Abstract: SA-PO632
Success and Safety of Native Kidney Biopsies Guided and Performed by Nephrologists
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Palacherla, Jith, Emory University, Atlanta, Georgia, United States
- O'Neill, W. Charles, Emory University, Atlanta, Georgia, United States
Background
Percutaneous kidney biopsy is a key procedure in nephrology and a requirement for training, but is often not performed by nephrologists, even in training programs. The reasons are manifold but include concerns about competence and safety, particularly the perceived need for real-time ultrasound guidance. To address this, we examined the outcomes of ultrasound-guided biopsies performed in their entirety by nephrologists at this institution.
Methods
All native kidney biopsies performed by the Renal Division at Emory University Hospital for clinical indications from 1/1/2008 to 9/30/2018 were identified from a database of ultrasound studies performed by the Division. Medical records were reviewed to determine clinical characteristics and outcomes. Large hematomas, gross hematuria, hypotension, transfusion, or endovascular intervention were considered clinically important complications.
Results
We identified 422 biopsies that were performed by 70 trainees (1-12 procedures each; median: 5) with the supervision or assistance of 22 faculty (1-105 procedures each; median: 5). Forty three were performed by faculty alone. Patient age was 45.6 + 0.8 (13-84) and body mass index (BMI) 27.2 + 0.3 kg/m2 (16.2-52.3). All biopsies were performed with a Monopty 18g device with a 1.7 cm sampling length (Bard Peripheral Vascular, Tempe, AZ). In 93%, the kidney was located by ultrasound prior to but not during the biopsy, with an 18.8 cm, 20g needle used to confirm the location and provide deep anesthesia. In 7%, ultrasound was used during the procedure (real-time guidance). Other characteristics of the biopsies were: left kidney 91%; prone position 99%; end-inspiration 51%; end-expiration 44%; depth 5.4 + 0.08 cm (2-11). Tissue was obtained in 98.6% (adequate for diagnosis in 96.9%) with 3.56 +0.07 (1-10) passes and 2.54 + 0.04 (1-5) tissue cores. The BMI was 40 kg/m2 or greater in 2 of the 6 unsuccessful procedures. Clinically significant complications occurred in 7 patients (1.7%), requiring transfusions in 3 and intervention in 2. These patients did not differ in characteristics or biopsy parameters from those with no complications.
Conclusion
Percutaneous renal biopsies can be performed in their entirety by nephrologists with excellent success and complication rates. Real-time ultrasound guidance is not essential and should not deter nephrologists from performing this important procedure.
Funding
- Clinical Revenue Support