scholarly journals Performing an Ultrasound-Guided Percutaneous Needle Kidney Biopsy: An Up-To-Date Procedural Review

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2186
Author(s):  
Antonio Granata ◽  
Giulio Distefano ◽  
Francesco Pesce ◽  
Yuri Battaglia ◽  
Paola Suavo Bulzis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Kidney Biopsy ◽  
Left Kidney ◽  
Renal Involvement ◽  
Observation Time ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Renal Diseases ◽  
Safe Procedure ◽  
Ultrasound Guided

Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats

2018 ◽  
Vol 21 (6) ◽  
pp. 529-536 ◽  
Author(s):  
Michelle Pavlick ◽  
Cynthia RL Webster ◽  
Dominique G Penninck
Keyword(s):  
Liver Biopsy ◽  
Vitamin K ◽  
Major Bleeding ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
P Value ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Coagulation Parameters ◽  
Ultrasound Findings

Objectives Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. Methods The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >−6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher’s exact test, ANOVA and Pearson’s correlation coefficient, with a P value <0.05 considered significant. Results All cats had a decrease in PCV after biopsy. The mean ΔPCV was −6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. Conclusions and relevance PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

Inherited renal diseases

2018 ◽  
Author(s):  
William G. Herrington ◽  
Aron Chakera ◽  
Christopher A. O’Callaghan
Keyword(s):  
Clinical Practice ◽  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Renal Involvement ◽  
Renal Diseases ◽  
Systemic Diseases ◽  
Polycystic Kidney ◽  
Adult Polycystic Kidney Disease

The causes of inherited renal diseases can be divided into cystic, glomerular, tubular, and systemic diseases. By far, the most common of these in clinical practice is adult polycystic kidney disease (APKD). This chapter reviews APKD, other inherited cystic renal diseases, inherited glomerular and tubular diseases, and inherited systemic diseases with renal involvement.

scholarly journals Percutaneous Renal Biopsy: Comparison of Blind and Real-time Ultrasound Guided Technique

2018 ◽  
Vol 16 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Anil Pokhrel ◽  
Rajendra Kumar Agrawal ◽  
Anil Baral ◽  
Ajaya Rajbhandari ◽  
Rajani Hada
Keyword(s):  
Renal Biopsy ◽  
Real Time ◽  
Randomized Study ◽  
Bleeding Complications ◽  
Renal Diseases ◽  
Ultrasound Guided ◽  
Macroscopic Hematuria ◽  
Percutaneous Renal Biopsy ◽  
Significant Difference ◽  
Perinephric Hematoma

Background: Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique.Methods: It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma.Results: Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours.Conclusions: Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.

scholarly journals A novel approach to ultrasound-guided percutaneous native renal biopsy: a better tissue sampling technique

2014 ◽  
Vol 8 (2) ◽  
pp. 203-210 ◽  
Author(s):  
Wiwat Chancharoenthana ◽  
Talerngsak Kanjanabuch ◽  
Wipawee Kittikowit ◽  
Nattachai Srisawat ◽  
Khajohn Tiranathanagula ◽  
...  
Keyword(s):  
Renal Biopsy ◽  
Sampling Technique ◽  
Middle Part ◽  
Bleeding Complications ◽  
Renal Diseases ◽  
Lower Pole ◽  
Tissue Sampling ◽  
Ultrasound Guided ◽  
Novel Approach ◽  
Approach Group

