Percutaneous Renal Biopsy Research Articles

Reduction of patients' bed rest time after percutaneous renal biopsy evaluated by the Nursing Outcomes Classification: Randomized clinical trial.

To evaluate the reduction of patients' bed rest time after percutaneous renal biopsy (PRB) from 24 to 8h using the Nursing Outcomes Classification (NOC). This was a randomized clinical trial registered with Clinical Trials number NCT04629235. The sample comprised 16 patients in the intervention group and 18 in the control group. In the intervention group, the rest time was modified to 8h, and afterward, the patients were released to ambulate, whereas the control patients remained at absolute rest for 24h after PRB according to institutional protocol. All patients were observed for 24h and evaluated at five time points with the outcomes and indicators of the NOC: before the biopsy, immediately after, at the 8th hour, at the 12th hour, and at the 24th hour after the procedure. In the 170 evaluations performed, statistically significant differences were identified in the outcome Comfort status: physical and the indicators "physical well-being and comfortable position." None of the complications were related to reduced bed rest time. Reducing patients' bed rest time from 24 to 8h did not increase complications from PRB, and using the NOC provided a standardized and reliable assessment. Important evidence was identified for patient care after PRB, demonstrating the positive impact on patient comfort and the possibility of reducing costs to the institution and the workload of the multidisciplinary team. In addition, these findings may contribute to strengthening the use of NOC in clinical practice, teaching, and research.

A Rare Complication of Ascariasis: A Case of Acute Interstitial Nephritis.

Acute interstitial nephritis (AIN) due to helminths is a rare cause of acute kidney injury (AKI). Helminthiases often progresses insidiously, making diagnosis difficult. This was the case of a 72-year-old man, who presented with renal failure, itching and diarrhoea. Urinalysis revealed leukocyturia, microhaematuria and mild proteinuria. A full blood count revealed leucocytosis with eosinophilia. A stool parasitological examination revealed fertilised eggs of Ascaris lumbricoides. Tubulointerstitial nephropathy secondary to A. lumbricoides infection was suspected. A percutaneous renal biopsy was not performed since the patient refused the anti-platelet therapy discontinuation. Mebendazole, albendazole and prednisone therapy was administered. After worm eradiation and discharge, recovery from the parasitosis, absence of pruritus and eosinophilia, and progressive improvement of renal function were observed, strongly suggesting a causal relationship between Ascaris infection and AIN. Parasite infection should be considered in the differential diagnosis of unexplained renal failure because early diagnosis and treatment are necessary to avoid irreversible complications.

Role Of Renal Artery Embolization In Treatment Of Iatrogenic Renal Bleeding.

To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal bleeding. The prospective study was conducted from December 2019 to December 2021 at Ain Shams University Hospital and Kafrelsheikh University Hospital, Egypt, and comprised patients of either gender who underwent renal artery embolization for iatrogenic arterial renal bleeding caused by percutaneous nephrolithotomy, renal biopsy and percutaneous nephrostomy. Diagnostic renal angiography was done to detect pseudoaneurysm and arteriovenous fistula. Embolization was done with either micro-coils or glue. Success of the procedure was defined astotal occlusion of the bleeding artery proved by post-embolization angiogram. Of the 15 patients, 9(60%) were males and 6(40%) were females. The overall mean age was 35+/-14 years. Percutaneous nephrolithotomy was the main cause 8(53.3%), followed by renal biopsy 5(33.3%) and percutaneous nephrostomy 2(13.2%). There were 9(50%) cases of pseudoaneurysm and 6(40%) of arteriovenousfistula. Embolization was done with micro-coils in 5(33.3%) cases and with glue in 10(66.6%). The technical success rate was 15(100%). No major complicationsrequiring intensive care orsurgical intervention were encountered, and there was no significant differences in estimated glomerular infiltration rate or renal function after renal artery embolization (p>0.05). Percutaneous endovascular renal artery embolization was found to be a safe and effective technique in the management of iatrogenic renal arterial injury.

