SAT-308 RENAL BIOPSY ADEQUACY AND COMPLICATIONS IN CHILDREN

Abstract

Renal biopsy is commonly used in the diagnosis of kidney diseases. Increasingly in paediatric practice, biopsies are performed under general anaesthetic by interventional radiologists, who perform their own ultrasound compared to nephrologists who use ultrasonographer-guided ultrasound in a sedated child. The sample adequacy and complication rates have not been determined in the two groups. This study aimed to compare biopsy size and adequacy between interventional radiologists and nephrologists and to compare complication rates. We examined consecutive kidney biopsies performed between January 2008 and December 2017 and probed the electronic medical records of patients for data regarding complications. In native biopsies, successful processing for light microscopy, immunofluorescence, and electron microscopy were used as proxy for specimen adequacy. In transplant biopsies, adequate specimens contained at least 10 glomeruli and 2 arteries, based on the Banff criteria. Data were analysed using Mann–Whitney U test, Pearson’s chi-squared test, and Fisher’s exact test in SPSS. Interventional radiologists performed 112 of the 355 biopsies obtained. Interventional radiologists made more passes (median number 3 vs 2, p < 0.01) and obtained more renal cores (median number 3 vs 2, p < 0.01). They obtained more total glomeruli (median number 32 vs 15, p < 0.01) and more glomeruli per core (median number 12.0 vs 7.0, p < 0.01). No differences in specimen adequacy of native renal biopsies were observed between the two groups, but interventional radiologists obtained more adequate transplant biopsy specimens (95.0% vs 51.4%, p < 0.01). There were no significant differences in complications, including de novo haematuria, pain requiring analgesia, unplanned overnight stay, transfusion requirement, biopsy-related infections, or AV fistula formation between the two groups. A statistically lower rate of perinephric haematoma (20.5% vs 31.9%, p = 0.03) was detected in the interventional radiologist group. However, they self-report haematoma, whereas ultrasonographers report haematoma for nephrologists. Interventional radiologists obtained significantly larger specimens than nephrologists. There were no significant differences in post procedural complications other than perinephric haematoma.