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1
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Bhadauria D, Jose L, Kushwaha R, Kaul A, Nandan R, Singh V, Prasad N. Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed? Acta Radiol 2022; 63:261-267. [PMID: 33497275 DOI: 10.1177/0284185120988812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the majority of bleeding complications after a percutaneous kidney biopsy (PKB) occur early (≤24 h), delayed onset bleeding complications (>24 h) have been rarely reported and can be catastrophic for the patient. PURPOSE To describe the incidence, risk factors, and outcomes of delayed bleeding complications after PKB. MATERIAL AND METHODS We retrospectively studied native and graft kidney biopsies in patients who developed delayed bleeding complications (>24 h) after the biopsy performed in the Department of Nephrology and Renal Transplantation of a tertiary care medical institution in north India between January 2014 to December 2018. RESULTS Of the 4912 renal biopsies reviewed, 20 patients (16 men, 4 women; 0.40%) had a delayed biopsy bleeding complication. Of these patients, 95% had major bleeding complications requiring blood transfusions and 85% needed intervention like gelfoam/coil embolization. Despite intervention, one patient (5%) had mortality due to complications of bleeding and sepsis. When compared to a control group of patients with early biopsy bleed, patients with the delayed biopsy bleed had similar demographic and clinical profiles except for higher pre-biopsy hemoglobin and lower systolic and diastolic blood pressure. CONCLUSION A post-PKB delayed onset bleed is not uncommon, and the vast majority of these patients had major bleeding complications requiring blood transfusions and/or intervention like embolization. They had a similar demographic and clinical profile presentation as early bleed patients. Meticulous outpatient monitoring and patient education after discharge may be useful to detect this complication promptly and to intervene early to have good patient outcome.
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Affiliation(s)
- Dharmendra Bhadauria
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Leena Jose
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Kushwaha
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anupma Kaul
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Raghu Nandan
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Vivek Singh
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology and Renal Transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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2
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Kidney biopsy adequacy and complications in children - does technique matter? Eur J Pediatr 2022; 181:2677-2684. [PMID: 35414029 PMCID: PMC9192435 DOI: 10.1007/s00431-022-04464-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
UNLABELLED Kidney biopsy is part of the diagnostic workup of many children with renal disease. Traditionally, a perpendicular approach to the biopsy has been used, but more recently, some proceduralists have favoured a tangential approach. It is not clear if one technique is superior with regards to tissue adequacy or complication rates. In our centre, interventional radiologists (IR) use general anaesthetic and a tangential approach, whereas paediatric nephrologists (PN) use sedation and a perpendicular approach. We examined consecutive native kidney biopsies performed between January 2008 and December 2017 for adequacy (sufficient tissue for light and electron microscopy and immunofluorescence) and examined the electronic medical records for data regarding technique and complications. IR performed 72 (29%) of the 245 native kidney biopsies, obtaining more total glomeruli (median 39 vs 16, p < 0.001) and more glomeruli per tissue core (median 13 vs 8, p < 0.001) than PN. No differences in specimen adequacy were observed between the two groups (79% IR vs 81% PN, p = 0.75) and a diagnosis could be made in 99% and 94% respectively (p = 0.1). A statistically lower rate of peri-nephric haematoma (28% vs 42%, p = 0.04) was detected in the IR group, but there were no significant differences in other complications. One patient required a blood transfusion (PN) and another required surgical intervention for a perinephric haematoma (IR). CONCLUSION IR obtained larger samples and number of glomeruli, but the overall adequacy for native kidney biopsies was good using both perpendicular and tangential techniques, with low rates of significant complications. WHAT IS KNOWN • Kidney biopsy is integral to the diagnostic work-up of many children with kidney disease. • Kidney biopsy is a safe procedure with well-established complications in a minority of children. WHAT IS NEW • Interventional radiologists had higher biopsy yield than paediatric nephrologists, possibly due to the tangential approach. • Biopsy adequacy rates are high using both techniques and provided a diagnosis in over 95% of cases.
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3
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Complications of Outpatient and Inpatient Renal Biopsy: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11040651. [PMID: 33916860 PMCID: PMC8066170 DOI: 10.3390/diagnostics11040651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether differences exist in the complication rates of renal biopsies performed in outpatient and inpatient settings. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1985 to February 2020. Two reviewers independently selected studies evaluating the bleeding risk from renal biopsies performed in outpatient and inpatient settings and reviewed their full texts. The primary and secondary outcomes were risks of bleeding and major events (including mortality) following the procedure, respectively. Subgroup analysis was conducted according to the original study design (i.e., prospective or retrospective). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effect meta-analysis. Heterogeneity was assessed using the I2 test. Results: Data from all 10 eligible studies, which included a total of 1801 patients and 203 bleeding events, were included for analysis. Renal biopsies in outpatient settings were not associated with a higher bleeding risk than those in inpatient settings (OR = 0.81; 95% CI, 0.59–1.11; I2 = 0%). The risk of major events was also comparable across both groups (OR = 0.45; 95% CI, 0.16–1.29; I2 = 4%). Conclusions: Similar rates of bleeding and major events following renal biopsy in outpatient and inpatient settings were observed.
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5
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Abuelo JG. How long should patients be observed after percutaneous kidney biopsies? Nephrol Dial Transplant 2019; 34:1979-1981. [PMID: 31377770 DOI: 10.1093/ndt/gfz157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julian Gary Abuelo
- Department of Medicine, Division of Hypertension and Kidney Diseases, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
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6
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Jayasinghe K, White SM, Kerr PG, MacGregor D, Stark Z, Wilkins E, Simons C, Mallett A, Quinlan C. Isolated proteinuria due to CUBN homozygous mutation - challenging the investigative paradigm. BMC Nephrol 2019; 20:330. [PMID: 31438875 PMCID: PMC6704575 DOI: 10.1186/s12882-019-1474-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Proteinuria is a common clinical presentation, the diagnostic workup for which involves many non-invasive and invasive investigations. We report on two siblings that highlight the clinically relevant functional role of cubulin for albumin resorption in the proximal tubule and supports the use of genomic sequencing early in the diagnostic work up of patients who present with proteinuria. Case presentation An 8-year-old boy was referred with an incidental finding of proteinuria. All preliminary investigations were unremarkable. Further assessment revealed consanguineous family history and a brother with isolated proteinuria. Renal biopsy demonstrated normal light microscopy and global glomerular basement membrane thinning on electron microscopy. Chromosomal microarray revealed long continuous stretches of homozygosity (LCSH) representing ~ 4.5% of the genome. Shared regions of LCSH between the brothers were identified and their further research genomic analysis implicated a homozygous stop-gain variant in CUBN (10p12.31). Conclusions CUBN mutations have been implicated as a hereditary cause of megaloblastic anaemia and variable proteinuria. This is the second reported family with isolated proteinuria due to biallelic CUBN variants in the absence of megaloblastic anaemia, demonstrating the ability of genomic testing to identify genetic causes of nephropathy within expanding associated phenotypic spectra. Genomic sequencing, undertaken earlier in the diagnostic trajectory, may reduce the need for invasive investigations and the time to definitive diagnosis for patients and families.