Pediatric primary renal lymphoma presenting with multiple masses: A challenging case report and narrative review.

Only 20 cases of pediatric primary renal non-Hodgkin's lymphoma have been reported since 1995, rare cases and a variety of imaging manifestations have led to difficulties in its diagnosis and treatment. Herein, we share in detail a case of primary renal lymphoma (PRL) in a child and summarize the common clinical manifestations, imaging features, and prognostic factors of pediatric PRL by retrospectively analyzing cases reported in the literature. A 2-year-old boy presented to the clinic with a large mass on the right side of his abdomen along with loss of appetite. Imaging revealed a large right renal mass, nearly replacing the entire renal tissue, along with numerous small nodules in the left kidney. Given no local adenopathy and metastases, the diagnosis was unclear. A percutaneous renal puncture was performed, which proved the diagnosis of Burkitt's lymphoma. Since no bone marrow involvement, this child was diagnosed with pediatric PRL. This PRL boy was treated with the NHL-BFM95 protocol and supportive care. Unfortunately, this boy died of multiple organ failure in the fifth month of treatment. As per literature review, the presentation of pediatric PRL is fatigue, loss of appetite, weight loss, abdominal swelling, or other nonspecific symptoms. Although in 81% of cases it often infiltrates the bilateral kidneys, urine abnormalities caused by pediatric PRL are uncommon. 76.2% of pediatric PRL were boys and 2/3 of all cases presented as diffuse renal enlargement. Those PRL presented as masses could easily be misdiagnosed as WT or other malignancies. Absent of local enlarged lymph node, no necrosis or calcification suggest atypical presentation of renal masses and a percutaneous biopsy is needed in timely establishing the accurate diagnosis for appropriate treatment. Based on our experience, percutaneous renal puncture core biopsy is a safe procedure.

Expresión de C4d en glomeruloesclerosis focal y segmentaria

BackgroundThere is a little information about of expression of C4d (complement fragment) in focal segmental glomerulosclerosis (FSGS) subtypes. Our aim was to determine the expression of C4d in FSGS subtypes in percutaneous native renal biopsies in a second-level hospital and its correlation with clinical, biochemical and histological variables. Material and methodsA retrospective study in paraffin blocks of patients with biopsy with FSGS aged 16-65 years, indistinct sex, not diabetic or obese. Immunohistochemistry was performed for C4d and their expression was analyzing in non-sclerosed glomerular capillaries (GC) and sclerosis areas (SA). Clinical and biochemical variables were recorded. The cases were divided into C4d positive and C4d negative groups and compared. The correlation between C4d staining scores in CG and SA with clinical and biochemical variables were analyzed. ResultsTwenty samples were analyzed, 4 for each subtype. At the time of biopsy average age was 38.8±18.6 years, 65% male, 8.7% with hypertension. The percentage of positivity for C4d was 40% in GC, 30% SA and 35% in mesangium. The highest expression was for cellular and collapsing subtypes. C4d positivity cases had increased proteinuria (p=0.035). A significant correlation was found between percentage of C4d expression in CG with SA (p=0.012) and SA with tubular atrophy and interstitial fibrosis (p<0.05). ConclusionsC4d expression in FSGS predominated in the cellular and collapsing subtypes, which translates complement activation. C4d is a possible surrogate marker in GSFS.

Renal biopsy - indication and its implications in management of children admitted at a tertiary care hospital, Mangalore

