Ultrasound-guided Renal Biopsy Research Articles

Effect of Ultrasound-Guided Renal Biopsies on Urinary N-Acetyl-Beta-D-Glucosaminidase Index Activity in Dogs with Diffuse Parenchymal Nephropathies.

Ultrasound-guided kidney biopsy is an essential diagnostics method that can increase the accuracy of the differential diagnosis between acute and chronic nephropathies. In addition, it will help clinicians perform an etiologic diagnosis, issue a prognosis, and orient therapy for the majority of parenchymal nephropathies. Due to the relative invasiveness and potential adverse effects, the use of kidney biopsies is limited among practitioners. Twenty-eight dogs, of mixed breed and variable ages, of which 11 (39, 29%) were males and 17 (60, 71%) were females, were examined and underwent an ultrasound-guided kidney biopsy to establish a definitive diagnosis. The patients were presented with a variety of diffuse nephropathies, such as kidney lymphoma: 1 (3.57%), glomerulonephritis: 13 (46.43%), tubulointerstitial nephritis: 11 (39.29%), and nephrocalcinosis. A total of 3 (10.71%) of 18 (64.29%) were in acute kidney injury, and 10 (35.71%) were CKD patients. The type and the severity of the kidney lesions were correlated with changes in the urinary n-acetyl-beta-d-glucosaminidase index (iNAG. To quantify the side effects of percutaneous kidney biopsy, the magnitude of post-biopsy hematuria and changes in urinary iNAG activity were evaluated. The results indicate a significant post-biopsy increase in the urinary iNAG activity in all the patients that underwent this procedure (100.08 ± 34.45 U/g), with a pre-biopsy iNAG vs. 147.65 ± 33.26 U/g post-biopsy iNAG (p < 0.001), suggesting an intensification in the kidney tubular damage that comes consecutives to kidney puncture and sampling. Transitory macro- or microhematuria were constant findings in all the dogs that underwent ultrasound-guided kidney biopsy, but the magnitude and extent could not be associated with the platelet count (PLT 109/L), aPTT (s), and PT (s) levels in our patients, and they were also resolved after 12-24 h without therapeutic interventions. Ultrasound-guided renal biopsy was shown to be a minimally invasive diagnostic procedure that causes transient and limited effects on kidney structures. Although these effects were minor and resolved without intervention, we feel that the benefit of obtaining higher-quality biopsied tissue outweighs the higher risks associated with this procedure.

#281 AVF formation is a common complication of percutaneous ultrasound-guided renal biopsy: a single-center analysis of risk factors and clinical outcome

