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Kidney Week

Abstract: TH-PO1121

Pre-Renal Biopsy (PRB) Ultrasound (US) Assessment: Does It Count?

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Sosa Barrios, Haridian, Hospital Universitario Ramón y Cajal, Madrid, Spain
  • Villabón ochoa, Paola Milena, Hospital Universitario de Guadalajara, Madrid, Spain
  • Burguera, Victor, Hospital Universitario Ramón y Cajal, Madrid, Spain
  • Blanco, Laura V., Hospital Universitario Ramón y Cajal, Madrid, Spain
  • Cintra Cabrera, Melissa, Hospital Universitario Ramón y Cajal, Madrid, Spain
  • Fernandez lucas, Milagros, Hospital Universitario Ramón y Cajal, Madrid, Spain
  • Rivera, Maite, Hospital Universitario Ramón y Cajal, Madrid, Spain
Background

PRB is an important technique providing relevant information to guide diagnosis and treatment in renal disease. As an invasive procedure it has complications, mainly bleeding related. At present, routine US assessment post PRB is recommended to diagnose haemorrhagic and/or vascular complications.
In our centre a PRB drill (SimPRB) is done routinely by the same nephrologists who will perform the procedure to evaluate its feasibility and rule out any anomalies that could prevent the patient from being biopsied.

Methods

We retrospectively analyzed all SimPRB done by Interventional Nephrology in our centre from January 2014 until December 2017. Our aim was to assess SimPRB findings and their influence on PRB technique. During SimPRB we evaluate each patient’s position and apnea tolerance, kidney US anatomy, previous renal abnormalities (like hydronephrosis and congenital deffects) and renal depth. This enables our team to avoid renal lesions and select needle size, puncture area and trajectory. Also, it allows interventional nephrologists to assess risks and benefits of PRB technique.

Results

Of 277 SimPRB done in the study period, 163 were male, 88 kidney transplants (KT) and 151 native kidneys (NK, 91% left sided). In 37 cases (13,3%) SimPRB found abnormalities and modified the technique: 7 patients were considered unsuitable for PRB and 30 had a relevant anomaly that modified the PRB procedure. SimPRB findings that contraindicated PRB were: hydronephrosis (n=2), bladder cancer (n=1), patient refusal (n=1), patient unable to tolerate apnea (n=1) and thinned parenchymal thickness (n=2 NK).
In 30 cases SimPRB modified PRB technique changing the selected puncture area: cysts in usual puncture area (n=11), severe scoliosis (n=2), prone position intolerance (n=3), inaccesible KT pole (n=1) and right NK biopsy (n=13).

Conclusion

The SimPRB offers a first PRB approach for both patient and interventional nephrologist, reducing the number of failed procedures, anxiety and uncertainty about the technique. Also, SimPRB minimises complications and unnecessary hospital stays, thus improving patient safety and care.
We suggest SimPRB should be included as a routine part of pre PRB protocols.