Background: Percutaneous renal biopsy is an established diagnostic tool for identification of renal pathology required for diagnosis, treatment, and prognostication. The present study was conducted to know the common indications and histopathological findings of renal biopsy, impact of biopsy report on treatment, and complications of procedure. Methods: This was a retrospective observational study conducted in the paediatric ward of a tertiary care level hospital. Indications of renal biopsy as suggested by medical records were noted down. Any treatment changes happened after final histopathological report were recorded. Statistical analysis was made using statistical package for the social sciences (SPSS) version 20.0 (IBM, NY). Results: The mean age of patients at which biopsy was done was 9.83±5.31 years. Most common indications of renal biopsy were nephritic onset nephrotic syndrome (34.8%), steroid-resistant nephrotic syndrome (21.7%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (17.4%), lupus nephritis (8.7%), nephrotic syndrome with later age of onset (8.7%), acute kidney injury (AKI) stage 3 (4.3%) and for evidence of calcineurin inhibitor toxicity (4.3%). Focal segmental glomerulosclerosis (26.1%), minimal change disease (21.7%) and membranoproliferative glomerulonephrosis (17.4%) were the most common histopathological findings. Conclusions: This study reiterates the fact that renal biopsy is one of the decisive and diagnostic procedures and has good prognostic value in further management of medical renal disease.

Unexpected cause of repeated peritoneal dialysis-related complications: a case study of autism spectrum disorder with normal intelligence quotient in an adolescent

BackgroundAutism spectrum disorder (ASD) is a common communication disorder, with an incidence rate of 3%. In most cases, clinicians can diagnose ASD in a single outpatient visit. However, in the case of ASD patients without intellectual disability, clinicians are sometimes unaware for a prolonged period that a patient has ASD. In such cases, delayed diagnosis can lead to serious complications.Case presentationAn 18-year-old boy had repeated severe complications of peritoneal dialysis. At the age of 9, the patient presented with proteinuria, and 5 years later, he developed end-stage kidney disease. Percutaneous renal biopsy and the clinical symptoms revealed focal segmental glomerulosclerosis with Charcot-Marie-Tooth disease due to a gene mutation in INF2. Peritoneal dialysis was initiated at the age of 14, but led to many related complications, including peritonitis, hypertensive retinopathy and encephalopathy, and acute heart failure. Initially, we were unaware of his developmental characteristics and autism spectrum disorder without intellectual disability, but through lengthy observations by various healthcare professionals, his unique characteristics were noticed. Because the patient often displayed a discrepancy between behavior and speech, we cautiously studied his thoughts and behaviors, and developed a special approach to ensure safe peritoneal dialysis.ConclusionsWhen many peritoneal dialysis-related complications occur in a patient with normal intelligence quotient, autism spectrum disorder should be considered as a possible cause.

37 Percutaneous Renal Biopsy in a Pregnant Patient: Taking a Different Approach

37 Percutaneous Renal Biopsy in a Pregnant Patient: Taking a Different Approach

Effects of receiving renal biopsy on the prognosis of chronic kidney disease patients with impaired renal function

BackgroundImpaired renal function was not a recognized indication for renal biopsy. The effects of receiving renal biopsy on the renal functional prognosis for chronic kidney disease (CKD) patients with impaired renal function need to be explored.MethodsThis study retrospectively enrolled 300 renal function impaired CKD patients in Renji Hospital from January 2015 to December 2017, 150 of them received percutaneous renal biopsy while the others did not. The endpoint was ≥ 50% estimated glomerular filtration rate (eGFR) decline from baseline or development of end-stage renal disease (ESRD). Kaplan-Meier analysis with log-rank test was performed to compare the renal survival probability between patients receiving renal biopsy or not. Univariate and multivariate analysis with Cox regression were conducted with predictors of poor renal outcomes in the study cohort.ResultsThe median follow-up period was 37.6 months. During the follow-up period, the eGFR of the biopsy group increased from 52.2 ± 14.4 to 67.4 ± 37.8 ml/min/1.73 m², but decreased from 55.3 ± 17.1 to 29.8 ± 19.1 ml/min/1.73 m² in the non-biopsy group. Patients who received renal biopsy had significantly higher renal survival probability (P < 0.001). Cox regression analysis revealed that 24-hour urine protein excretion (24 h UPE) more than 1 g/d was an independent predictor for poor renal outcomes in the non-biopsy group but not in the renal biopsy group (HR = 1.719, P = 0.040).ConclusionCKD patients with impaired renal function are recommended to receive renal biopsy to make pathological diagnoses, especially for those with the 24-hour urine protein excretion more than 1 g/d.