Abstract Background and Aims Percutaneous renal biopsy is a key procedure for the work-up of renal diseases. Among the possible complications of such procedure, prevalence, risk factors and clinical outcome of arterio-venous fistula (AVF) formation is unclear. We present here a single-center experience on renal biopsy-related complications with a focus on risk factors for AVFs formation and their management. Method We retrospectively analyzed all the kidney biopsies performed in our center between January 2012 and December 2022. All biopsies were conducted under real-time ultrasound (US) guidance by trained nephrologists. Kidney US and doppler mapping were performed routinely 6 and 24 hours post-procedure. In accordance with the description provided in the US report, AVFs were categorized into small, moderate, and high-flow rates. Patients’ comorbidities, histologic sample characteristics, blood tests results and the clinical course were recorded. Logistic regression was employed to investigate potential risk factors for complications. Results 1016 adult native renal biopsies were performed. The average age of patients was 55 ± 17 years, and 677/1016 (66.6%) were males. The histological sample was unsuitable in 29/1016 (2.9%) of the cases; moreover, prevalence of renal medulla and presence of large-caliber arteriole were observed in 88/1016 (8.7%) and 38/1016 (3.7%) of the samples, respectively. The most common complication was hematoma, detected by US in 175/1016 (17.2%), which was considered “complicated” in 21/1016 (2.1%) due to the association with macroscopic hematuria (n = 10), blood transfusion requirement (n = 8), or signs of active bleeding (n = 8), requiring embolization in 6/1016 patients (0.6%). AVFs were identified in 119/1016 (11.7%) biopsies; of these 20/119 (16.8%) required embolization after a median time of 16 days (IQR 5-65). Spontaneous resolution was documented in 65/119 (55%) of cases and occurred after a median of 27 days (IQR 15-49), with 50/55 (90.9%) of cases spontaneously resolving within the first month and the remaining cases no later than the fourth month (Fig. 1). High-flow AVFs more frequently necessitated angiographic intervention compared to moderate and small AVFs (75% vs 25% vs 7%), with a prolonged spontaneous resolution time (median 78 days; IQR 51-106) (Table 1). In the cases requiring embolization, the median creatinine level before and 6 months after procedure was respectively 1.7 mg/dL and 1.9 mg/dL (paired Wilcoxon signed-rank test: p = 0.908). In three cases post-embolization, a loss of renal vascularization at angiography higher than 30% was reported; however, even in these cases no differences in terms of renal function were observed at 6 months compared to the baseline. At multivariate logistic regression, hypertension (OR = 2,2; p = 0.003; 95% CI [1.3-3.7]), renal medulla prevalence (OR = 2,8; p = 0,001; 95% CI [1.6-4.8]), and large-caliber arteriole presence (OR = 2,9; p = 0,008; 95% CI [1.3-6.3]) were associated with a higher risk of AVFs, while obesity emerged as a protective factor (OR = 0,27; p = 0,013; 95% CI [0.1-0.8]). Conclusion AVF is a common complication following renal biopsy but therapeutic intervention is rarely required, as spontaneous resolution is typically observed within one month. In case of symptomatic or persistent AVFs, embolization may be required without an apparent impact on the renal function, at least in the short term. Hypertension and surrogate factors associated with a deeper penetration of the needle into the renal parenchyma are associated with an increased risk of AVF. Conversely, obesity was protective toward the risk of AVF development.

Endoscopic Ultrasound-Guided Renal Parenchymal Biopsy: A Series of Two Cases

Endoscopic Ultrasound-Guided Renal Parenchymal Biopsy: A Series of Two Cases

Simulation of Ultrasound-Guided Renal Biopsy Using a Novel Custom-Made Training Model

Simulation of Ultrasound-Guided Renal Biopsy Using a Novel Custom-Made Training Model

Purslane-induced oxalate nephropathy: case report and literature review

BackgroundThe kidney is particularly vulnerable to toxins due to its abundant blood supply, active tubular reabsorption, and medullary interstitial concentration. Currently, calcium phosphate-induced and calcium oxalate-induced nephropathies are the most common crystalline nephropathies. Hyperoxaluria may lead to kidney stones and progressive kidney disease due to calcium oxalate deposition leading to oxalate nephropathy. Hyperoxaluria can be primary or secondary. Primary hyperoxaluria is an autosomal recessive disease that usually develops in childhood, whereas secondary hyperoxaluria is observed following excessive oxalate intake or reduced excretion, with no difference in age of onset. Oxalate nephropathy may be overlooked, and the diagnosis is often delayed or missed owning to the physician’s inadequate awareness of its etiology and pathogenesis. Herein, we discuss the pathogenesis of hyperoxaluria with two case reports, and our report may be helpful to make appropriate treatment plans in clinical settings in the future.Case presentationWe report two cases of acute kidney injury, which were considered to be due to oxalate nephropathy in the setting of purslane (portulaca oleracea) ingestion. The two patients were elderly and presented with oliguria, nausea, vomiting, and clinical manifestations of acute kidney injury requiring renal replacement therapy. One patient underwent an ultrasound-guided renal biopsy, which showed acute tubulointerstitial injury and partial tubular oxalate deposition. Both patients underwent hemodialysis and were discharged following improvement in creatinine levels.ConclusionsOur report illustrates two cases of acute oxalate nephropathy in the setting of high dietary consumption of purslane. If a renal biopsy shows calcium oxalate crystals and acute tubular injury, oxalate nephropathy should be considered and the secondary causes of hyperoxaluria should be eliminated.

