Abstract
Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.
Highlights
IntroductionNephrology was revolutionized in the 1950s and 1960s by the introduction of percutaneous renal biopsy (PRB) into clinical practice
When an intrinsic etiology is suspected, hematuria associated with proteinuria and/or decreased renal function or suspected secondary glomerular disease, rapid, and unexpected worsening of eGFR, or rapid increase in proteinuria in known chronic kidney disease (CKD)
Position of the Patient A kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, which is preferred to reduce the risk of inadvertent injury to a major vessel
Summary
Nephrology was revolutionized in the 1950s and 1960s by the introduction of percutaneous renal biopsy (PRB) into clinical practice. The first attempt to perform a percutaneous needle biopsy of the kidney was described in 1951 by Iversen and Brun, who used a fluoroscopically guided approach and obtained parenchyma samples after antegrade pyelography in a sitting position, with a success rate of only 40% [1]. The technique was modified by Karm, who, in 1954, proposed the performance of the biopsy in the prone position with an ad hoc needle, reaching success in 96% of cases [2]. We provide an operative guide for the safe and successful execution of ultrasound-guided renal biopsies for clinical nephrologists and radiologists
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