Superselective Renal Artery Embolization for Serious Renal Hemorrhage after Percutaneous Renal Biopsy in a Young Male.

Null.

An unusual complication of ureteric obstruction after transplant Kidney biopsy: A case report

Percutaneous renal biopsy was an incidental discovery when physicians obtained renal tissue accidentally while performing intended liver biopsies. Subsequently, Iversen and Brun in Copenhagen described their results using cutting and aspiration techniques in 1951 [1]. However, the success was inconsistent and operator-dependent.

Reliability and Management Outcomes Following a Percutaneous Biopsy Diagnosis of Oncocytoma: A 15-year Retrospective Analysis.

Background There is uncertainty in the management of renal masses diagnosed as oncocytomas with image-guided percutaneous biopsy. Purpose To assess the reliability of a diagnosis of oncocytoma based on image-guided percutaneous renal mass biopsy and evaluate patient outcomes following different management strategies. Materials and Methods In this retrospective study, image-guided percutaneous biopsy pathology reports from April 2004 to April 2019 were searched for keywords "oncocytoma" and "oncocytic neoplasm" and compared with surgical pathology or repeat biopsy results. Patients with at least 12 months of clinical follow-up and known cause of death were grouped according to management strategies, and disease-specific survival and metastatic renal cell carcinoma (RCC)-free survival were compared. Mass growth rates were calculated with use of a normal linear mixed model. Results The database yielded 160 biopsy reports of 149 renal masses in 139 patients; 149 masses were categorized as oncocytoma (n = 107), likely oncocytoma (n = 12), oncocytic neoplasm (n = 28), and indeterminate with oncocytoma in differential (n = 2). Biopsied masses categorized as oncocytoma or likely oncocytoma were oncocytomas in 16 of 17 masses (94%) based on surgical pathology or repeat biopsy; four of eight masses (50%) categorized as oncocytic neoplasms were low-grade RCCs. Outcome analysis included 121 patients (mean age ± SD, 68 years ± 9.1; 82 men); 80 patients initially underwent active surveillance (11 were later treated), 33 underwent ablation, and eight underwent surgery. Disease-specific survival and metastatic-free survival were 100% after each management strategy (median follow-up, 86.6 months; range, 14.2-207.9 months). Mass growth rate (mean, 1.7 mm per year) showed no evidence of a significant difference among biopsy result categories (P = .37) or initial (P = .84) or final management strategies (P = .11). Conclusion Image-guided percutaneous biopsy diagnosis of renal oncocytoma was reliable. Although some masses diagnosed as oncocytic neoplasms were low-grade renal cell carcinomas (RCCs) at final diagnosis, no patients died of RCC, including those managed with active surveillance. © RSNA, 2023 See also the editorial by Lockhart in this issue.

Comparison of bleeding complications after pediatric kidney biopsy between intravenous sedation and general anesthesia: a nationwide cohort study

BackgroundAn increasing number of studies are evaluating the safety of intravenous sedation compared with that of general anesthesia; however, data on bleeding complications after pediatric percutaneous renal biopsy performed under intravenous sedation or general anesthesia are lacking. We aimed to examine differences in bleeding complications between intravenous sedation and general anesthesia in pediatric patients.MethodsData of pediatric patients aged ≤ 15 years undergoing percutaneous kidney biopsy for kidney disease between July 2007 and March 2019 were retrieved from a national inpatient database in Japan. We examined differences in bleeding complications after renal biopsy performed under intravenous sedation, defined by the absence of the record of general anesthesia with intubation but by the presence of intravenous sedation during biopsy, and general anesthesia, defined by the presence of the record of general anesthesia with intubation during biopsy, among pediatric patients admitted for percutaneous renal biopsy. We performed binomial regression using overlap weights based on propensity scores for patients receiving intravenous sedation. Analyses stratified by age or sex, a sensitivity analysis using generalized estimating equations considering cluster effects by hospital among a propensity score-matched cohort, and another sensitivity analysis using the instrumental variable method were performed to confirm the robustness of the results.ResultsWe identified 6,560 biopsies performed in 5,999 children aged 1–15 years from 328 hospitals and 178 events. Only three severe complications and no death were observed. No significant difference in the proportion of bleeding complications was observed between procedures performed under intravenous sedation and those performed under general anesthesia (unadjusted proportions, 2.8% and 2.3%; adjusted proportions, 2.5% and 2.2%), with an unadjusted relative risk of 1.21 (95% confidence interval, 0.80–1.81) and adjusted relative risk of 1.13 (95% confidence interval, 0.74–1.73). Both age- and sex-stratified analyses yielded similar results. The analysis using generalized estimating equation and the instrumental variable method showed relative risks of 0.95 (95% confidence interval, 0.48–1.88) and 1.18 (95% confidence interval, 0.74–1.89), respectively.ConclusionThis retrospective cohort study using a national database revealed that the risk of biopsy-related bleeding was comparable between intravenous sedation and general anesthesia during pediatric percutaneous kidney biopsy, suggesting that intravenous sedation alone and general anesthesia may have a similar bleeding risk in pediatric percutaneous kidney biopsies.

