Value of ultrasound-guided percutaneous renal biopsy in diagnosis of the renal diseases
Odjel nefrologije, Interna klinika, Klinicka bolnica Dubrava, Zagreb, Hrvatska.Acta medica Croatica: c̆asopis Hravatske akademije medicinskih znanosti 10/2007; 61(4):399-403.
Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is a safe and effective tool in the diagnosis of glomerular, vascular and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. PRB of native kidneys was performed by nephrologists in 249 patients consecutively from May 1997 through May 2005 at the Department of Nephrology, Dubrava University Hospital, Zagreb, Croatia. The biopsy was done using continuous ultrasound guidance and a 16-gauge biopsy needle (Tru-Cut) in an automated gun (Biopty Bard). All biopsies were processed for light, immunofluorescence and electron microscopy. We analyzed yield of diagnostically useful material and frequency of postbiopsy complication. Adequate tissue for histologic diagnosis was obtained in 95% of the procedures. The mean glomerular yield was 11.9 glomeruli. The main indications for renal biopsy were nephrotic syndrome (33%) hematuria and/or non-nephrotic proteinuria (13%) and renal failure (12%). The dominant types of primary glomerulonephritis (GN) were focal segmental glomerulosclerosis (FSGS) in 27%, mesangioproliferative in 13%, IgA nephropathy in 11%, membranous GN in 11%, membranoproliferative GN in 5%, crescentic GN--5%, and minimal change disease (MCD) in 3% of cases. The most frequent complications were perirenal hematoma (clinically asymptomatic) in 3.6%, macrohematuria in 1.2%; bleeding complications requiring blood transfusion and/or therapeutic radiologic intervention were not seen, and surgical procedure was indicated in one (0.4%) patient. We conclude that real-time ultrasound is a safe, accurate method in localizing the kidney for percutaneous renal biopsy and a very effective approach for early detection of perirenal hematoma and other potential postbiopsy complications. The present data are an important contribution to the epidemiology of renal disease, highlighting significant epidemiological differences in European countries, particularly a higher incidence of FSGS as a proportion of primary GN in our population. This report represents a basis for the future Croatian Registry of Renal Biopsies and is intended to serve as a source of information for further studies.
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ABSTRACT: Renal biopsy is an integral part of the nephrologists' diagnostic armamentarium. Usually it is performed by radiologists or nephrologists with radiologist's assistance. Our aim was to assess the efficacy and safety of percutaneous ultrasound-guided renal biopsy performed solely by nephrologists. We performed real-time ultrasound-guided renal biopsy on 37 patients (N group). The results were then compared with those of a similar number of biopsies done with radiologist's support (NR group) immediately prior to these. In the N group, 36 biopsies (97.3%) were successful and were histopathologically adequate, whereas in the NR group, all biopsies were successful but only 28 were adequate (75.68%). Eighteen patients required only a single attempt in the N group, whereas majority (34 patients) in the NR group required two or more attempts. The average attempt per bit of renal tissue was 1.22 in both the groups. The average number of passes per patient was 1.77 in the N group and 2.32 in the NR group. The mean size of renal tissue obtained was 1.41 ± 0.47 cm in the N group and 1.19 ± 0.42 cm in the NR group. The average number of glomeruli was 15.62 ± 5.26 and 13.7 ± 7.38 in the N and NR groups, respectively (P<0.05). In the N group, there were no complications except two cases of post procedural hematuria that was managed conservatively. There was no need for blood transfusion and both of them were discharged after 48 hours. No patient had peri-renal collection or hematoma on repeat ultrasonography of the abdomen at 24 hours. However, in the NR group, five patients developed complications and one patient required laparotomy. Our study shows that percutaneous ultrasound-guided renal biopsy can be safely and successfully performed entirely by nephrologists without outside assistance. In our series, nephrologists who performed solely took fewer attempts, had better yield and fewer complications when compared to biopsies performed with radiologist's assistance. More and more nephrologists should take up this simple yet vital procedure.Indian Journal of Nephrology 07/2010; 20(3):137-41. DOI:10.4103/0971-4065.70844
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ABSTRACT: Renal biopsies are uncommonly performed in horses and little is known about their diagnostic utility and associated complication rate. 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. One hundred and forty-six horses from which 151 renal biopsies were obtained. Animals ranged in age from 48 hours to 30 years. Multicenter retrospective study, with participation of 14 institutions (1983-2009). 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. 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.Journal of Veterinary Internal Medicine 03/2011; 25(3):532-9. DOI:10.1111/j.1939-1676.2011.0700.x · 1.88 Impact Factor
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ABSTRACT: Purpose: There is a paucity of epidemiological data on biopsy-proven renal disease in Croatia. The purpose of this report is a review of clinical and histological data, over a period of 15 years, from the single biggest adult native renal biopsy center in Croatia. Methods: This report includes data from 922 adult native renal biopsies in patients referred from the whole country and performed in our center from 1996 till February 2012. Data on age, gender, serum creatinine, urine sediment, 24-h proteinuria, clinical syndrome and histological diagnosis were collected and analyzed retrospectively. In all patients, light, immunofluorescence and electron microscopic analysis was performed. Results: The median age of the patients was 48 years (interquartile range 36-59 years), and the majority of patients were men (57.8 %). The most common indication for renal biopsy was nephrotic syndrome (40.3 %) followed by asymptomatic urinary abnormalities (31.7 %). The most common biopsy-proven renal disease in total was IgA glomerulonephritis (19.3 %), followed by focal segmental glomerulosclerosis (FSGS) (15.8 %) and membranous glomerulonephritis (9.2 %). In men, similar results were found, while in women, the most common were hereditary nephritis (13.4 %), FSGS (12.9 %) and connective tissue disease-related glomerular disorders (11.6 %). Conclusion: The presented data are an important contribution to the better understanding of the epidemiology of biopsy-proven renal disease in Croatia and Europe throughout comparison with other registry data. This data should be the basis for the formation of Croatian Registry of Renal Biopsies.International Urology and Nephrology 03/2013; 45(6). DOI:10.1007/s11255-013-0397-z · 1.52 Impact Factor
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