#6949 MPO ANCA-ASSOCIATED VASCULITIS IN A PATIENT WITH A HISTORY OF METHAMPHETAMINE ABUSE

Abstract Background and Aims Methamphetamines cause kidney damage by different mechanisms. The most common is the tubular lesion associated with myoglobinuria secondary to rhabdomyolysis. Other renal effects include prerenal azotemia, acute tubular necrosis, malignant hypertension, and necrotizing vasculitis have been reported. It is important to consider this drug as a possible cause of glomerulonephritis. Method We present the case report of a patient with suspected MPO ANCA-associated vasculitis from methamphetamines. Results A 24-year-old male, he was admitted to nephrology due to hematuria and proteinuria accompanied by serum creatinine elevation (2.5 mg/dl). He reported inhaled methamphetamine abuse since the age of 14, smoking and occasional ethylism. His symptoms began in October 2022 with asthenia and adinamia, accompanied by generalized pallor and edema in both malleoli. At admission with normal blood pressure (112/70 mmHg). Laboratory tests revealed: leukocytes 6.35 thousand/UL, hemoglobin 7.7 g/dl, platelets 698,000 thousand/UL, urea 70.81 mg/dl, sodium 137 mmol/L, potassium 4.72 mmol/L, albumin 3.85 g/dl, urine test with proteinuria 25 mg/dl, hemoglobinuria 250 eri/microL, leukocytes 15-20 field and countless erythrocytes, albuminuria 450.87 mg/day, globular sedimentation rate 18 mm/hr, reactive protein C 37 mg/L. Complement levels were normal, negative serologies for hepatitis B, C, human immunodeficiency viruses, antinuclear antibodies, double-stranded anti DNA and anti-proteinase 3, but was positive for IgG anti myeloperoxidase (anti-MPO) 33.6 U/ml. Urinary sediment showed the presence of dysmorphic erythrocytes, as well as abundant erythrocyte and granular casts. Ultrasound-guided renal biopsy was performed; light microscopy reported 21 glomeruli, 6 globally sclerosed, 4 with irregular segmental sclerosis, 4 with destruction and granuloma formation. Immunofluorescence showed traces of mesangial IgM, the rest negative for IgG, IgA, C3, C1q, fibrinogen, kappa and lambda. The patient received 3 pulses of methylprednisolone 500 mg followed by oral prednisone and rituximab. Baseline creatinine decreased to 1.88 mg/dl. Conclusion Inhaled methamphetamine is commonly used in young people, it is important to consider this drug as a possible cause of crescentic and necrotizing glomerulonephritis.

#2780 THE STRAIGHTFORWARD AND IMMEDIATE KIDNEY BIOPSY USING A GUIDE NEEDLE (SIGN) REDUCES THE PUNCTURE TIME AND ENABLES ADEQUATE TISSUE TO BE OBTAINED