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Affiliation(s)
- Kushani Jayasinghe
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia.,Monash University, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia
| | - Susan M White
- The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Medical Centre, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Duncan MacGregor
- Department of Pathology, Royal Children's Hospital, Melbourne, Australia
| | - Zornitza Stark
- Murdoch Children's Research Institute, Melbourne, Australia.,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ella Wilkins
- Murdoch Children's Research Institute, Melbourne, Australia.,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - Cas Simons
- Murdoch Children's Research Institute, Melbourne, Australia.,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia
| | - Andrew Mallett
- Murdoch Children's Research Institute, Melbourne, Australia.,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia.,Kidney Health Service and Conjoint Renal Research Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Catherine Quinlan
- Murdoch Children's Research Institute, Melbourne, Australia. .,The KidGen Collaborative, Australian Genomics Health Alliance, Victoria, Australia. .,Department of Paediatric Nephrology, Royal Children's Hospital, 50 Flemington Street, Parkville, Australia.
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7
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Varnell CD, Stone HK, Welge JA. Bleeding Complications after Pediatric Kidney Biopsy: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol 2019; 14:57-65. [PMID: 30522995 PMCID: PMC6364534 DOI: 10.2215/cjn.05890518] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney biopsy is an essential tool for the diagnosis and treatment of patients with kidney disease; however, because of its invasive nature, bleeding complications may arise. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a meta-analysis of prospective or retrospective observational studies and randomized, controlled trials in pediatric patients undergoing native or transplant kidney biopsy in an inpatient or outpatient setting in MEDLINE-indexed studies from January 1998 to November 1, 2017 to determine the proportion of patients who develop hematoma, need blood transfusion, or need an additional intervention due to a complication after kidney biopsy. RESULTS Twenty-three studies of 5504 biopsies met inclusion criteria. The proportion of patients developing hematoma after biopsy was between 11% (95% confidence interval, 7% to 17%) and 18% (95% confidence interval, 9% to 35%) using two analyses that included different time periods. The proportion needing blood transfusion was 0.9% (95% confidence interval, 0.5% to 1.4%). The proportion needing an additional intervention due to postbiopsy complication was 0.7% (95% confidence interval, 0.4% to 1.1%). Secondary analysis was not possible due to lack of data in the original manuscripts on laboratory values, needle gauges, number of needle passes, age of patient, or performer (attending versus trainee). Analysis with metaregression found that use of real-time ultrasound during biopsy did not modify the risk for hematoma, requirement of a blood products transfusion, or requirement of an additional procedure after biopsy. Analysis with metaregression comparing native biopsies with transplant biopsies did not reveal that biopsy type (native kidney biopsy versus transplant kidney biopsy) was associated with the need for a blood transfusion or requirement of an additional intervention after biopsy. CONCLUSIONS The development of perinephric hematoma after kidney biopsy is not an infrequent finding. The proportion of patients requiring blood transfusion or needing an additional intervention as a result of kidney biopsy in pediatric patients is significantly smaller.
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Affiliation(s)
- Charles D. Varnell
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of
- Pediatrics
| | - Hillarey K. Stone
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Departments of
| | - Jeffrey A. Welge
- Psychiatry and Behavioral Neuroscience, and
- Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
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8
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Smith EMD, Lewandowski LB, Jorgensen AL, Phuti A, Nourse P, Scott C, Beresford MW. Growing international evidence for urinary biomarker panels identifying lupus nephritis in children - verification within the South African Paediatric Lupus Cohort. Lupus 2018; 27:2190-2199. [PMID: 30348048 DOI: 10.1177/0961203318808376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A urinary biomarker panel including alpha-1-acid-glycoprotein (AGP), lipocalin-like-prostaglandin-D-synthase (LPGDS), transferrin and ceruloplasmin demonstrates an 'excellent' ability for identifying active lupus nephritis in UK/US children. This study aimed to assess whether this panel identifies active lupus nephritis within the South African Paediatric Lupus Cohort. METHODS Juvenile-onset-systemic lupus erythematosus (JSLE) patients aged < 19 years at diagnosis and healthy controls were recruited. Patients were categorized as having active lupus nephritis (renal BILAG score; A/B and previous histological confirmation) or inactive lupus nephritis (renal BILAG score: D/E). Urinary biomarkers were quantified by ELISA. Mann-Whitney U-test compared biomarker levels between groups. Binary logistic regression and receiver operating curve analysis assessed biomarker combinations. RESULTS Twenty-three juvenile-onset-systemic lupus erythematosus patients were recruited with a median age of 13.5 years (interquartile range (IQR) 12.7-14.9) and disease duration of 2.6 years (IQR 1.8-4.0). Eighteen healthy controls had a median age of 11.0 years (IQR 10.0-12.0). AGP, LPGDS, transferrin, ceruloplasmin and VCAM-1 were significantly higher in active than in inactive lupus nephritis patients (corrected p-values, all pc < 0.05), with no difference between inactive lupus nephritis patients and healthy controls (all pc = 1.0). The optimal biomarker combination included AGP, ceruloplasmin, LPGDS and transferrin (area under the curve = 1.0). CONCLUSIONS A urinary biomarker panel comprising AGP, ceruloplasmin, LPGDS and transferrin previously validated within UK/US cohorts also performed excellently within a racially distinct South African cohort which displayed more severe lupus nephritis.