The pathological spectrum of pediatric kidney disease: 18-Year experience from a single tertiary care center in northern Taiwan.

Glomerular disease is one of the leading causes of chronic kidney disease in children worldwide. Recent studies outlined the changing spectrum of glomerular disease in certain countries. Therefore, our study aimed to evaluate the histopathological patterns and changes in pediatric kidney disease over the past 18 years in northern Taiwan. This was a retrospective chart review study of pediatric patients (≤18 years of age) undergoing percutaneous renal biopsies (PRBs) of native kidneys between January 2002 and July 2020 from a Pediatric Care Center at Chang Gung Memorial Hospital, Taoyuan, Taiwan. This study analyzed a total of 339 pediatric native PRBs. The mean age of the subjects was 13.7±7.0 years (184 girls and 155 boys). The most common indications of PRBs included acute nephritic syndrome (55.7%), idiopathic nephrotic syndrome (22.7%), persistent asymptomatic hematuria (13.9%), and unexplained renal failure (7.7%). Our study revealed that proliferative lupus nephritis (LN), minimal change disease (MCD)-related nephrotic syndrome, and IgA nephropathy (IgAN) were the most frequent biopsy-proven pediatric glomerular diseases. In addition, we showed that severe acute post-streptococcal glomerulonephritis (APSGN) was infrequent and has not even been diagnosed since 2010. Our result revealed that the spectrum of biopsy-proven pediatric kidney disease has not changed significantly over the past two decades. Furthermore, proliferative LN, MCD, and primary IgAN continue to be the most common histopathological diagnoses among Taiwanese children.

Renal Biopsy

The extent of renal biopsy indication is being widened because of the increasing incidence of incidental renal masses; the increasing treatment options for renal cell carcinoma, including ablation therapy and novel targeted treatment; and the increasing incidence of kidney transplantation. However, percutaneous renal biopsy is technically difficult, particularly for beginners, because the skin-to-organ distance is relatively longer than those associated with other organs. In the present review, we will discuss the indications, technical considerations, efficacy, and complications of renal biopsy. Furthermore, we share practical tips of renal biopsy through many examples to help radiologists perform renal biopsy safely and effectively in various situations.

Indications for Percutaneous Ultrasound-Guided Renal Biopsy and Complications Associated with it: An Observational Study

Renal biopsy is performed for various reasons depending on the clinical manifestations presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications could occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Patients who underwent percutaneous ultrasound-guided renal biopsy at the institute between October 2017 and June 2019 were enrolled in the study. Data regarding indications for performing a percutaneous renal biopsy and incidence of minor and major post-biopsy complications were collected. A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy were enrolled in the study. The most common indications for ultrasound-guided percutaneous renal biopsy were nephrotic syndrome (33.3%), subnephrotic proteinuria with azotemia (14%), and unexplained azotemia with proteinuria and hematuria (13.5%). Post-biopsy complications were observed in 89 (37.55%) patients. Minor complications developed in 83 (36.22%) patients and major complications in six (2.62%) patients. Among patients with major complications, two (0.87%) patients underwent invasive procedures (embolization and cystoscopic removal of bladder clot) and four patients developed hemodynamic instability. No procedure-related mortality was reported in the study. The most common indications for renal biopsy were nephrotic syndrome, subnephrotic proteinuria with azotemia, unexplained azotemia with proteinuria, and hematuria. The incidence of major complications was low.