Abstract Background and Aims Advances in kidney biopsy procedures have improved tissue adequacy and reduced complications. Here, we report the usefulness of the Straightforward and Immediate ultrasound-guided kidney biopsy using a Guide Needle (SIGN) technique, which allows the operator to insert a biopsy gun through a guide needle placed into the fascia of the posterior abdominal wall. In this study, we retrospectively analyzed our daily practice to determine whether this technique enables nephrologists, including nephrology fellows, to shorten the procedure time and obtain more glomeruli with complication rates comparable to those of the standard ultrasound-guided kidney biopsy technique. Methods A single-center retrospective cross-sectional study was conducted to compare the time spent on the procedure and the number of glomeruli obtained in a group using the SIGN technique (n = 81) and a group using the standard ultrasound-guided renal biopsy technique with a needle guide (n = 143). Biopsies were performed by four board-certified nephrologists of the Japanese Society of Nephrology and four fellows. It was left to the operator to decide whether to use the standard technique or the SIGN technique. In the standard technique, an operator inserted a biopsy gun through a needle guide attached to the ultrasound probe and obtained a biopsy core from the lower pole of the kidney. In the SIGN technique, after local anesthesia, an operator inserted a 17-gauge guide needle (TSK Laboratory, Tochigi, Japan) through the needle guide without making a skin incision. The guide needle was placed in the fascia of the posterior abdominal wall. Then the operator inserted a biopsy gun through the guide needle into the lower pole of the kidney and obtained the biopsy core. The puncture time was calculated by subtracting the minute of the last puncture from the first. The number of glomeruli in the specimen for light and fluorescence microscopy was counted by kidney pathologists who did not have procedural information. Results The proportion of fellows using the SIGN method was significantly higher than that of specialists (56.9% and 27.7%, respectively, P&amp;lt;0.001). The median age of subjects in the SIGN group (58 years old) was younger than that of subjects in the standard technique group (64 years old) (P = 0.009). There was no significant difference between the two groups in gender, BMI, clinical diagnosis, kidney depth, kidney volume, eGFR, or hemoglobin level. The median puncture time in the SIGN group (2 min, IQR: 1-3 min) was significantly shorter than that in the standard technique group (3 min, IQR: 2–4 min) (P &amp;lt;0.001). The number of glomeruli obtained in the SIGN group (29 ± 15) was significantly larger than that in the standard technique group (24 ± 12) (P = 0.008). The prevalence of major complications in the SIGN group (1.2%) was similar to that in the standard technique group (2.1%) (P = 1.0). Logistic regression analysis with adjustment for age, gender, BMI, kidney depth, kidney volume, and the operator's experience showed that the use of the SIGN technique was independently associated with the puncture time ≤ 2 min (odds ratio: 5.84, 95% CI 3.0–11.4). In addition, multiple linear regression analysis with adjustment for age, gender, BMI, number of punctures, use of an 11 mm stroke biopsy gun, kidney depth, kidney volume, and operator's experience showed use of SIGN method was independently associated with a significantly larger number of glomeruli to be obtained (P = 0.015). Conclusion Use of the SIGN technique reduces the procedure time and enables adequate biopsy tissue to be obtained with complication rates comparable to those of the standard technique regardless of the operator's experience. Since the biopsy procedures in the current study were performed by multiple nephrologists, including fellows, the SIGN technique can be applied in a nephrology training program and can be used as the standard biopsy procedure.

The use of renal biopsy in the kidney tumor management: A retrospective analysis of consecutive cases in a referral center

Ultrasound-guided renal masses biopsy (RMB) is a useful and underestimated tool to evaluate suspected renal tumors. This study aimed to assess the safety and feasibility of this technique. Data of 80 patients with suspected primary or secondary kidney tumors who underwent RMB between January 2012 and December 2020 were included in this retrospective study. Twelve patients were excluded due to incomplete data. Biopsy outcomes were collected through our electronic medical records system and then compared with definitive pathology. RMB was performed in 68 cases. Pathological examination reported 43 (63%) malignant cases, while RMB was negative in 15 (22%) samples. On the other hand, a benign lesion was present in 8 (12%) cases, and 2 (3%) biopsies were non diagnostic. One major and one minor post-procedure complication were reported among the patients. A total of 31 patients underwent renal surgery including 19 partial and 12 radical nephrectomies. Out of them, 4 patients had a negative biopsy, but radiological imaging strongly suggested malignancy. The concordance between biopsy and definitive pathology occurred in 22 out of 31 (71%) cases, with a higher rate among the masses greater than 4 cm, 9/11 (82%) compared to smaller ones 13/20 (65%). Pathologic examination of the 4 cases with negative biopsy showed 3 renal cell and a translocation renal cell carcinoma. Ultrasound-guided biopsy for renal masses is a safe and effective procedure. Its ability to identify malignancy is evident, especially for primary renal tumors. However, low concordance between biopsy and definitive pathology in cases with negative biopsies, especially for tumors < 4 cm, does not reliably guarantee the absence of tumor and, therefore, strict follow-up or repeat biopsy may be indicated.

