Percutaneous Renal Needle Biopsy Research Articles

Histopathological evaluation of percutaneous renal biopsies: A single center experience

Aim: The aim of this study was to examine the indications, demographic features and histopathological diagnosis category of renal biopsies evaluated at the Pathology Laboratory of the University of Health Sciences Diyarbakir Gazi Yasargil Training and Research Hospital. Materials and Methods: The information of 190 patients who underwent percutaneous renal needle biopsy between July 2017 and February 2020 was obtained from the approved final pathology reports. Results: 190 biopsies were performed. 60% (n=114) and 40% (n=76) of the biopsies were native and transplant, respectively. 59.5% of the patients were male. Four of the patients were under 18 years. The mean ages of the native and transplant biopsy groupes were 37±14, and 34±14, respectively. Proteinuria was the most common biopsy indication (79.5%).Nonspecific changes were the most common diagnosis of the native biopsies. It was followed by focal segmental glomerulonephritis (FSGS), membranous glomerulonephritis (MGN), and IgA nephritis (IgAN). The most common secondary cause of glomerulonephritis was lupus nephritis. Acute cellular rejection was the most common diagnosis of the transplant renal biopsies. Conclusion: Proteinuria was identified as the most common indication for biopsy. In the present study, the primary glomerular disease was FSGS while the secondary was lupus nephritis. With electron microscopic examination, it might be possible to decrease the number of patients who cannot be definitively diagnosed histomorphologically.

Comparison of efficacy and safety between negative pressure suction puncture and biopsy-gun puncture in ultrasound-guided percutaneous renal needle biopsy

Objective To compare the efficacy and safety of different percutaneous renal needle biopsy methods. Methods Total 453 patients underwent renal needle biopsy in Taizhou Central Hospital during June 2009 and December 2014, including 221 patients received ultrasound-guided negative pressure suction puncture and 232 patients received ultrasound-guided biopsy gun puncture. The glomerular filtration rates (GFRs) were measured with single photon computed tomography [ECT (99mTc-DTPA)] before and after renal puncture. The amount of glomeruli obtained and incidence of perirenal hematoma were documented and compared between two groups. Results GFRs of punctured renal in negative pressure group were(37.7±11.6)ml/min before puncture and(38.3±11.7)ml/min after puncture (t=0.485, P=0.628); those in biopsy gun group were(36.8±11.3)ml/min before puncture and(37.4±11.9)ml/min after puncture (t=0.565, P=0.572). The incidence of perirenal hematoma >5 cm and ≤5 cm was 5.3%(24/453) and 6.0% (27/453), respectively. In hematoma >5cm group the GFR was decreased from(37.5±10.7)ml/min before renal puncture to(33.5±10.1)ml/min after puncture (t=2.103, P=0.038). The amount of glomeruli obtained by negative pressure puncture and by biopsy gun puncture was 26.4±15.9 and 20.6±9.9, respectively (t=4.648, P=0.000). The incidence of perirenal hematoma in negative pressure and biopsy gun groups was 6.8% (15/221) and 15.5% (36/232), respectively (χ2=8.634, P=0.003). The successful rate of renal needle biopsy in biopsy gun group was significant higher than that in negative pressure group [98.7±7.5% vs. 61.4±25.8%, t=5.453, P=0.000]. Conclusions The large hematoma in punctured kidney would reduce the GFR in short-time. Negative pressure suction puncture may obtain more glomeruli and have lower incidence of perirenal hematoma, but have lower successful rate of renal needle biopsy. Key words: Biopsy, needle; Kidney; Glomerular filtration rate; Hematoma

Use of Propofol for Pediatric Percutaneous Renal Needle Biopsy: 164 Cases of Experience

