Félix Lavigne1, Louis-Charles Desbiens1, Guillaume Garneau2, François Côté2, Fabrice Mac-Way3. 1. Division of Nephrology, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 11 Côte-du-Palais, Quebec City, QC, G1R2J6, Canada. 2. Department of Radiology, Faculty of Medicine, CHU de Québec, L'Hôtel-Dieu de Québec Hospital, Université Laval, 11 Côte-du-Palais, Quebec City, QC, G1R 2J6, Canada. 3. Division of Nephrology, Faculty and Department of Medicine, CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Université Laval, 11 Côte-du-Palais, Quebec City, QC, G1R2J6, Canada. fabrice.mac-way@mail.chuq.qc.ca.
Abstract
INTRODUCTION: Chronic kidney disease-mineral and bone disorder (CKD-MBD) leads to increased fracture risk. Iliac crest biopsy remains the gold standard for diagnosing bone disease in CKD. Unfortunately, bone biopsy is rarely performed which is mainly due to the inability of clinicians to perform the procedure. In this paper, we propose a fluoroscopy-guided procedure performed by interventional radiologists as a novel approach to iliac crest biopsy in adult population. We describe the implementation of the procedure and present the first 11 cases of CKD patients who underwent iliac crest biopsy with this new approach. METHODS: A nephrologist already trained in performing iliac crest biopsy initiated the creation of a fluoroscopy-based iliac crest biopsy program. Two interventional radiologists underwent a short training. Patients' demographical, clinical and biochemical data were collected on the day of the biopsy. Complications within the first three months after the procedure were collected from electronical records. RESULTS: IR rapidly mastered the procedure. The use of fluoroscopy allowed a precise localisation of the biopsy site and standardization of the intervention, which ensured specimen quality. The new approach allowed CKD patients to access iliac crest biopsy, which resulted in precise bone disease diagnosis (levels of bone turnover and mineralization) and targeted therapy for each case. There were no complications during, nor within 3 months after the intervention. CONCLUSIONS: We believe this approach will increase the access to iliac crest biopsy for diagnosing bone disease in CKD population. Studies are now needed to evaluate whether CKD patients will benefit from anti-osteoporotic therapy based on the results of iliac crest biopsy.
INTRODUCTION:Chronic kidney disease-mineral and bone disorder (CKD-MBD) leads to increased fracture risk. Iliac crest biopsy remains the gold standard for diagnosing bone disease in CKD. Unfortunately, bone biopsy is rarely performed which is mainly due to the inability of clinicians to perform the procedure. In this paper, we propose a fluoroscopy-guided procedure performed by interventional radiologists as a novel approach to iliac crest biopsy in adult population. We describe the implementation of the procedure and present the first 11 cases of CKDpatients who underwent iliac crest biopsy with this new approach. METHODS: A nephrologist already trained in performing iliac crest biopsy initiated the creation of a fluoroscopy-based iliac crest biopsy program. Two interventional radiologists underwent a short training. Patients' demographical, clinical and biochemical data were collected on the day of the biopsy. Complications within the first three months after the procedure were collected from electronical records. RESULTS: IR rapidly mastered the procedure. The use of fluoroscopy allowed a precise localisation of the biopsy site and standardization of the intervention, which ensured specimen quality. The new approach allowed CKDpatients to access iliac crest biopsy, which resulted in precise bone disease diagnosis (levels of bone turnover and mineralization) and targeted therapy for each case. There were no complications during, nor within 3 months after the intervention. CONCLUSIONS: We believe this approach will increase the access to iliac crest biopsy for diagnosing bone disease in CKD population. Studies are now needed to evaluate whether CKDpatients will benefit from anti-osteoporotic therapy based on the results of iliac crest biopsy.
Entities:
Keywords:
Bone histomorphometry; CKD-MBD; Iliac crest biopsy; Interventional radiologist
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