. A metallic mark is placed at the right side of the back to localize the entrance skin site, the lower pole cortex and to calculate the depth between the skin and the target. A local anesthetic agent is then injected following the calculating depth. A 16-gauge core biopsy is introduced following exactly the calculating depth and the position of the needle tip is confirmed on CT. Once two samples are acquired, the needle is removed and postprocedure images are obtained to assess for perinephric haemorrhage. RESULTS Renal parenchyma was obtained in all patients (100%); over 123 biopsies, 121 presented between 1 to 48 glomerulus (98.37%), 2 biopsies presented a medulla tissue (1.62%), 97 patients (78%) presented a perinephric haemorrhage no more than 1 cm in postprocedure images and 15 patients presented a macroscopic hematuria (12.19%). One patient required renal embolization for a rapid expansive perinephric haemorrhage with severe pain. CONCLUSION The CT-guided renal biopsy is a precise and rapid technique to have a renal parenchyma with a failure rate bordering 0%, but the cost and the radiations rate should be compared with the other methods.