Abstract
Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique. It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma. Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours. Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.
Highlights
Percutaneous renal biopsy(PRB) and histopathological evaluation is a mandatory tool for definitive diagnosis was conducted to compare the efficiency, adequacy of tissue and bleeding complications between blind and real time USG-guided PRB.and prediction of prognosis of renal parenchymal METHODS diseases.Adequate tissue yield with at least 8-10 glomeruli with no or minor bleeding complications have always been the goal.[1, 2] Historically, PRB was performed blindly by radiography[3] and later ultrasound(USG) guided surface marking
In Nepal, this process was performed by nephrologists in the very beginning by blind technique through skin surface marking from X-ray KUB (Kidney, Ureter, Bladder) or nephrogram film by themselves and later through USG surface marking made by radiologists
We found that real-time ultrasound- guided renal biopsy was more efficient than blind technique with significantly less number of attempts to yield two adequate tissues (p=0.008) for light microscopic and immunofluorescence study and two tissue bits were obtained by two attempts in 89% of patients in USG guided group compared to 65% in blind group (p=0.011)
Summary
Percutaneous renal biopsy(PRB) and histopathological evaluation is a mandatory tool for definitive diagnosis was conducted to compare the efficiency, adequacy of tissue and bleeding complications between blind and real time USG-guided PRB.and prediction of prognosis of renal parenchymal METHODS diseases.Adequate tissue yield with at least 8-10 glomeruli with no or minor bleeding complications have always been the goal.[1, 2] Historically, PRB was performed blindly by radiography[3] and later ultrasound(USG) guided surface marking. Percutaneous renal biopsy(PRB) and histopathological evaluation is a mandatory tool for definitive diagnosis was conducted to compare the efficiency, adequacy of tissue and bleeding complications between blind and real time USG-guided PRB. PRB started in 1973 by nephrologist in Nepal had evolved from blind technique via radiography[6] and USG guided surface markingto real-time USG guided technique and histopathological diagnosis of kidney disease been reported after 2000.7-9 So, present study. This was a cross sectional,randomized, comparative study conducted in the Department of Nephrology, Bir Hospital, Kathmandu, Nepal from June 2016 to December 2016. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure.We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique
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