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Affiliation(s)
- E M D Smith
- 1 Department of Women's & Children's Health, University of Liverpool, UK.,2 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L B Lewandowski
- 3 Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, USA
| | - A L Jorgensen
- 4 Department of Biostatistics, University of Liverpool, UK
| | - A Phuti
- 5 Paediatric Rheumatology, University of Cape Town, South Africa
| | - P Nourse
- 6 Paediatric Nephrology, University of Cape Town, South Africa
| | - C Scott
- 5 Paediatric Rheumatology, University of Cape Town, South Africa
| | - M W Beresford
- 1 Department of Women's & Children's Health, University of Liverpool, UK.,2 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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9
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Nazario M, Nicoara O, Becton L, Self S, Hill J, Mack E, Evans M, Twombley K. Safety and utility of surveillance biopsies in pediatric kidney transplant patients. Pediatr Transplant 2018; 22:e13178. [PMID: 29582530 DOI: 10.1111/petr.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 01/04/2023]
Abstract
There is currently no way to diagnose a rejection before a change in serum creatinine. This had led some to start doing SB, but little data exist on the utility and safety of SB in pediatric patients. There is also little known on practice patterns of pediatric nephrologists. A retrospective review of pediatric kidney transplant SB between January 2013 and January 2017 at a single center was performed. A survey went to the PedNeph email list. There were 47 SB; 15 at 6 months, 12 at 1 year, 13 at 2 years, and 7 at 3 years. There were 3 minor (1 gross hematuria and 2 hematomas) and no major complications. On 6-month SB, 1 had SC 1A ACR (6.7%) with no BR ACR. On the 12-month SB, there were 5 with SCBR ACR (41.7%) and 1 with SC AMR (8.3%). On the 2-year SB, there were 4 that had SCBR ACR (30.8%), and 1 with SC AMR (7.7%). On the 3-year SB, 1 had chronic transplant glomerulitis (14.3%). The survey showed that 34.3% of pediatric nephrologists perform SB. SB can be performed safely. By early identification of histological lesions, SB gives us an opportunity for individualized immunosuppressive regimens that may prevent chronic allograft dysfunction and improve long-term graft outcome.
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Affiliation(s)
- Maritere Nazario
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Oana Nicoara
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Lauren Becton
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Sally Self
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pathology, Medical University of South Carolina, Charleston, SC, USA
| | - Jeanne Hill
- Medical University of South Carolina, Charleston, SC, USA.,Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Elizabeth Mack
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Melissa Evans
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Katherine Twombley
- Medical University of South Carolina, Charleston, SC, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Division of Pediatric Nephrology, Medical University of South Carolina, Charleston, SC, USA
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10
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Oates A, Ahuja S, Lee MM, Phelps AS, Mackenzie JD, Courtier JL. Pediatric renal transplant biopsy with ultrasound guidance: the 'core' essentials. Pediatr Radiol 2017; 47:1572-1579. [PMID: 28573315 DOI: 10.1007/s00247-017-3905-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 05/11/2017] [Indexed: 12/16/2022]
Abstract
This review provides a comprehensive and practical approach to pediatric percutaneous renal transplant biopsies, highlighting techniques and strategies to optimize adequate sample yield and ensure patient safety. In children with end-stage renal disease, transplantation is the preferred choice of therapy, providing for overall lower long-term morbidity and mortality compared with dialysis. In the ongoing management of renal transplant patients, core tissue sampling via a percutaneous renal biopsy remains the gold standard when transplant dysfunction is suspected. Indications for renal transplant biopsy and techniques/tools for adequate sample yield are discussed. Strategies for common challenges such as poor visualization and renal transplant mobility are addressed. We discuss the clinical signs, techniques and imaging findings for common complications including hematomas, arteriovenous fistulas and pseudoaneurysms. Although the percutaneous renal transplant biopsy procedure is generally safe with rare complications, care must be taken to ensure major complications are promptly recognized and treated. Adequate tissue samples obtained via renal biopsy are imperative to promptly identify transplant rejection to provide valuable information for patient diagnosis, treatment and outcomes. Radiologist and nephrologist attention to proper ultrasound techniques and optimal biopsy tools are critical to ensure tissue adequacy and minimize complications.
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Affiliation(s)
- Aris Oates
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA.
| | - Saveen Ahuja
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Marsha M Lee
- Division of Nephrology, Department of Pediatrics, University of California, 550 16th St., 5th floor, Mailstop 3214, San Francisco, CA, 94143- 3214, USA
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - John D Mackenzie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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11
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Isiyel E, Fidan K, Buyukkaragoz B, Akcaboy M, Kandur Y, Gonul II, Buyan N, Bakkaloglu S, Soylemezoglu O. Results of native and transplant kidney biopsies of children in a single center over a 15 years period. Ren Fail 2017; 39:702-706. [PMID: 29130775 PMCID: PMC6446142 DOI: 10.1080/0886022x.2017.1398094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/12/2017] [Accepted: 10/23/2017] [Indexed: 11/09/2022] Open
Abstract
Renal biopsy is an important diagnostic procedure in pediatric nephrology. This study retrospectively investigates the indications, results and complications in a single tertiary children's hospital in Turkey. We evaluated the native and transplant kidney biopsies in Gazi University Pediatric Nephrology Department between 2001 and 2015. A total of 196 biopsies (144 natives and 52 transplants) were included into the study. The mean age of the patients was respectively 10.8 ± 3.5, 13.9 ± 1.5 years. The main indication for a biopsy was non-nephrotic proteinuria with or without hematuria (n= 35), followed by steroid-resistance nephrotic syndrome (SRNS) (n = 34) and Henoch-Schönlein purpura (HSP)-related proteinuria (n = 20) for native kidneys. We found that focal segmental glomerulosclerosis (FSGS) (11.7%) was the most common histopathologic diagnosis for native kidneys, but acute cellular rejection (7.6%) was the most common histopathologic diagnosis for transplant kidneys. The complication rate in our study was founded 6.6% totally. Different complication rates were found in other studies; however, we think that this difference comes from the inspecting methodology of the complications. Hence, we wanted to share our own experience in the context of other studies in the literature.
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Affiliation(s)
- Emel Isiyel
- Division of Pediatric Nephrology, Gazi University, Ankara, Turkey;
| | - Kibriya Fidan
- Division of Pediatric Nephrology, Gazi University, Ankara, Turkey;
| | | | - Meltem Akcaboy
- Division of Pediatric Nephrology, Gazi University, Ankara, Turkey;
| | - Yasar Kandur
- Division of Pediatric Nephrology, Gazi University, Ankara, Turkey;
| | - Ipek Isik Gonul
- Division of Pediatric Nephropathology, Gazi University, Ankara, Turkey
| | - Necla Buyan
- Division of Pediatric Nephrology, Gazi University, Ankara, Turkey;
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12
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Measuring hemoglobin prior to early discharge without routine surveillance ultrasound after percutaneous native renal biopsy in children. Pediatr Nephrol 2017; 32:1927-1934. [PMID: 28477259 DOI: 10.1007/s00467-017-3680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to evaluate the role of post-procedural hemoglobin (hb), without pre-discharge ultrasound (US), after US-guided renal biopsy in children. METHODS A retrospective review was conducted of consecutive outpatient native kidney biopsies over an 8-year period. Procedures were performed under real-time US guidance. Data collected included number of passes, presence and size of perinephric hematoma, age, body mass index (BMI), blood pressure (BP), fasting status, hb and platelets. Continuous variables were expressed as mean ± standard deviation, group differences were tested with Student's unpaired t test and analysis of variance and correlations were assessed using Pearson's r. Significance was defined as p < 0.05. Hb changes (g/L), percentage hb (%hb) change, hematoma size and positive and negative predictive values (PPV, NPV, respectively) were analyzed. RESULTS A total of 330 procedures in 300 children (141 females, mean age 11.2 ± 4.30 years) were analyzed. Post-procedural hematoma occurred in 63%. There was a significant (p = 0.0001) post-procedural hb decrease of 6.3 ± 5.5 g/L and %hb decrease of 4.56 ± 4.01%. Fasting during pre-procedural hb estimation and procedural hematoma was associated with a greater hb drop. A ≥10% hb drop had 73% PPV for repeat blood work and US and a 17% PPV for admission, whereas a <10% hb drop had a NPV of 84% and 98%, respectively. Hb change showed a weak correlation with age, and hematoma size showed a weak inverse correlation with platelet count, but no correlation with BMI, number of passes or BP. CONCLUSIONS Bleeding complications from US-guided native kidney biopsies in pediatric outpatients can be safely followed by a complete blood count at 6 h post procedure. A 10% hb decrease is strongly associated with requirement for further testing and/or admission.