Non-invasive evaluation of the pathological and functional characteristics of chronic kidney disease by diffusion kurtosis imaging and intravoxel incoherent motion imaging: comparison with conventional DWI.

To explore the diagnostic performance of diffusion kurtosis imaging (DKI) and incoherent intravoxel movement (IVIM) in evaluating the clinical and pathological characteristics in chronic kidney disease (CKD) compared to conventional diffusion-weighted imaging (DWI). Forty-nine CKD patients and 24 healthy volunteers were included in this retrospective study from September 2020 to September 2021. All participants underwent MRI examinations before percutaneous renal biopsy. Coronal T2WI, axial T1WI and T2WI, and DWI (including IVIM and DKI) sequences obtained in one scan. We measured the apparent diffusion coefficient (ADC), true diffusion coefficient (Dt), pseudo-diffusion coefficient (Dp), perfusion fraction (fp), mean kurtosis (MK), and mean diffusivity (MD) values. One-way analysis of variance, correlation analysis, and receiver operating characteristic curve analysis were used in our study. Cortex and medulla ADC, MK, Dt, fp were significantly different between the healthy volunteers and CKD stages 1-2 (all p < 0.05). All diffusion parameters showed significant differences between CKD stages 1-2 and CKD stages 3-5 (all p < 0.05). Except for the uncorrelation between MDMedulla and vascular lesion score, all other diffusion parameters were low-to-moderately related to clinical and pathological indicators. fpMedulla was the best parameter to differentiate healthy volunteers from CKD stages 1-2. MKCortex was the best parameter to differentiate CKD stages 1-2 from that CKD stages 3-5. Renal cortex and medulla fp, Dt, and MK can provide more valuable information than ADC values for the evaluation of clinical and pathological characteristics of CKD patients, and thus can provide auxiliary diagnosis for fibrosis assessment and clinical management of CKD patients. IVIM and DKI can provide more diagnostic valuable information for CKD patients than conventional DWI.

One hour observation of patients after image-guided percutaneous renal mass biopsy.

Imaging-guided percutaneous biopsy of renal masses is regarded as safe and is widely used for histopathology diagnosis before treatment. Recommended observation time after tumour biopsy varies in international guidelines and the literature is sparse. To assess the effect of a 1-h post-biopsy observation time of percutaneous image-guided renal mass biopsy. This was a single-centre retrospective study. During January 2015 to September 2019, a total of 484 patients underwent renal mass biopsies. 4-h-observation-group: 178 patients and 1-h-observation-group 306 patients. All records were retrospectively reviewed, and data such as complications was obtained and compared between the two groups. A total complication rate of 4.5% (n = 22) without any major complications (Cardiovascular and Interventional Radiological Society of Europe-grade (CIRSE) 5-6). Furthermore, a non-significant difference of 1.3% of the 1-h group and 3.4% in the 4-h group experiencing complications was found (p = .18). A total biopsy-accuracy of 84% was observed. This study shows that renal mass biopsy is safe with no major complications. This suggests that an outpatient approach with 1-h-observation time can be safely implemented for renal mass biopsy.

Percutaneous Renal Biopsy Is Associated With Higher Bleeding Risks in Diabetics: A National Population Based Study

Percutaneous Renal Biopsy Is Associated With Higher Bleeding Risks in Diabetics: A National Population Based Study

A Clinical Tool for Prediction of Bleeding Complications After Percutaneous Renal Biopsy

A Clinical Tool for Prediction of Bleeding Complications After Percutaneous Renal Biopsy