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.

Fluorescence Imaging Using Enzyme-Activatable Probes for Detecting Diabetic Kidney Disease and Glomerular Diseases.

A clear identification of the etiology of glomerular disease is essential in patients with diabetes. Renal biopsy is the gold standard for assessing the underlying nephrotic pathology; however, it has the risk for potential complications. Here, we aimed to investigate the feasibility of urinary fluorescence imaging using an enzyme-activatable probe for differentiating diabetic kidney disease and the other glomerular diseases. Hydroxymethyl rhodamine green (HMRG)-based fluorescent probes targeting gamma-glutamyl transpeptidase (GGT) and dipeptidyl-peptidase (DPP) were used. Urinary fluorescence was compared between groups which were classified by their histopathological diagnoses (diabetic kidney disease, glomerulonephritis, and nephrosclerosis) as obtained by ultrasound-guided renal biopsy. Urinary fluorescence was significantly stronger in patients with diabetic kidney disease compared to those with glomerulonephritis/nephrosclerosis after DPP-HMRG, whereas it was stronger in patients with nephrosclerosis than in patients with glomerulonephritis after GGT-HMRG. Subgroup analyses of the fluorescence performed for patients with diabetes showed consistent results. Urinary fluorescence imaging using enzyme-activatable fluorescence probes thus represents a potential noninvasive assessment technique for kidney diseases in patients with diabetes.

Targeted Renal Biopsy: Predictors on Imaging

Abstract Objectives The renal nephrometry score uses imaging characteristics such as lesion diameter, location, and proximity to hilar vessels to categorize renal masses by complexity for preoperative planning. These characteristics may also be used to determine the best approach to targeted renal biopsy. This study was conducted to investigate the impact of renal lesion characteristics as measured by the renal nephrometry score on the choice of modality used for performing a targeted renal lesion biopsy and increasing the chance of yielding a diagnostic biopsy. Materials and Methods All targeted computed tomography (CT)/ultrasound-guided renal biopsies performed by our radiology department from January 2017 to February 2020 were reviewed. Radiological characteristics and pathological outcomes were recorded with data on lesion size/ side, location in craniocaudal/anterior–posterior planes, endophytic/exophytic/mixed nature, and skin-lesion distance. Statistical Analysis Chi-squared tests, multivariate analysis, and t-tests were used in this study. Results Of the 145 consecutive patients included in the study, 86.2% (125/145) biopsies were diagnostic. About 54.5% (79/145) biopsies were ultrasound-guided, while 45.5% (66/145) were CT-guided. About 62.1% (90/145) biopsies revealed renal cell carcinoma. The highest rate of diagnostic biopsy was in the exophytic, laterally positioned mass either entirely below lower polar or above upper polar line. Ultrasound was preferred for lesions under 4cm and 4 to 7cm (p = 0.06). CT was used for anterior lesions and ultrasound for posterior and lateral lesions (p &lt; 0.001). Of the 20 nondiagnostic biopsies, 7/20 had a repeat biopsy, 7/20 underwent surveillance, 5/20 underwent partial or total nephrectomy, and 1/20 underwent a pathological lymph node biopsy. Conclusions Our study highlights some factors radiologists should consider when predicting whether CT or ultrasound guidance is more appropriate and the probability of achieving a diagnostic biopsy based on lesion characteristics. At our institution, both modalities achieved high accuracy, although we favored ultrasound in lateral, posterior, and small lesions. These factors should be weighed against local experience and preference.

Simulation for ultrasound-guided renal biopsy using boiled egg.