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13
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Özkayın N, Çıplak G, Usta U, Gençhellaç H, Temizöz O. Assessment of Ten-Year-Long Results of Kidney Biopsies Performed on Children in the Thrace Region of Turkey. Balkan Med J 2016; 33:589-593. [PMID: 27994909 DOI: 10.5152/balkanmedj.2016.150506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 03/24/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many children with kidney diseases can be diagnosed and treated without a biopsy. However, biopsy is a valuable method for the diagnostic and prognostic evaluation of children with kidney diseases. AIMS To evaluate the clinical and pathological profiles of the kidney biopsies in our department to provide epidemiological data for clinical practice. STUDY DESIGN Retrospective cross-sectional study. METHODS Kidney biopsies and patient's charts in pediatric patients performed between May 2005 and February 2015 at the Pediatric Nephrology Department, Trakya University School of Medicine were assessed retrospectively. RESULTS A total of 100 patients were examined. Their mean age was 9.62±4.26 years (range: 1-17 years); 54% of the patients were girls and 46% were boys. The most frequent indication for kidney biopsy was nephrotic syndrome (33%). The most common kidney disease was primary glomerulonephritis, which was observed in 65% of cases. IgA nephropathy (24%) was the most frequently observed subtype in primary glomerulonephritis groups. Secondary glomerulonephritis was diagnosed in 35% of cases. Systemic lupus erythematosus (51%) was the most frequently observed subtype in the secondary glomerulonephritis groups. CONCLUSION IgA nephropathy and systemic lupus erythematosus were the most frequent primary and secondary glomerulonephritis in our region among children, respectively.
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Affiliation(s)
- Neşe Özkayın
- Department of Pediatric Nephrology, Trakya University School of Medicine, Edirne, Turkey
| | - Gökçe Çıplak
- Department of Pediatric Nephrology, Trakya University School of Medicine, Edirne, Turkey
| | - Ufuk Usta
- Department of Pathology, Trakya University School of Medicine, Edirne, Turkey
| | - Hakan Gençhellaç
- Department of Pediatric Radiology, Trakya University School of Medicine, Edirne, Turkey
| | - Osman Temizöz
- Department of Radiology, Selçuk University School of Medicine, Konya, Turkey
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Gupta A, Campion-Smith J, Hayes W, Deal JE, Gilbert RD, Inward C, Judd BA, Krishnan RG, Marks SD, O'Brien C, Shenoy M, Sinha MD, Tse Y, Tyerman K, Mallik M, Hussain F. Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice. Pediatr Nephrol 2016; 31:613-21. [PMID: 26525201 DOI: 10.1007/s00467-015-3247-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Paediatric renal biopsy standards introduced in the UK in 2010 were intended to reduce variation and improve practice. A concurrent national drive was aimed at building robust paediatric nephrology networks to ensure services cater for the needs of the family and minimise time away from home. We aimed to identify current national practice since these changes on behalf of the British Association for Paediatric Nephrology. METHODS All UK paediatric nephrology centres were invited to complete a survey of their biopsy practice, including advance preparation. From 1 January to 30 June 2012, a national prospective audit of renal biopsies was undertaken at participating centres comparing practice with the British Association for Paediatric Nephrology (BAPN) standards and audit results from 2005. RESULTS Survey results from 11 centres demonstrated increased use of pre-procedure information leaflets (63.6 % vs 45.5 %, P = 0.39) and play preparation (90.9 % vs 9.1 %, P = 0.0001). Audit of 331 biopsies showed a move towards day-case procedures (49.5 % vs 32.9 %, P = 0.17) and reduced major complications (4.5 % vs 10.4 %, P = 0.002). Biopsies with 18-gauge needles had significantly higher mean pass rates (3.2 vs 2.3, P = 0.0008) and major complications (15.3 % vs 3.3 %, P = 0.0015) compared with 16-gauge needles. CONCLUSIONS Percutaneous renal biopsy remains a safe procedure in children, thus improving family-centered service provision in the UK.
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Affiliation(s)
- Asheeta Gupta
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH.
| | | | - Wesley Hayes
- Bristol Royal Hospital for Children, Bristol, UK
| | | | | | | | - Brian A Judd
- Alder Hey Children's Hospital in Liverpool, Liverpool, UK
| | | | | | - Catherine O'Brien
- Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, UK, B4 6NH
| | - Mohan Shenoy
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Yincent Tse
- Great North Children's Hospital, Newcastle Upon Tyne, UK
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Gillio-Meina C, Zielke HR, Fraser DD. Translational Research in Pediatrics IV: Solid Tissue Collection and Processing. Pediatrics 2016; 137:peds.2015-0490. [PMID: 26659457 DOI: 10.1542/peds.2015-0490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
Solid tissues are critical for child-health research. Specimens are commonly obtained at the time of biopsy/surgery or postmortem. Research tissues can also be obtained at the time of organ retrieval for donation or from tissue that would otherwise have been discarded. Navigating the ethics of solid tissue collection from children is challenging, and optimal handling practices are imperative to maximize tissue quality. Fresh biopsy/surgical specimens can be affected by a variety of factors, including age, gender, BMI, relative humidity, freeze/thaw steps, and tissue fixation solutions. Postmortem tissues are also vulnerable to agonal factors, body storage temperature, and postmortem intervals. Nonoptimal tissue handling practices result in nucleotide degradation, decreased protein stability, artificial posttranslational protein modifications, and altered lipid concentrations. Tissue pH and tryptophan levels are 2 methods to judge the quality of solid tissue collected for research purposes; however, the RNA integrity number, together with analyses of housekeeping genes, is the new standard. A comprehensive clinical data set accompanying all tissue samples is imperative. In this review, we examined: the ethical standards relating to solid tissue procurement from children; potential sources of solid tissues; optimal practices for solid tissue processing, handling, and storage; and reliable markers of solid tissue quality.