To the Editor: Over the past decade, propofol has been applied as a rapid and short-acting sedative-hypnotic agent during pediatric invasive procedures [1]. However, there are few studies regarding use of propofol sedation in children undergoing percutaneous renal needle biopsy (PRNB). We retrospectively analyzed propofol’s use in 164 children under the age of 18 y who underwent PRNB between January 2009 and March 2010. Patients were kept fasting for 6 h before the procedures. Propofol was injected at 1 mg/s until the desired sedation level was achieved. If necessary, repeated propofol was added as 5–20 mg bolus every 2 min to maintain proper sedation to allow the PRNB to continue. All patients underwent standard monitoring and biopsy protocol. Lignocaine skin infiltration was administered before biopsy. Patients were given oxygen via. nasal prongs. After the procedures, patients were watched in the recovery room until recovery of full consciousness. After analysis of 164 elective pediatric PRNB, a remarkable safety profile of propofol has emerged. Transient hypotension was the most common complication during the procedures. The median decrease in systolic blood pressure was 15 mmHg. No vasoactive agents and volume expanders were required to reverse hypotension. Transient desaturation was the second common complication. None of these children needed positive bag ventilation or endotracheal intubation. All of hypotension and desaturation were corrected spontaneously in a short time (less than 5 min). There were no episodes of apnea and bradycardia and no PRNB had to be terminated early or aborted for sedation-related issues. All of the patients were alert within 11 min after the precedures, and the median duration of recovery was 5.4 min. PRNB is a frightening procedure that is rarely performed in children without sedation [2]. Until recently, most nephrologists use a combination of benzodiazepines and narcotic analgesic agents to induce sedation. However, children usually require more medications and deeper sedation level, often resulting in more side effects. In contrast, propofol has been demonstrated to show rapid onset and termination of action in accompany with better subject comfort and less complications [3]. Current recommendations limit its use in pediatric PRNB, primarily because of the potential for respiratory depression. Our study has shown that propofol has an excellent record of safety and efficacy for sedation in children and patients look very comfortable during the PRNB. We conclud that propofol is a superior alternative to conventional sedative for invasive procedures.

Renal arteriovenous fistula: A rare complication of electro-hydraulic lithotripsy

Renal arteriovenous fistula (rAVF) is an uncommon condition, usually iatrogenic and in most cases caused by percutaneous renal needle biopsy. This is a report of rAVF following flexible ureteroscopic electro-hydraulic lithotripsy of a lower pole renal calculus and its subsequent management. A high index of suspicion is required for the diagnosis of this rare complication, which is easily treated by radiological intervention.

Effect of solution-focused approach nursing on the perioperative anxiety and depression of patients with percutaneous renal needle biopsy

Objective To explore the effect of solution-focused approach nursing on the perioperative anxiety and depression of patients with percutaneous renal needle biopsy.Methods Totals of 60 cases who underwent renal biopsy were randomly divided into control group and experimental group with 30 cases each group.Two groups were received regular health education,while the experimental group from 1 day before surgery to 3 days after surgery received the nursing intervention on the solution-focus approach.Before and after surgery,self-rating anxiety scale (SAS),self-rating depression scale (SDS) were used to investigated the patients and compared.Results The incidence of anxiety and depression among all patients was 63.3％ and 66.7％,and no significant difference was found in the score of SAS and before received the percutaneous renal needle biopsy between two groups( P ＞0.05 ).After intervention,the score of SAS and SDS score of experimental group were ( 42.60 ± 6.95 ) and ( 46.80 ± 7.73 ),respectively,and that of control group were ( 50.53 ± 8.63 ),(53.53 ± 10.93 ),and the differences were statistically significant ( P ＜ 0.05 ).Conclusions The intervention solution-focused approach nursing can reduce renal biopsy perioperative patients' degree of anxiety and depression,and improve the quality of nursing. Key words: Anxiety ; Depression; Percutaneous renal needle biopsy; Solution-focused approach

腎骨髄肉腫の1例

A 40-year-old man was referred to our department for left renal tumor pointed out on a checkup ultrasonography. CT (computed tomography) and MRI (magnetic resonance imaging) demonstrated left renal tumor, clinically T2N0M0. Percutaneous renal needle biopsy was performed because of malignant lymphoma was suspected. Pathological diagnosis was malignant tumor. However, malignant lymphoma could not denied. Therefore, left nephrectomy was performed retroperitonealy. Histological examination revealed myeloid sarcoma of the kidney. Myeloid sarcoma is a rare tumor composed of leukemia cells and usually progresses to acute myelogenous leukemia. To our knowledge, our case is the first report of myeloid sarcoma of the kidney in Japan.

