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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2017  |  Volume : 28  |  Issue : 2  |  Page : 430-431
The complications of ultrasound-guided percutaneous renal biopsy


Department of Nephrology-Dialysis, Civico-Benfratelli-Di Cristina Hospital, Palermo, Italy

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Date of Web Publication23-Mar-2017
 

How to cite this article:
Li Cavoli G, Bono L, Tortorici C, Li Cavoli TV, Giammarresi C, Ferrantelli A, Rotolo U. The complications of ultrasound-guided percutaneous renal biopsy. Saudi J Kidney Dis Transpl 2017;28:430-1

How to cite this URL:
Li Cavoli G, Bono L, Tortorici C, Li Cavoli TV, Giammarresi C, Ferrantelli A, Rotolo U. The complications of ultrasound-guided percutaneous renal biopsy. Saudi J Kidney Dis Transpl [serial online] 2017 [cited 2019 Apr 25];28:430-1. Available from: http://www.sjkdt.org/text.asp?2017/28/2/430/202784
To the Editor,

Renal biopsy is one of the most important investigations in establishing the histological diagnosis, adequacy of therapy, and prognosis of kidney diseases. Although in recent years, advances in the diagnostic imaging and biopsy procedures have changed it from a blind procedure to a safer ultrasound-guided technique, percutaneous renal biopsy (PRB) still carries a potential risk for complications, and renal biopsy is still not a risk-free procedure. Here, we analyze some reports about case series of renal biopsies and complications that have occurred.

Usually, the biopsy is performed of the lower renal pole with ultrasound guidance and disposable biopsy needles mounted on a spring-loaded automated gun instrument. The patients lie supine with the flank on the side to be sampled preferably elevated by 30°. For obese patients and patients with respiratory conditions which make the prone position difficult, the supine anterolateral approach is preferred. The biopsy needle is inserted through Petit’s triangle. It has been suggested that postbiopsy complications may be less frequent with use of smaller gauge needles. The standard of care after PRB includes bed rest with close observation for 24 h, with each sample of urine inspected for hematuria. Contraindications to PRB are related to kidney status (multiple cysts, solitary kidney, acute pyelonephritis or perinephric abscess, renal neoplasm) and patient status (uncontrolled bleeding diathesis, uncontrolled blood pressure, uremia, obesity, and uncooperative patients).

According to literature, the complication rate ranges between 0% and 45%. Complications are labeled as major (necessity of blood product transfusion, radiographic or surgical invasive procedure, acute renal obstruction, extended hospitalization, septicemia, or death) or minor complications (subcapsular perinephric hematoma <5 cm diameter, transient macro-hematuria, and flank pain). The bleeding complications are the most common one, and a degree of perirenal bleeding accompanies every PRB. Manno investigated the rate of bleeding complications in 471 consecutive biopsies of native kidneys. Postbiopsy bleeding complications occurred in 34.1% of the study cohort: macrohematuria was seen in 0.4%, arteriovenous fistula in 0.4%, and hematoma in 33.3% of patients. Minor complications were seen in 32.9% of patients, and major complications were seen in 1.2%.[1] Volpe reviewed reports of PRB and fine needle aspiration of renal tumors published from 1977 to 2006; significant bleeding was unusual and almost always self-limiting. The renal biopsy carried minimal risk of tumor spread.[2] Londoño reviewed 126 medical reports of patients who underwent PRB for renal masses; no complication was observed immediately after PRB.[3] Franke, among 438 PRB (169 on kidney transplants) in 295 children-adolescents, reported no lethal-major complication. The author concluded that ultrasound examination after 4 h postbiopsy or even earlier when symptoms occurred, was able to detect complications and determine indications for intervention.[4] Ali in 527 native and kidney transplant biopsies reported, when using a 14-gauge needle, higher risk of minor complications in free hands renal biopsy compared to US PRB; no difference in major complications rates was seen between the 2 techniques using a 14-gauge needle.[5]

To conclude, PRB is safe and free of complications in the majority of cases. Although the PRB technique has significantly improved and has became safer, complications are still do occur. Ultrasound examinations pre-during and post-PRB are recommended.

Conflict of interest:

None declared.

 
   References Top

1.
Manno C, Strippoli GF, Arnesano L, et al. Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. Kidney Int 2004;66:1570-7.  Back to cited text no. 1
    
2.
Volpe A, Kachura JR, Geddie WR, et al. Techniques, safety and accuracy of sampling of renal tumors by fine needle aspiration and core biopsy. J Urol 2007;178:379-86.  Back to cited text no. 2
    
3.
Londoño DC, Wuerstle MC, Thomas AA, et al. Accuracy and implications of percutaneous renal biopsy in the management of renal masses. Perm J 2013;17:4-7.  Back to cited text no. 3
    
4.
Franke M, Kramarczyk A, Taylan C, Maintz D, Hoppe B, Koerber F. Ultrasound-guided percutaneous renal biopsy in 295 children and adolescents: role of ultrasound and analysis of complications. PLoS One 2014;9:e114737.  Back to cited text no. 4
    
5.
Ali H, Murtaza A, Anderton J, Ahmed A. Post renal biopsy complication rate and diagnostic yield comparing hands free (ultrasound-assisted) and ultrasound-guided biopsy techniques of renal allografts and native kidneys. Springerplus 2015;4:491.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Gioacchino Li Cavoli
Department of Nephrology-Dialysis, Civico-Benfratelli-Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.202784

PMID: 28352034

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