Ultrasonography and CT Guided Percutaneous Renal Biopsy in Diagnosis of Renal Parenchymal Diseases

Atef Hammad Teama

doi:10.11648/j.ijmi.20150306.13

Abstract

Objective: to evaluate the role of US &CT guided percutanous renal biopsy (PRB) in diagnosis and monitoring of renal parenchymal diseases. Patients &Methods: This study included 30 patients who were presented by and/or known cases of renal parenchymal disease referred for US and/or CT guided PRB for etiological & histopathological diagnosis. The histopathological results were correlated with clinical, US & laboratory data for each patient. Results: Out of those 30 patients; 29 patients had adequate PRB (29/30) (96.7%) for histopatholgical diagnosis. Out of those 29 patients; 23 showed increase in renal cortical echogenicity (13 with GI, 8 with GII, &2 with GIII) & 6 cases showed normal echogenicity (G0). The lupus nephritis was the most accounted diagnosis (16/29) (55.2%)(7 with GI, 5 with GII, 4 with G0 cortical echogenicity). The glomerular changes were depicted in 25 cases (13 with GI, 7 with GII, 2 with GIII, 3 with G0), tubular changes in 21 cases (10 with GI, 7 with GII, 2 with GI, 2 with G0), and interstitial changes in 24 cases (12 with GI, 8 with GII, 2 with GIII, 2 with G0). Post biopsy complications (minor) were accounted only in 2 cases (2/30) (6.7%). Conclusions: Ultrasound PRB is the standard method for most non-focal renal biopsies as it has the advantage of real-time needle placement without radiation & fundamental procedure for diagnosis, monitoring &treatment of RPD. US and CT guided PRB is generally considered safe with minimal risk.

Highlights

The prevalence of chronic kidney disease (CKD) is so high that is simulates a worldwide epidemic and public health problem all over the world
This study included 30 patients who presented clinically and/or known cases of renal parenchymal diseases & referred from Nephrology Units of Internal Medicine & Pediatric Department to Radiodiagnosis & Medical Imaging Department for performing percutanous renal biopsy (PRB) of native kidney guided by US and/or CT for etiological & histopathological diagnosis
All 30 patients of our study underwent PRB by automatic biopsy needles 18G x 20 cm used for younger patients (≤ 16ys) & 16G x 20 cm used for adult patients (>16Ys) to ensure the adequacy of the biopsy sample

Summary

Introduction

The prevalence of chronic kidney disease (CKD) is so high that is simulates a worldwide epidemic and public health problem all over the world. [1] In United States, the prevalence of CKD based on data from the NHANES III was 11% (3.3% with stage 1, 3% with stage 2, 4.3% with stage 3, 0.2% with stage 4, and 0.2% with stage 5) [2]. Barsoum declared in a statistic done at 2003 based on the available data in the period between 19932002 that the incidence of end stage renal disease (ESRD) in Egypt 74 per million population [3]. Diagnosis is based on the patient’s clinical history, outcome of physical examination, laboratory tests, scintigraphy, diagnostic imaging and renal biopsy. Diagnostic imaging is an important tool as it is essential to exclude urinary tract obstruction, differentiate between acute and chronic pathologies, follow-up on diagnosed diseases and guide biopsy. US and color Doppler US are used in the initial evaluation as both are widely available, easy to perform, inexpensive and have no undesired side effects. [4]

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