AbstractBackground: Percutaneous renal biopsy (PRB) is an essential tool in diagnosis and management of various renal diseases. Conventional ultrasound-guided free-hand approaches to the lower pole of the kidney for PRB yield marginal tissue adequacy and causes a certain incidence of bleeding complications.Objective: To describe a novel ultrasound-guided approach to the middle part of the kidney for PRB to obtain better tissue sampling.Patients and methods: The plane angle between the renal biopsy needle and the skin was set at 30° for patients in the novel middle part approach group (n = 15) and 45° for patients in the conventional lower pole approach group (n = 15).Results: The perpendicular distance between the needle tip and renal capsule in the middle part approach was significantly shorter than the lower pole approach group (0.92 ± 0.6 vs. 1.49 ± 0.4 cm, p = 0.005). The middle part approach to PRB yielded a significantly higher number of glomeruli (22.8 ± 7.2 vs. 15.3 ± 4.1, p = 0.002) and arcuate arteries (0.9 ± 0.6 vs. 0.5 ± 0.1, p = 0.02). The bleeding complications in the middle part approach seemed to be less than in the lower pole approach technique. Pain scores between the two methods as assessed using a visual analog scale were not different.Conclusion: This novel approach to the middle part of the kidney for PRB provides comparable patient satisfaction and a superior adequacy of renal tissue when compared with the conventional lower pole approach with its consequent lower post biopsy bleeding complications. Larger studies to confirm this finding are warranted.

scholarly journals Case Report: Hyponatremia Secondary to Desmopressin Administration Prior to Percutaneous Kidney Biopsy: A Case-Based Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Alexandra Vornicu ◽  
Bogdan Obrişcă ◽  
Bogdan Cotruta ◽  
Adriana Octaviana Dulămea ◽  
Nicu Caceaune ◽  
...  
Keyword(s):  
Serum Sodium ◽  
Kidney Biopsy ◽  
Current Evidence ◽  
Bleeding Complications ◽  
Spot Urine ◽  
Recurrent Vomiting ◽  
Bleeding Prophylaxis ◽  
Life Threatening ◽  
History Of ◽  
The One

Bleeding remains the most clinically relevant complication of kidney biopsy and several prophylactic approaches were proposed, including desmopressin administration. We present the case of a 60-year-old man with a history of liver transplantation, admitted for the evaluation of a renal dysfunction. As part of our department protocol, desmopressin 60 μg was administered orally, 2 h before the percutaneous kidney biopsy. The patient developed acute, severe, symptomatic hyponatremia (i.e., headache and recurrent vomiting), followed by a life-threatening upper gastrointestinal bleeding due to a Mallory-Weiss syndrome. Although it is often used as bleeding prophylaxis prior to kidney biopsy, data regarding the efficacy and safety of desmopressin in this setting are inconsistent. Accordingly, we performed a thorough literature review of the use of desmopressin as bleeding prophylaxis prior to kidney biopsy, focusing on the incidence of hyponatremia. The reported incidence of hyponatremia (&lt;130 mmol/l) was 7–11%, probably because serum sodium was monitored in few studies. Nevertheless, hyponatremia was rarely symptomatic but, in some cases, like the one presented here, its complications could be severe. Pre-biopsy low serum sodium and estimated glomerular filtration rate as well as high spot urine sodium and non-restricted fluid intake were reported to be associated with hyponatremia incidence. However, the current evidence cannot clearly establish which patients benefit the most from desmopressin use with respect to bleeding complications. We propose that when desmopressin is used for bleeding prophylaxis prior to kidney biopsy, measurements of serum sodium levels, before and every 6 h after, should complement ultrasound and hemoglobin as part of the patient post-procedural monitoring. Also, water intake should be restricted in the day of biopsy. However, this proposed approach should be adequately evaluated in a clinical trial.

Correlation between coagulation profile findings and bleeding complications after ultrasound-guided biopsies: 434 cases (1993-1996)

2001 ◽  
Vol 37 (3) ◽  
pp. 228-233 ◽  
Author(s):  
LA Bigge ◽  
DJ Brown ◽  
DG Penninck
Keyword(s):  
Medical Records ◽  
Normal Values ◽  
Activated Partial Thromboplastin Time ◽  
Bleeding Complications ◽  
Histopathological Diagnosis ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Guided Biopsy ◽  
Adequate Tissue ◽  
Ultrasound Guided Biopsy

