Brett W Plattner1,2, Pauline Chen1, Richard Cross3, Matthew A Leavitt1,2, Paul D Killen1,4, Michael Heung1,2. 1. 1 University of Michigan, Ann Arbor, MI, USA. 2. 2 Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 3. 3 St. John Hospital and Medical Center, Detroit, MI, USA. 4. 4 Department of Pathology, University of Michigan, Ann Arbor, MI, USA.
Abstract
INTRODUCTION: Kidney biopsies are an essential tool in the diagnosis and management of kidney diseases, particularly in kidney transplant recipients. Biopsies carry a risk for serious complications and not all biopsies achieve adequate tissue. We examined the impact of kidney biopsy technique on complications and biopsy adequacy. METHODS: The cohort consisted of consecutive kidney transplant patients undergoing biopsy by one of three techniques: ultrasound localization, real-time ultrasound guidance, and ultrasound-guided trocar placement. Variables of interest included patient characteristics and procedural characteristics. The primary outcome was serious complication attributable to kidney biopsy, and the secondary outcome was biopsy adequacy as defined by Banff criteria. RESULTS: Among 263 patients undergoing biopsy, 27 (10.3%) had a complication (14 with gross hematuria, 10 requiring blood transfusion, 3 requiring an unplanned interventional radiology procedure, 1 kidney loss; no deaths). Complications were more common among patients biopsied using ultrasound-guided trocar compared to real-time ultrasound and ultrasound localization (21.4% vs 7.9% vs 7.1%, respectively, p = 0.008). After adjusting for patient and procedure characteristics, technique was no longer significantly associated with complication. Biopsy adequacy was significantly higher when using ultrasound localization and real-time ultrasound compared to ultrasound-guided trocar (84.6% vs 86.8% vs 69.6%, p = 0.029), and this finding persisted in adjusted analysis. CONCLUSION: Kidney biopsy complications appear to be similar when using any of the three techniques examined in our study. However, ultrasound-guided trocar technique may yield lower biopsy adequacy when compared to non-trocar techniques.
INTRODUCTION: Kidney biopsies are an essential tool in the diagnosis and management of kidney diseases, particularly in kidney transplant recipients. Biopsies carry a risk for serious complications and not all biopsies achieve adequate tissue. We examined the impact of kidney biopsy technique on complications and biopsy adequacy. METHODS: The cohort consisted of consecutive kidney transplant patients undergoing biopsy by one of three techniques: ultrasound localization, real-time ultrasound guidance, and ultrasound-guided trocar placement. Variables of interest included patient characteristics and procedural characteristics. The primary outcome was serious complication attributable to kidney biopsy, and the secondary outcome was biopsy adequacy as defined by Banff criteria. RESULTS: Among 263 patients undergoing biopsy, 27 (10.3%) had a complication (14 with gross hematuria, 10 requiring blood transfusion, 3 requiring an unplanned interventional radiology procedure, 1 kidney loss; no deaths). Complications were more common among patients biopsied using ultrasound-guided trocar compared to real-time ultrasound and ultrasound localization (21.4% vs 7.9% vs 7.1%, respectively, p = 0.008). After adjusting for patient and procedure characteristics, technique was no longer significantly associated with complication. Biopsy adequacy was significantly higher when using ultrasound localization and real-time ultrasound compared to ultrasound-guided trocar (84.6% vs 86.8% vs 69.6%, p = 0.029), and this finding persisted in adjusted analysis. CONCLUSION: Kidney biopsy complications appear to be similar when using any of the three techniques examined in our study. However, ultrasound-guided trocar technique may yield lower biopsy adequacy when compared to non-trocar techniques.
Authors: Akanksha Verma; Thangamani Muthukumar; Hua Yang; Michelle Lubetzky; Michael F Cassidy; John R Lee; Darshana M Dadhania; Catherine Snopkowski; Divya Shankaranarayanan; Steven P Salvatore; Vijay K Sharma; Jenny Z Xiang; Iwijn De Vlaminck; Surya V Seshan; Franco B Mueller; Karsten Suhre; Olivier Elemento; Manikkam Suthanthiran Journal: JCI Insight Date: 2020-02-27
Authors: Enver Akalin; Matthew R Weir; Suphamai Bunnapradist; Daniel C Brennan; Rowena Delos Santos; Anthony Langone; Arjang Djamali; Hua Xu; Xia Jin; Sham Dholakia; Robert N Woodward; Jonathan S Bromberg Journal: Kidney360 Date: 2021-09-28