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Affiliation(s)
- Carolina Gillio-Meina
- Translational Research Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | | | - Douglas D Fraser
- Translational Research Centre, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Centre for Critical Illness Research, Critical Care Medicine and Pediatrics, Clinical Neurologic Sciences, and Physiology and Pharmacology, Western University, London, Ontario, Canada
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16
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Wenderfer SE, Lane JC, Shatat IF, von Scheven E, Ruth NM. Practice patterns and approach to kidney biopsy in lupus: a collaboration of the Midwest Pediatric Nephrology Consortium and the Childhood Arthritis and Rheumatology Research Alliance. Pediatr Rheumatol Online J 2015; 13:26. [PMID: 26087651 PMCID: PMC4474548 DOI: 10.1186/s12969-015-0024-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no clear consensus regarding optimal indications or timing of initial or repeat kidney biopsy in the management of pediatric systemic lupus erythematosus (pSLE). METHODS A web-based survey was designed to assess current practice patterns among pediatric nephrologists and pediatric rheumatologists and distributed to members of Midwest Pediatric Nephrology Consortium (MWPNC) and Childhood Arthritis and Rheumatology Research Alliance (CARRA). RESULTS Respondents included 111 rheumatologists and 71 nephrologists from 65 and 34 centers, respectively. Numbers of years in sub-specialty practice were comparable. Rheumatologists and nephrologists frequently collaborate in the care of children with lupus nephritis (LN). More than 90% of respondents refer patients to each either other after diagnosing LN. Over 60% describe shared decision making regarding when to perform kidney biopsy and how to interpret biopsy findings. Many pediatric nephrologists consider biopsy to be of higher risk for complication in pSLE and alter their standard pre-or post-biopsy management. CONCLUSIONS It is uncommon for pediatric nephrologists to manage LN without input from pediatric rheumatologists and vice versa. Consensus exists between specialties in general, and practice differences that exist occur between individual physicians rather than between specialties. A systematic approach to biopsy may result in improved health related outcomes in pSLE.
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Affiliation(s)
- Scott E. Wenderfer
| | - Jerome C. Lane
| | - Ibrahim F. Shatat
| | - Emily von Scheven
- Pediatric Rheumatology, University of California San Francisco, San Francisco, CA, USA.
| | - Natasha M. Ruth
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Franke M, Kramarczyk A, Taylan C, Maintz D, Hoppe B, Koerber F. Ultrasound-guided percutaneous renal biopsy in 295 children and adolescents: role of ultrasound and analysis of complications. PLoS One 2014; 9:e114737. [PMID: 25489731 PMCID: PMC4260870 DOI: 10.1371/journal.pone.0114737] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 11/13/2014] [Indexed: 01/31/2023] Open
Abstract
Introduction Percutaneous renal biopsy (PRB) is a decisive diagnostic procedure for children and adolescents with renal diseases. Aim of this study was to evaluate retrospectively the complication rates of percutaneous kidney biopsies and their therapeutic consequences to assess the role of ultrasound-guidance including Doppler ultrasound examinations in preparation, execution and follow-up care and to present a recommended protocol. Patients and Methods Institutional review board approved this retrospective study; informed consent was waived. Between 1997 and 2011 a total of 438 ultrasound-guided biopsies were performed in 295 patients, 169 of the biopsies were performed on kidney transplants. Average age of patients was 10.2+/−5.2 years (range of 15 days until age of 23). Before and post biopsy ultrasound examination including Doppler examination was carried out. Biopsy itself was ultrasound monitored. Complications were analysed with regard to age of patient, kidney transplants, year of occurrence, number of punctures, performing physician and time interval of occurrence to develop an optimized protocol for ultrasound-guidance. Results In 99% of cases successful PRB were performed, i.e. enough kidney parenchyma for histological analysis was obtained. No lethal or major complication that required surgical intervention occurred. Eighteen relevant complications were observed (complication rate: 4.1%). Except in one case in which additional MRI diagnostic was necessary, ultrasound examination after 4 hours post biopsy or even earlier when symptoms occurred, was able to detect complications and determine indications for intervention. Conclusion Ultrasound-guided PRB is an established and effective method in children and adolescents, but shows a certain rate of complications and therefore should not be indicated without diligence. Ultrasound including Doppler ultrasound is a valuable tool in preparation, guidance of biopsy, detection of complications and in follow-up care. Ultrasound examinations (including Doppler) pre-, during and 4 hours post kidney biopsy and, depending from case, a few days until weeks after biopsy is recommended.
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Affiliation(s)
- Mareike Franke
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | | | - Christina Taylan
- Department of Pediatrics, University Hospital Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Bernd Hoppe
- Department of Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Friederike Koerber
- Department of Radiology, University Hospital Cologne, Cologne, Germany
- * E-mail:
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Brachemi S, Bollée G. Renal biopsy practice: What is the gold standard? World J Nephrol 2014; 3:287-294. [PMID: 25374824 PMCID: PMC4220363 DOI: 10.5527/wjn.v3.i4.287] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/22/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Renal biopsy (RB) is useful for diagnosis and therapy guidance of renal diseases but incurs a risk of bleeding complications of variable severity, from transitory haematuria or asymptomatic hematoma to life-threatening hemorrhage. Several risk factors for complications after RB have been identified, including high blood pressure, age, decreased renal function, obesity, anemia, low platelet count and hemostasis disorders. These should be carefully assessed and, whenever possible, corrected before the procedure. The incidence of serious complications has become low with the use of automated biopsy devices and ultrasound guidance, which is currently the “gold standard” procedure for percutaneous RB. An outpatient biopsy may be considered in a carefully selected population with no risk factor for bleeding. However, controversies persist on the duration of observation after biopsy, especially for native kidney biopsy. Transjugular RB and laparoscopic RB represent reliable alternatives to conventional percutaneous biopsy in patients at high risk of bleeding, although some factors limit their use. This aim of this review is to summarize the issues of complications after RB, assessment of hemorrhagic risk factors, optimal biopsy procedure and strategies aimed to minimize the risk of bleeding.