Real-time ultrasound-guided renal biopsy is generally applied to diagnose multiple kidney diseases. A practical simulation model is desired since it is an invasive technique with higher risks of complications such as bleeding. We developed a simple simulation tool for ultrasound-guided renal biopsy using boiled eggs. Boiled chicken eggs were embedded in the agar, and a biopsy simulation was performed using a real-time ultrasound-guided technique as the renal biopsy simulator by trainees and biopsy-proficient nephrologists, and the feedback from the participants was obtained. The ultrasonographic evaluation revealed a clear contrast between egg yolk and white, which clearly mimicked the kidney cortex and medulla region. In addition, we observed the needle entering the egg white under needle penetration, and we obtained the biopsy core consisting of egg white. As for the simulations, all the participants succeeded in obtaining the appropriate samples. A total of 92% of the trainees agreed that the simulation could reduce their fears of performing renal biopsies in patients. In addition, all the trainees and biopsy-proficient nephrologists recommend using the simulator for trainees before conducting renal biopsies on patients. The total cost of the simulator was low (<USD 1/simulator). Collectively, our simulation tool using boiled eggs may be a good candidate for practical simulation models of renal biopsy.

MO202: Pulmonary-Renal Syndrome in Patient with Chronic Hepatitis C And HIV Disease

Abstract BACKGROUND AND AIMS Pulmonary-renal syndrome (PRS) is characterized by rapidly progressive glomerulonephritis and lung vasculitis. Most common causes of PRS are Goodpasture's disease, antineutrophil cytoplasm antibody (ANCA) associated vasculitis and systemic lupus erythematosus; rarely it could be caused by cryoglobulinemic vasculitis. ANCA and cryoglobulins are present in a wide range of infectious, inflammatory and malignant conditions with or without evidence of clinical vasculitis. ANCA positivity has been described in patients with human immunodeficiency virus (HIV) or chronic hepatitis C (HCV), but only a negligible proportion of these patients developed true ANCA vasculitis. Cryoglobulinemia is seen in ∼50% of patients with HCV and ∼5% of these patients have symptomatic disease. According to previous studies, rapidly progressive glomerulonephritis and pulmonary involvement are rare manifestations of cryoglobulinemia. We describe a patient with HIV and HCV infection who presented with rapidly progressive glomerulonephritis and lung vasculitis. METHOD Case report presentation. RESULTS A 43-year-old male presented with fatigue, nausea and decreased urinary output of 3–4 days. Vital signs were stable and physical examination showed abdominal distention and peripheral oedema. His past medical history included heroin abuse. However, he denied any illicit drug use, and he had been on methadone maintenance treatment for 8 years. The patient was diagnosed with HIV 11 years previously. His antiretroviral therapy included abacavir, dolutegravir and lamivudine. CD4 count before admission was 180–200 cells/mm3. In addition to HIV infection, the patient had HCV diagnosed 20 years ago, but he has not received any treatment. The laboratory tests revealed pancytopenia (leukocytes 1.3 × 109/L, haemoglobin 66 g/L, platelets 66 × 109/L), kidney injury (proteinuria 0.8 g/24 h and haematuria) with renal insufficiency (creatinine 727 mcmol/L, urea 36.6 mmol/L). Ultrasound workup demonstrated diffuse changes in liver parenchyma with signs of portal hypertension, and normal-sized, non-obstructed kidneys with Grade 0 parenchymal echogenicity. Chest CT revealed wide areas of ground-glass opacity with patchy airspace consolidations, more severe in the left upper lobe. A serologic workup was positive for cryoglobulins, ANA, c-ANCA (high titre of anti-PR3 143 IU/mL), with decreased levels of C3 and C4. CRP level was slightly elevated (40 mg/L). Moreover patient had positive treponemal and non-treponemal syphilis serological tests. An ultrasound-guided renal biopsy showed crescentic glomerulonephritis with predominant IgM and focal C3, C1q deposition in glomerular capillary walls without any significant glomerular proliferative features. Changes could be interpreted as an immune complex and/or cryoglobulin-mediated glomerulonephritis, but overlapping pauci-immune glomerulonephritis could not be ruled out. Haemodialysis was initiated due to kidney failure and hyperhydration. The patient was treated with pulse methylprednisolone followed by a tapering course of oral prednisolone. Rituximab 1000 mg was prescribed after excluding HIV opportunistic infections, and treatment of syphilis with three doses of benzathine penicillin was used. Due to low GFR, HIV treatment was switched to Dolutegravir/Rilpivirine. The patient refused to initiate HCV therapy. The patient responded well to treatment and lung vasculitis and kidney function improved, therefore haemodialysis was discontinued. Serum creatinine level decreased to 130–120 mcmol/L and remained stable after 18 weeks since the treatment. CONCLUSION PRS in a patient with chronic infections, positive cryoglobulins and positive c-ANCA clinically seems more applicable to c-ANCA vasculitis than to cryoglobulinemic vasculitis. Still overlapping of both diseases could not be excluded.

