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Kidney Week

Abstract: PO2269

Inadequate Tissue for Renal Biopsy Analysis Has Significantly Increased Since the Switch to Interventional Radiology (IR)

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Walker, Patrick D., Arkana Laboratories, Little Rock, Arkansas, United States
  • Moreno, Vanessa, Arkana Laboratories, Little Rock, Arkansas, United States
  • Nissen, Caleb, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
Background

The aim of this study was to determine the incidence of inadequate native renal biopsy (Bx) samples in our laboratory over time.

Methods

A retrospective study of native kidney biopsy adequacy from 2004 through the first month of 2020 was done. Adequacy was defined by the number of glomeruli for light microscopy (LM) as follows: 1. Ideal ≥20; 2 Adequate 10-19; Limited 4-9; Miss ≤3. An in-depth study of kidney biopsies received in 2004 and April-August of 2018 was done to compare Nephrologists (Neph) vs Interventional Radiologists. In 2004, there were 1,535 native Bx’s: Neph 1,489 (97%); IR 46 (3%). In the 20-week 2018 study, there were 5,134 native needle Bx’s: Neph 250 (5%); IR 4,884 (95%).

Results

The mean miss rate changed from 2% in 2004-2008 to 7% in 2009 through 2020 (figure). This correlates with the change from Neph to IR as operators. The miss rate deep (medulla) v miss rate shallow (peri-renal tissue) also significantly changed from 10% deep in 2004 to 90% deep in 2018. The needle gauge significantly changed from 14g 20%, 16g 73%, 18g 7% in 2004 to 14g 0%, 16g 14%, 18g 86% in 2018. This has resulted in significantly less volume available for serial sections and special stains (Figure).

Conclusion

The availability of advanced tissue analysis techniques and more importantly, the increase in therapeutic options has made the renal biopsy an even more important diagnostic tool. The change to IR as primary operators has significantly reduced tissue adequacy. An extraordinary educational outreach to IR is needed.

Biopsy Widths 14g, 16g and 18g