696 THE EFFECT OF FENOLDOPAM ON RENAL FUNCTION IN SOLITARY KIDNEY PARTIAL NEPHRECTOMY

histologic subtype and nuclear grade, and illustrate the role of renal biopsy in surgical versus non-surgical management. METHODS: A retrospective chart review was performed including patients in the Southern California Kaiser Permanente Medical Region that underwent either CT or ultrasound guided core percutaneous renal biopsy of a solid renal mass from January 2005 to December 2009. Patients were stratified by size of renal mass, comparing SRMs (less than or equal to 4 cm) to larger renal tumors. Initial biopsy results including tumor histology and nuclear grade were evaluated and related to postoperative pathology specimens when surgery was performed. RESULTS: The study included 126 patients (129 renal units with 132 biopsies). Sixty-three patients (50%) ultimately underwent surgery (23 partial and 40 radical nephrectomies). Patients who did not have surgical intervention tended to be older, average 68 years old versus 61 years old and have larger tumors 5.5 cm versus 4.0 cm. The overall sensitivity for detecting cancer (verified by final pathology) in our series was 75.4% with 100% specificity. The positive predictive value for patients who underwent surgery was 100% and negative predictive value 11.7%. When evaluating factors associated with accuracy of predicting cancer, larger tumor size has an odds ratio of 1.21 (p 0.10) and increasing number of biopsy samples has an odds ratio of 1.57 (p 0.17). CONCLUSIONS: Percutaneous renal needle biopsy in the modern era has respectable sensitivity, excellent specificity and good concordance with final pathology. This modality can assist in clinical decision-making for renal masses, particularly for SRMs, as treatment options are expanding.

Reply

I first thank the editor for writing excellent comments on this article. The real question is “Who really needs a needle biopsy and will it gain acceptance as a diagnostic tool?” Percutaneous renal needle biopsy is accepted as the main diagnostic tool in unresectable renal cell carcinoma, metastatic masses, and lymphoma. 1 Sahni V.A. Silverman S.G. Biopsy of renal masses: when and why. Cancer Imaging. 2009; 9: 44-55 Crossref PubMed Scopus (60) Google Scholar Widespread use of imaging modalities has led to the increased diagnosis of small renal masses. If we consider small renal masses in the largest series of partial nephrectomy, 28%-34% of masses removed were benign at final pathology. 2 Gill I.S. Kavoussi L.R. Lane B.R. et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007; 178: 41-46 Abstract Full Text Full Text PDF PubMed Scopus (961) Google Scholar , 3 Venkatesh R. Weld K. Ames C.D. et al. Laparoscopic partial nephrectomy for renal masses: effect of tumor location. Urology. 2006; 67: 1169-1174 Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar However, small renal masses, detected in elderly patients who have comorbidities and are at high risk for postoperative morbidity and mortality, can be treated with ablative therapies such as cryotherapy, radiofrequency ablation, thermoablation, and active surveillance. In these clinical settings, needle biopsy is the only tool for histopathologic data available. Percutaneous renal needle core biopsy has an acceptable sensitivity and specificity in the diagnosis of renal masses being 91.4% and 60% in our study, respectively. Based on recent findings and published data, if practice is sufficient, the biopsy results have the potential to affect treatment decisions. As a conclusion, practicing urologists should increase the use of renal biopsies for suspicious masses to better characterize these masses preoperatively. Editorial CommentUrologyVol. 76Issue 3PreviewThe authors add to the literature an experience of 42 patients who underwent ultrasound-guided, 2-core 18-gauge needle biopsies of a kidney mass followed by surgical resection. In 39 of 42 cases (92.8%) an accurate diagnosis was achieved and in 36 of 40 cases (90%) a malignant mass could be differentiated from a benign mass. However, histologic subtype was correctly determined in 31 of 40 cases (77.5%) and Fuhrman grade in 17 of 33 cases (51.5%). No serious adverse events occurred after the biopsies. Full-Text PDF