Percutaneous ultrasound-guided renal biopsies in a paediatric population: comparison of coaxial and non-coaxial techniques using 18-gauge core biopsy needles.

Percutaneous ultrasound-guided biopsy is performed in paediatric patients for evaluation of diffuse renal parenchymal disease. When compared with the non-coaxial technique, the coaxial technique has the advantages of obtaining multiple tissue cores via a single capsular puncture and post-biopsy tract embolisation. To compare the coaxial and non-coaxial techniques of percutaneous ultrasound (US)-guided biopsy of native kidney parenchyma in children and adolescents with renal disease. We retrospectively identified consecutive patients who underwent percutaneous US-guided renal biopsy using an 18-gauge core biopsy needle from July 2019 to July 2021 in a single tertiary paediatric nephrology centre. Focal renal tumour biopsy and transplant kidney biopsy were excluded. The total glomerular yield, specimen adequacy, complication rate and procedural time between the coaxial and non-coaxial groups were compared. There were 34 percutaneous US-guided renal biopsies: 22 using a coaxial technique and 12 using a non-coaxial technique. The total median glomerular yield obtained was higher in the coaxial group (coaxial=37.9; non-coaxial=22.2; P=0.02). No statistically significant difference was noted between specimen adequacy (coaxial=100%; non-coaxial=91.7%; P=0.35). While no statistically significant difference was detected for overall complication rates (coaxial=13.6%; non-coaxial=41.7%; P=0.09), the coaxial group had a lower rate of haemorrhagic complications (coaxial=4.5%; non-coaxial=41.7%; P=0.01). One patient in the non-coaxial group had post-biopsy haemorrhage requiring embolisation. The procedural time was shorter in the coaxial group (coaxial=26.3 ± 7.0min; non-coaxial=51.3 ± 11.5min; P&lt;0.001). Percutaneous US-guided renal biopsy in children using the coaxial technique has significantly higher total glomerular yield, shorter procedural time and fewer haemorrhagic complications, compared to biopsies using the non-coaxial technique.

Indications for Percutaneous Ultrasound-guided Renal Biopsy and Complications Associated with It

Introduction: Renal biopsy is performed for various reasons depending on the signs and symptoms presented. Although percutaneous kidney biopsy is a safe procedure, major or minor complications may occur. Our study aimed to assess the indications for percutaneous renal biopsy and complications associated with the procedure. Materials and Methods: This was a prospective observational study conducted in the Department of Nephrology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar. 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. Results: A total of 229 patients who underwent ultrasound-guided percutaneous renal biopsy under ultrasound guidance 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 6 (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. There was no procedure-related mortality reported in the study. Conclusions: 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.