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Simard-Meilleur MC, Troyanov S, Roy L, Dalaire E, Brachemi S. Risk factors and timing of native kidney biopsy complications. NEPHRON EXTRA 2014; 4:42-9. [PMID: 24803920 PMCID: PMC4000304 DOI: 10.1159/000360087] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The appropriate observation period, rate and risk factors of complications after a percutaneous renal biopsy remain debated. Methods We retrospectively studied native kidney biopsies performed in our institution between January 2007 and July 2011. Outpatients had either an 8- (67%) or a 24-hour (33%) observation period. Results 312 biopsies were reviewed (287 patients), 51% of patients were female and the mean age was 54 ± 15 years. Half of these biopsies were performed in outpatients. A total of 15% of patients developed a symptomatic hematoma, 9% received a red blood cell transfusion and 1% required an angio-intervention. Eighty-four percent of the complications manifested within the first 8 h, 86% at 12 h and 94% at 24 h. Outpatients experienced significantly less complications, all manifesting within the first 8 h, 14% required an observation period longer than planned. The risk of symptomatic hematoma increased to 11, 20, 35 and 40% in patients with >200, 140-200, 100-140 and <100 × 109/l platelets, respectively (p = 0.002). It also increased in hemodialysis patients (29% compared to 14%, p = 0.02). We found no association of risk with the number of biopsy passes and only a trend with needle size. Conclusion Symptomatic hematomas occurred in 15% of kidney biopsies and were strongly associated with platelet count and hemodialysis. Outpatients experienced fewer complications; therefore, we can conclude that same-day discharge in selected patients is safe.
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Affiliation(s)
| | - Stéphan Troyanov
- Division of Nephrology Division, Hôpital du Sacré-Cœur de Montréal, Montreal, Que., Canada
| | - Louise Roy
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada
| | - Etienne Dalaire
- Division of Radiology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada
| | - Soumeya Brachemi
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Hôpital Saint-Luc, Que., Canada
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Saarela V, Nuutinen M, Ala-Houhala M, Arikoski P, Rönnholm K, Jahnukainen T. Tubulointerstitial nephritis and uveitis syndrome in children: a prospective multicenter study. Ophthalmology 2013; 120:1476-81. [PMID: 23511116 DOI: 10.1016/j.ophtha.2012.12.039] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 12/14/2012] [Accepted: 12/19/2012] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the occurrence and characteristics of uveitis related to tubulointerstitial nephritis (TIN) in children. DESIGN Prospective, observational, multicenter, partly placebo-controlled treatment trial. PARTICIPANTS Nineteen children with a biopsy-proven TIN. METHODS Patients were treated with prednisone or followed without treatment. In addition to the nephrologic evaluations, the prospective follow-up included structured ophthalmological examinations at the onset of TIN and at 3 and 6 months after the diagnosis. MAIN OUTCOME MEASURES Occurrence, clinical features, and outcome of uveitis. RESULTS Some 84% (16/19) of the patients had uveitis, 83% (5/6) in the nontreatment group and 82% (9/11) in the prednisone-treated group. The remaining 2 patients, originally in the nontreatment group, were switched to the prednisone group after 2 weeks. Both of them developed uveitis. Altogether, 3 patients developed uveitis during prednisone treatment and 2 patients showed worsening of uveitis despite the systemic corticosteroid. Some 50% (8/16) of the patients with uveitis presented with no ocular symptoms; 88% (14/16) of the patients had a chronic course of uveitis. Two patients were diagnosed with uveitis before nephritis; nephritis and uveitis were diagnosed within 1 week from each other in 7 patients, and uveitis developed 1 to 6 months after the diagnosis of TIN in 7 patients. CONCLUSIONS There was no statistically significant difference in the occurrence of uveitis in patients with TIN in the prednisone and nontreatment groups. In this study, the occurrence of uveitis associated with TIN was considerably higher than previously reported. Uveitis related to TIN may develop late and is often asymptomatic. The ophthalmological follow-up of all patients with TIN is warranted for at least 12 months starting with 3-month intervals. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any material discussed in this article.
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Affiliation(s)
- Ville Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland.
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Golay V, Sarkar D, Thomas P, Trivedi M, Singh A, Roychowdhary A, Dasgupta S, Pandey R. Safety and feasibility of outpatient percutaneous native kidney biopsy in the developing world: Experience in a large tertiary care centre in Eastern India. Nephrology (Carlton) 2012; 18:36-40. [PMID: 23043224 DOI: 10.1111/j.1440-1797.2012.01663.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Vishal Golay
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Dipankar Sarkar
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Punnoose Thomas
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Mayuri Trivedi
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Ametashver Singh
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Arpita Roychowdhary
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Sanjay Dasgupta
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
| | - Rajendra Pandey
- Department of Nephrology; Institute of Postgraduate Medical Education and Research; Kolkata; West Bengal; India
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22
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Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012; 19:179-87. [PMID: 22578678 DOI: 10.1053/j.ackd.2012.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/04/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022]
Abstract
Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.
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Bollée G, Moulin B, Martinez F, Meulders Q, Rougier JP, Baumelou A, Glotz D, Subra JF, Ulinski T, Vrigneaud L, Brasseur J, Alhenc-Gelas M, Martin L, Daniel L, Kourilsky O, Deteix P, Sie P, Ronco P, Houillier P. [Renal biopsy practice: results of a French study and recommendations]. Nephrol Ther 2012; 8:168-76. [PMID: 22425459 DOI: 10.1016/j.nephro.2011.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/12/2011] [Accepted: 12/27/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although several risk factors associated with complications after renal biopsy (RB) have been identified, recommendations for RB procedures are still lacking. Our working group, appointed by the scientific commission of the Société de néphrologie in France, aimed to depict the main aspects of the practice of RB in adults in France, before establishing some guidelines. METHODS Members of the Société de néphrologie in France were asked to participate to a questionnaire survey on RB procedures. RESULTS Eighty-eight nephrologists from 74 units (27 in teaching hospitals, 35 in public general hospitals, and 12 in private centers) participated in our study. Native kidney and graft biopsies were performed in 73 and 35 units, respectively. RB activity was highly variable among units, ranging from several hundred to less than ten per year. Transjugular RB was judged to be smoothly accessible in 28 out of 73 units (38.4%). Significant variations in practices were observed regarding patient information before RB, assessment of hemorrhagic risk factors, care of patients with antiplatelet agents and hemorrhagic risk factors, and radiological guidance. Early discharge (<12 hours) was the rule in three (4.1%) units for native kidney biopsies and in ten (28.6%) units for graft biopsies. CONCLUSIONS Our study is the first to provide a representative picture of "everyday" RB practices in a country. Consensual recommendations on all points mentioned are provided here.