A one-center experience with pediatric percutaneous renal biopsy and histopathology in Ankara, Turkey

In this study we evaluated the indications, complications, and the spectrum of histopathological results of percutaneous renal needle biopsy (PRNB) performed in our clinic. Between June 1990 and December 2006, 679 PRNBs were performed on native kidneys of 614 children (304 boys, 310 girls) with a mean age of 10.4 years. Most frequent indications for PRNB were nephrotic syndrome (47%), hematuria, and/or proteinuria (15.9%), acute renal failure (14.6%) and complex renal manifestations (18.9%). The overall complication rate was 15.2%. The most common complications were perirenal hematoma (12.4%) and macroscopic hematuria (2.6%). The most frequent histopathological group of diseases were glomerulopathies; these were diagnosed in 376 patients (61.2%) and included membranoproliferative glomerulonephritis (11.1%), mesangial proliferation (10.7%), diffuse proliferative glomerulonephritis (7.7%), and focal segmental glomerulosclerosis (7.3%) as the most frequent. The second most frequent group of histopathology was manifestations secondary to systemic diseases; these were shown in 195 patients (31.8%). Amyloidosis (11.4%) and Henoch-Schönlein nephritis (9.9%) made the majority of this group. In conclusion, our study demonstrated that PRNB is a safe procedure with usually transient complications showing the most frequent renal diseases that cause diagnostic and therapeutic difficulties for pediatric nephrologists.

IgA deficiency and membranous glomerulonephritis presenting as nephrotic syndrome

Selective IgA deficiency associated with glomerulonephritis is rare and no previous reports in childhood have been made of the association of IgA deficiency and membranous glomerulonephritis (MGN). We report a 5-year-old boy with selective IgA deficiency and MGN. He presented with nephrotic syndrome. Percutaneous renal needle biopsy showed diffuse global thickening on light microscopy and heavy IgG and moderate C3 deposits were found on immunofluorescence. Electron microscopy detected extensive global subepithelial deposition of electron-dense material with frequent intramembranous extension and spike formation. The pathological diagnosis was diffuse MGN stage 1. Oral prednisolone (1 mg kg(-1) day(-1)), angiotensin-converting enzyme inhibitors (ACEI), and angiotensin II receptor blocker (ARB) were given resulting in reduction of proteinuria. The prednisolone dose was gradually tapered and discontinued after 2 months. At present the patient has been in complete remission for 10 months despite the discontinuance of prednisolone. In conclusion, our treatment with corticosteroid, ACEI and ARB reduced proteinuria and was effective for our case with selective IgA deficiency and MGN.

Bilateral renal cortical necrosis

Bilateral renal cortical necrosis is a pathological diagnosis of a clinical entity characterized by the abrupt onset of gross hematuria, oliguria and anuria, usually in individuals without known renal disease, and proceeding to a uremic syndrome with a predominantly fatal outcome. Pathologically, there is a patchy to diffuse bilateral ischemic coagulative cortical necrosis, with characteristic sparing of the renal medulla. Its greatest incidence is in pregnant women with accidental hemorrhage (abruptio placentae) in the last trimester. It may also occur in infants and children, usually as a result of diarrhea and dehydration, while in men it usually occurs as a result of infections or poisons. Its main clinical feature is the sudden onset of oliguria and anuria. The clinical diagnosis is difficult but is aided by percutaneous renal needle biopsy. Experimentally, it has been produced in animals principally by intravenous injection of bacterial toxins and vasoconstrictor substances. Although it is believed to result from spasm of renal interlobular arteries and afferent arterioles, its exact pathogenesis remains obscure. The treatment is similar to that employed in other causes of acute renal insufficiency. Proper management makes survival possible.