Nephrology Dialysis Transplantation, Vol 13, Issue 4 975-977, Copyright © 1998 by Oxford University Press
O Hergesell, H Felten, K Andrassy, K Kuhn and E Ritz
Background: Ultrasound-guided renal biopsy with an
automated spring-loaded biopsy device has become the standard method for
kidney biopsy. Information on the success rate and safety of the routine
use of this procedure from large series is not available. Such information
is of interest for cost benefit considerations and for medicolegal
purposes. We performed an audit of this procedure. Subjects and
methods: From January 1993 to June 1997, 1090 percutaneous renal
biopsies were performed in the renal units of Heidelberg (n=557) and
Karlsruhe (n=533) using a spring-loaded biopsy device (Biopty®;
Radiplast AB, Uppsala, Sweden). After intensive local disinfection,
biopsies were performed under local anaesthesia and direct visualization by
ultrasound (Sonolayer SSH-140 A, Toshiba Inc., Japan). A puncturing adaptor
was used (model UAGV 990 A, Toshiba, Japan). Of the 1090 biopsies 114
(10.4%) were performed on renal allografts and 976 (89.6%) on orthotopic
kidneys. Biopsies were performed only if patients were strictly
normotensive (<104/90 mm Hg) and had normal coagulation parameters
(PT, PTT, factor VIII, thrombocyte count and bleeding time). All patients
had been advised not to take aspirin or non-steroidal anti-inflammatory
agents for at least 5 days prior biopsy. We analysed (1) yield of
diagnostically useful material, and (2) frequency of postbiopsy
complications (e.g. macrohaematuria, haematoma, infections, and AV
fistula). Results: Except for one case requiring
interventional radiology because of persisting blood loss and three cases
requiring blood transfusions, no serious complications were seen in the
1090 consecutive renal biopsies, e.g. death, loss of kidney,
life-threatening haemorrhage, or persisting haemodynamically relevant AV
fistulae. The frequency of minor haematoma with an extension <2x2
cm, but no significant decrease of haemoglobin, was 2.2% (25/1090).
Self-limited mild macrohaematuria occurred in 0.8% (9/1090). The incidence
of small, haemodynamically irrelevant AV fistulae detected by Doppler
ultrasound was 9% (48/533). Sufficient tissue for reliable
histopathological diagnosis was obtained in almost all cases
(1077/1090=98.8%). The median number of glomeruli per biopsy sample was 9
(range 1-37). Conclusion: If contraindications,
especially high blood pressure and abnormal haemostasis, are respected,
ultrasound-guided percutaneous renal biopsy with an automated biopsy device
is safe. Skilled operators obtain satisfactory amounts of kidney tissue in
almost all cases. Key words: automated biopsy device;
complications; efficacy; percutaneous renal biopsy
TECHNICAL NOTES
Safety of ultrasound-guided percutaneous renal biopsy-retrospective analysis of 1090 consecutive cases
Department of Nephrology, University of Heidelberg, Bergheimer Str. 56 A, D-69115 Heidelberg, Germany; Renal Unit, Municipal-Hospital Karlsruhe, Germany; Corresponding author
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