POS-485 Percutaneous ultrasound-guided renal biopsy in children: A retrospective review of a tertiary hospital experience in Lagos, Nigeria

Percutaneous renal biopsy (PRB) is an invasive procedure in nephrology that is extremely important in making diagnosis, prognostication and evaluation of treatment outcome in children with renal diseases. Currently the use of real time ultrasound guided PRB has greatly increased the tissue yield and also reduced the complications associated with the procedure. The prevalence of renal diseases as well as mortality associated with renal diseases is increasing worldwide and especially in developing countries like Nigeria.

Ultrasound-Guided Renal Mass Biopsy and Its Clinical Utility: A Single-Centre Experience

Introduction: Renal mass biopsy (RMB) is still underutilized, partially because many urologists argue that it does not substantially influence the management of renal masses. We sought to evaluate the influence of RMB on the management of renal tumours in our institution. Materials and Methods: A total of 387 RMBs performed at our institution from January 2016 to June 2020 were included. Patient demographics, mass size, biopsy result, and subsequent clinical management were retrospectively reviewed. Results: The mean mass size was 47.8 mm. Fifty-six percentage of tumours ≤40 mm (247) and 8% of tumours >40 mm (64) were biopsied. Seventy-six RMBs of disseminated tumours were performed. 14.9% of RMBs were non-diagnostic, and 27.1% of RMBs of tumours ≤40 mm were benign. The majority of tumours with first non-diagnostic RMB followed by histopathological verification were found to be malignant. There was significantly more conservative management and no radical nephrectomies in the benign biopsy group. One case of Clavien-Dindo grade ≥2 complication occurred. Conclusions: RMB result affects treatment decisions. Ultrasound-guided RMB is a safe procedure, and performing biopsies of tumours ≤40 mm may reduce the number of unnecessary interventions. Non-diagnostic RMBs should be repeated or treated as malignant.

Retraction: Indications for percutaneous ultrasound-guided renal biopsy and complications associated with it: An observational study

Retraction: Indications for percutaneous ultrasound-guided renal biopsy and complications associated with it: An observational study

Endoscopic ultrasound-guided renal biopsy: an alternative to transjugular renal biopsy in high-risk patients.

Endoscopic ultrasound-guided renal biopsy: an alternative to transjugular renal biopsy in high-risk patients.

Comparative analysis of blind vs real-time ultrasound-guided pediatric renal biopsies: A cross-sectional study

BackgroundRenal biopsy has a definite role in the management of pediatric kidney diseases. Most centers have given up the earlier practice of performing blind biopsy using Tru-Cut needle and started doing real time ultrasound-guided renal biopsy with an automated spring-loaded gun, which has become standard of care in the last decade or so. MethodsWe performed a cross-sectional analysis of the pediatric biopsies conducted at our center over the years by both methods to evaluate whether ultrasound-guided renal biopsy with a disposable automated spring-loaded gun was superior to blind biopsy with a disposable needle of the same size in terms of reduction of complications and improving the yield. We also reviewed the indications and the histopathological diagnosis of pediatric renal biopsies at our center. ResultsA total of 45 native kidney biopsies were performed blind and 48 ultrasound-guided biopsies using the curvilinear probe (frequency 3-5 Hz) of GE Logiq P3 ultrasound machine with disposable spring-loaded automated guns. There was a significant increase in the yield of biopsy in terms of the number of glomeruli per pass. A significant increase in the mean number of glomeruli was noted when a biopsy was performed under ultrasound guidance (P < 0.0001). Gross hematuria was significantly reduced as compared to the earlier biopsies done blind i.e., without ultrasound (P ¼ 0.03). Nephrotic syndrome was the commonest indication for biopsy in our patients during both time periods studied. The most common histopathological diagnosis was MesPGN among the children who underwent kidney biopsy from 2005 to 2007, while Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS) were most frequently reported. ConclusionUltrasound guided kidney biopsies in pediatric age group have significant reduction in incidence of post gross hematuria and significant increase in the mean number of glomeruli per pass.