Medical records of 434 consecutive dogs (n=310) and cats (n=124) that received coagulation studies prior to ultrasound-guided biopsy procedures between January 1993 and June 1996 were reviewed for bleeding complications. Minor complications occurred in 21.9% of cases. Major complications occurred in 6% of the cases. Significant bleeding complications were observed in thrombocytopenic cases (P=0.0001). Dogs with a prolonged one-stage prothrombin time (OSPT) (P=0.031) and cats with prolonged activated partial thromboplastin time (aPTT) (P=0.024) were more likely to have complications than patients with normal values. Adequate tissue for histopathological diagnosis was obtained in 96.3% of cases. The likelihood of complication was smaller when the liver was biopsied than when the kidney was biopsied (n=259; P=0.0327). Ultrasound-guided biopsy of intracavitary structures is an effective and relatively safe procedure, but delay of the procedure should be considered when thrombocytopenia is present in the patient.

scholarly journals Safety of Kidney Biopsy when Performed as an Outpatient Procedure

2021 ◽  
pp. 1-13
Author(s):  
Marco Bonani ◽  
Harald Seeger ◽  
Nina Weber ◽  
Johan M. Lorenzen ◽  
Rudolf P. Wüthrich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Major Bleeding ◽  
Kidney Biopsy ◽  
University Hospital ◽  
Renal Diseases ◽  
Safe Procedure ◽  
Surveillance Period ◽  
Outpatient Procedure ◽  
Outpatient Procedures ◽  
Transplant Kidney

<b><i>Introduction:</i></b> Kidney biopsy remains the gold standard for the diagnosis of most renal diseases. A major obstacle to performing a biopsy is safety concerns. However, many safety measures are not evidence based and therefore vary widely between centers. We sought to determine the rate and timing of kidney biopsy complications in our center, to compare the complication rate between native and transplant kidney biopsies, to evaluate the feasibility of performing kidney biopsies as an outpatient procedure and the value of a postbiopsy ultrasound before discharge, and to identify risk factors for complications. <b><i>Methods:</i></b> We performed a single-center, retrospective, observational study at the Division of Nephrology of the University Hospital Zurich including all patients who underwent renal biopsy between January 2005 and December 2017. Major bleeding (primary outcome) and any other bleeding or nonbleeding complications (secondary outcomes) were compared between native and transplant kidney biopsies and between inpatient and outpatient procedures and correlated with clinical factors possibly affecting bleeding risk. <b><i>Results:</i></b> Overall, 2,239 biopsies were performed in 1,468 patients, 732 as inpatient and 1,507 as outpatient procedures. Major bleeding was observed in 28 (3.8%) inpatient and in 15 (1.0%) outpatient procedures, totaling to 43 (1.9%) of all biopsies. Major bleeding requiring intervention amounted to 1.0% (0.5% of outpatient procedures). Rate of major bleeding was similar between native and transplant kidneys. 13/15 (87%) bleeding episodes in planned outpatient procedures were detected during the 4-h surveillance period. Risk factors for bleeding were aspirin use, low eGFR, anemia, cirrhosis, and amyloidosis. Routine postbiopsy ultrasound did not change management. <b><i>Conclusions:</i></b> Kidney biopsy is an overall safe procedure and can be performed as an outpatient procedure in most patients with an observation period as short as 4 h. The value of routine postbiopsy ultrasound is questionable.

Delayed onset bleed after percutaneous kidney biopsy: is it the same as early bleed?

2021 ◽  
pp. 028418512098881
Author(s):  
Dharmendra Bhadauria ◽  
Leena Jose ◽  
Ravi Kushwaha ◽  
Anupma Kaul ◽  
Raghu Nandan ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Kidney Biopsy ◽  
Tertiary Care ◽  
North India ◽  
Bleeding Complications ◽  
Control Group ◽  
Blood Transfusions ◽  
Delayed Bleeding ◽  
Delayed Onset ◽  
Good Patient Outcome

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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