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Maripuri S, Penson DF, Ikizler TA, Cavanaugh KL. Outpatient versus inpatient observation after percutaneous native kidney biopsy: a cost minimization study. Am J Nephrol 2011; 34:64-70. [PMID: 21677428 DOI: 10.1159/000328901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/30/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Percutaneous kidney biopsy (PKB) is the primary diagnostic tool for kidney disease. Outpatient 'day surgery' (ODS) following PKB in low-risk patients has previously been described as a safe alternative to inpatient observation (IO). This study aims to determine if ODS is less costly compared to IO while accounting for all institutional costs (IC) associated with post-PKB complications, including death. METHODS A cost minimization study was performed using decision analysis methodology which models relative costs in relation to outcome probabilities yielding an optimum decision. The potential outcomes included major complications (bleeding requiring blood transfusion or advanced intervention), minor complications (bleeding or pain requiring additional observation), and death. Probabilities were obtained from the published literature and a base case was selected. IC were obtained for all complications from institutional activity-based cost estimates. The base case assumed a complication rate of 10% with major bleeding occurring in 2.5% of patients (for both arms) and death in 0.1 and 0.15% of IO and ODS patients, respectively. RESULTS ODS costs USD 1,394 per biopsy compared to USD 1,800 for IO inclusive of all complications. IC for ODS remain less when overall complications <20%, major complications <5.5%, and IC per death <USD 1.125 million. ODS remained favored through sensitivity analysis. CONCLUSION Outpatient management after PKB for low-risk patients costs less from the institutional perspective compared to IO, inclusive of complications and death. ODS should be considered for low-risk patients undergoing native kidney biopsy.
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Affiliation(s)
- Saugar Maripuri
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Whittier WL. Percutaneous Kidney Biopsy: “The Needle and the Damage Done”? Am J Kidney Dis 2011; 57:808-10. [DOI: 10.1053/j.ajkd.2011.02.375] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 02/22/2011] [Indexed: 11/11/2022]
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Tyner GA, Nolen-Walston RD, Hall T, Palmero JP, Couëtil L, Javsicas L, Stack A, Schott H, Johnson A, Hardefeldt L, Gruntman A, Sommardahl C, Menzies-Gow N, dePedro P, Norman T, Fennell LC, Axon JE, Lindborg S, Aceto H, Boston R, Engiles J. A multicenter retrospective study of 151 renal biopsies in horses. J Vet Intern Med 2011; 25:532-9. [PMID: 21382083 DOI: 10.1111/j.1939-1676.2011.0700.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Renal biopsies are uncommonly performed in horses and little is known about their diagnostic utility and associated complication rate. OBJECTIVE To describe the techniques, the complication rate, risk factors, and histopathology results; as well as evaluate the safety and diagnostic utility of renal biopsy in the horse. ANIMALS One hundred and forty-six horses from which 151 renal biopsies were obtained. Animals ranged in age from 48 hours to 30 years. METHODS Multicenter retrospective study, with participation of 14 institutions (1983-2009). RESULTS Renal biopsy in horses was associated with a similar rate of complications (11.3%) to that occurring in humans and companion animals. Complications were generally associated with hemorrhage or signs of colic, and required treatment in 3% of cases. Fatality rate was low (1/151; 0.7%). Biopsy specimens yielded sufficient tissue for a histopathologic diagnosis in most cases (94%) but diagnoses had only fair (72%) agreement with postmortem findings. Risk factors for complications included biopsy specimens of the left kidney (P = .030), a diagnosis of neoplasia (P = .004), and low urine specific gravity (P = .030). No association with complications was found for age, sex, breed, institution, presenting complaint, other initial clinicopathologic data, biopsy instrument, needle size, or use of ultrasonographic guidance. CONCLUSIONS AND CLINICAL IMPORTANCE Renal biopsy in horses has low morbidity and results in a morphological histopathologic diagnosis in 94% of cases. However, this procedure might result in serious complications and should only be used when information obtained would be likely to impact decisions regarding patient management and prognosis.
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Affiliation(s)
- G A Tyner
- Large Animal Internal Medicine Center, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA
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Carrington CP, Williams A, Griffiths DF, Riley SG, Donovan KL. Adult day-case renal biopsy: a single-centre experience. Nephrol Dial Transplant 2010; 26:1559-63. [PMID: 20858764 DOI: 10.1093/ndt/gfq571] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite improvements in safety seen over the last 20 years, percutaneous renal biopsy is still associated with haemorrhagic complications. Due to concerns over delayed bleeding, most nephrologists would advocate overnight observation. Recent evidence in both adult and paediatric populations suggest that in some groups, this is unnecessary. Since 1991, we have provided a day-case renal biopsy service performing 70 such procedures per year. In this study, we present a retrospective analysis of this practice. METHODS A total of 192 patients over a consecutive 3-year period were analysed retrospectively. Patients were selected according to standardized criteria, and biopsy was performed using a modern technique (automated biopsy needles under ultrasound guidance). Complications were identified by examination of case notes and local hospital admission databases, and by telephone interview. Our pathology database was examined for sample adequacy and diagnosis. RESULTS There were no delayed complications in the study group with 187 patients (97.4%) being discharged home on the same day. Major complications occurred in five patients (2.6%), all related to bleeding. Of these, two needed radiological intervention to achieve haemostasis. Sufficient tissue for diagnosis was achieved in 97% of cases, with a mean of 47 ± 23 glomeruli obtained per patient. Most biopsies were obtained with ≤ 2 passes (84%). CONCLUSIONS Our findings show that in selected adult patients, renal biopsy can be performed as a day-case procedure. Given the benefits of day-case strategies in terms of patient and healthcare costs, we advocate increased utilization of this technique.
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Ishikawa E, Nomura S, Obe T, Katayama K, Oosugi K, Murata T, Tanoue A, Fujimoto M, Matsuo H, Ito M. How long is strict bed rest necessary after renal biopsy? Clin Exp Nephrol 2009; 13:594-7. [DOI: 10.1007/s10157-009-0206-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 06/01/2009] [Indexed: 11/24/2022]
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Hussain F, Mallik M, Marks SD, Watson AR. Renal biopsies in children: current practice and audit of outcomes. Nephrol Dial Transplant 2009; 25:485-9. [PMID: 19729468 DOI: 10.1093/ndt/gfp434] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is considerable variation in the way that children are prepared for and the techniques employed in a renal biopsy. There was national agreement between UK paediatric renal centres to review current practice and audit outcomes METHODS An initial questionnaire survey was undertaken and a 12-month prospective audit performed of renal biopsies against agreed standards for the number of needle passes, adequacy of biopsy material and complication rates. RESULTS Eleven of 13 centres participated. Information leaflets are sent pre-biopsy in five centres with only one using play preparation. Six of 11 routinely perform biopsies as day-case (DC) procedures and 6 use general anaesthesia (GA). Real-time ultrasound is the favoured method in eight centres. Biopsies are performed by nephrologists only in four centres, nephrologists with radiologists in five and radiology alone in two. Of 531 biopsies (352 native), 31% were performed as a DC with 49% being done under GA. The standard for the number of passes of native kidneys (<or=3 in 80%) was achieved in 86.4%, but the standard of <or=2 passes in 80% was achieved in only 73.4% of transplanted kidneys. Adequate tissue was obtained for diagnosis in 97.5% (standard >95%). The major complication rate was higher than the standard of <or=5% at 10.4%. There was no significant difference in complication rates when the biopsy was performed as a DC or inpatient procedure (P = 0.73) or when GA or sedation was used (P = 0.8). CONCLUSIONS The audit highlights significant variation in clinical practice with limited use of preparation materials and DC procedures. The results have stimulated constructive debate about preparation and indications for biopsy and training issues. The audit enables centres and individuals to monitor performance.
