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Abstract: PO2243

Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical


  • Sousanieh, George, Rush University Medical Center, Chicago, Illinois, United States
  • Whittier, William Luke, Rush University Medical Center, Chicago, Illinois, United States
  • Rodby, Roger A., Rush University Medical Center, Chicago, Illinois, United States
  • Peev, Vasil, Rush University Medical Center, Chicago, Illinois, United States
  • Korbet, Stephen M., Rush University Medical Center, Chicago, Illinois, United States

As percutaneous renal biopsies (PRB) are increasingly performed by interventional radiologists, an increase in the use of the smaller 18-gauge automated biopsy needle has been observed. The use of smaller gauge needles stands to compromise adequacy, ideally >20 glomeruli per biopsy. We compare the adequacy and safety of PRB with a 14, 16 and 18-gauge automated needles.


PRB of 592 native (N) and 1023 transplant (T) kidneys was performed by a nephrologist or a supervised nephrology fellow at Rush University Medical Center from 1/2002 to 12/2019 using real-time ultrasound guidance. Baseline clinical and laboratory data, biopsy sample data (number of cores, total glomeruli per biopsy (glomeruli on light + immunofluorescence + electron microscopy) and total glomeruli per core) and outcome data (hematoma on renal US 1-hr post-PRB and complications requiring a transfucion or procedure post-PRB) were collected prospectively. PRB with N14g (n=337) vs N16g (n=255) and T16g (n=892) vs T18g (n=131) needles were compared. A P value of <0.05 was significant.


PRB with an 18g needle yielded the lowest number of total glomeruli per biopsy (N14g vs N16g: 33±13 vs 29±12, P<0.01 and T16g vs T18g: 34±16 vs 21±11, P <0.0001 and N16g vs T18g, P <0.001). PRBs with 18g needle were also less likely to have >20 total glomeruli per biopsy (N14g vs N16g: 85% vs 82%, P=0.4 and T16g vs T18g: 83% vs 46%, P<0.0001). The number of cores per biopsy was: N14g-2.3±0.7, N16g- 2.2±0.6, T16g-2.8±0.7 and T18g- 2.2±0.6. Adjusting for the number of cores obtained, the total glomeruli per core was significantly less with 18g needle (N14g vs N16g: 15±8 vs 14±6, P=0.1 and T16g vs T18g: 13±6 vs 10±5, P<0.001 and N16g vs T18g, P <0.001). A hematoma by routine screening renal US 1-hr post-PRB was similar for native (14g-35% vs 16g-29%, P=0.2), and transplant biopsies (16g-10% vs 18g-9%, P=0.9) irrespective of needle size. The complication rate for native (14g-8.9% vs 16g-7.1%, P=0.5), and transplant biopsies (16g-4.6% vs 18g-1.5%, P=0.2) as well as the transfusion rate for native (14g-7.7% vs 16g-5.8%, P=0.4), and transplant biopsies (16g-3.8% vs 18g-0.8%, P=0.1) were not significantly different irrespective of needle size.


The use of the smaller, 18g biopsy needle compromises the adequacy and thus, quality of the PRB while not enhancing safety.