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Affiliation(s)
- Farida Hussain
- Children's Renal & Urology Unit, Nottingham University Hospitals, Nottingham, UK
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A one-center experience with pediatric percutaneous renal biopsy and histopathology in Ankara, Turkey. Int Urol Nephrol 2008; 41:933-9. [PMID: 18696251 DOI: 10.1007/s11255-008-9433-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 06/30/2008] [Indexed: 10/21/2022]
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Abstract
Interventional radiology has become increasingly involved in the diagnosis and management of the pediatric oncology patient. Percutaneous biopsy and needle aspiration can be performed for solid and liquid lesions with image guidance, both for the primary diagnosis and for management of sequelae of cancer therapy. Therapeutic options also can be performed with image guidance, including radiofrequency ablation and transarterial chemoembolization. When surgical resection is required, image guided tumor localization can be used to aid in identifying small lesions.
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Affiliation(s)
- Mark A Bittles
- Department of Radiology, Division of Interventional Radiology, Children's Hospital and Regional Medical Center and University of Washington, Seattle, USA
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Abstract
The safe observation time following pediatric renal transplant biopsy is unknown. To predict the safety of day-care pediatric renal transplant biopsy, we retrospectively evaluated the timing, incidence and severity of post-biopsy complications in children observed overnight. Biopsies were performed under real time ultrasound guidance using an 18-gauge Bard Biopty needle. Coagulation screen and platelet counts were measured preprocedure. Hemoglobin (Hb) was measured preprocedure, at 6 h and at 1-day post-procedure. Twenty-eight of 45 children transplanted between January 2002 and May 2004 underwent 65 biopsies. There was gross hematuria following 8 (12%) biopsies; 2/8 occurred after 6 h. Hb fell by >15 g/L in six cases (9%) - three had Hb drop within 6 h post-procedure and three had a steady decline over 24 h. No patient required blood transfusion. Oral analgesia post-procedure was required in seven cases (11%). One of these had gross hematuria. No patient required surgical intervention or transfusion. Three complications were recorded >6 h post-biopsy but none required intervention. Daycare renal transplant biopsy appears to be safe in selected patients.
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Affiliation(s)
- Clodagh Sweeney
- Division of Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
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Schwarz A, Gwinner W, Hiss M, Radermacher J, Mengel M, Haller H. Safety and adequacy of renal transplant protocol biopsies. Am J Transplant 2005; 5:1992-6. [PMID: 15996250 DOI: 10.1111/j.1600-6143.2005.00988.x] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The protocol biopsy strategy has been criticized because of risks and marginal utility. We tested the risk. We performed 1171 protocol biopsies in 508 patients at 6, 12 and 26 weeks after renal transplantation, as well as 499 biopsies as indicated in 429 transplant patients. Biopsies were done as an outpatient procedure using an 18- or 16-gauge automated biopsy needle followed by 4 h bed rest. Complications were: gross hematuria 3.5%, perirenal hematomas 2.5%, arterio-venous fistulas 7.3% and vasovagal reactions 0.5%. Major complications requiring invasive procedures such as blood transfusions or urinary catheter were seen in 1% of cases. The hospitalization rate for observation was 1.9%. According to the Banff criteria of specimen adequacy, biopsies with 18-gauge needles yielded >7 glomeruli and at least one artery in 53% of cases. Changing the needle size in October 2003, those biopsies done with 16-gauge needles yielded >7 glomeruli and at least one artery in 76% of cases, while the rate of major complications did not change. In conclusion, transplant protocol biopsies with 16-gauge needles provide better utility and similar risk as biopsies with 18-gauge needles. A 4-h recovery after biopsy appears adequate for discharge.
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Affiliation(s)
- Anke Schwarz
- Department of Nephrology, Hannover Medical School, Hannover, Germany.
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Abstract
PURPOSE OF REVIEW The renal biopsy is an invaluable tool in the diagnosis, prognosis, and management of patients with kidney disease. As the success of the procedure is defined not only by the ability to obtain adequate tissue but also by the safety profile, significant advances which define risk factors and determine the optimal timing of observation after the percutaneous native renal biopsy merit discussion. Alternative methods of obtaining tissue, such as transvenous renal biopsies, have also been described, especially in patients with contraindications to the percutaneous method. RECENT FINDINGS The percutaneous renal biopsy has been established as a safe and effective method of obtaining renal parenchyma. Complications, although rare, may occur and the majority of these are related to bleeding. The optimal timing of observation after the biopsy should be determined by when most complications occur, and, as over 33% of complications occur after 8 h, an observation period of at least 24 h is recommended. In patients with contraindications to the percutaneous approach, such as failure of adequate radiologic visualization or a bleeding diathesis, alternative methods of obtaining tissue have been attempted. These include open, laparascopic, transurethral, or transvenous renal biopsy. SUMMARY Without contraindications, the percutaneous renal biopsy remains the standard method of acquiring renal tissue. At least 24 h of observation is recommended after the percutaneous native kidney biopsy for the development of potential complications. When a contraindication to the procedure exists, other methods of renal biopsy by experienced physicians may be attempted.
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Affiliation(s)
- William L Whittier
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
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Abstract
Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is essential in the diagnosis of glomerular, vascular, and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. The use of real-time ultrasound and automated biopsy needles has simplified and improved the success and safety of this procedure. In the recent past, we have seen a shift of the PRB from nephrologists to radiologists and this has raised appropriate concern that loss of this procedure may undermine the nephrologist's status as a subspecialist. We must continue to properly train young nephrologists in the proper technique and value of performing renal biopsy procedures or we stand to lose control of a procedure that was an integral part of the development of our subspecialty.
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Affiliation(s)
- Stephen M Korbet
- Section of Nephrology, Department of Medicine, Rush Presbyterian St. Lukes Medical Center Chicago, IL 60612, USA
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