University Hospital of Wales, Heath Park, Cardiff CF14 4XW UK.
Nephrol Dial Transplant. 2011 May;26(5):1559-63. doi: 10.1093/ndt/gfq571. Epub 2010 Sep 21.
Despite improvements in safety seen over the last 20 years, percutaneous renal biopsy is still associated with haemorrhagic complications. Due to concerns over delayed bleeding, most nephrologists would advocate overnight observation. Recent evidence in both adult and paediatric populations suggest that in some groups, this is unnecessary. Since 1991, we have provided a day-case renal biopsy service performing 70 such procedures per year. In this study, we present a retrospective analysis of this practice.
A total of 192 patients over a consecutive 3-year period were analysed retrospectively. Patients were selected according to standardized criteria, and biopsy was performed using a modern technique (automated biopsy needles under ultrasound guidance). Complications were identified by examination of case notes and local hospital admission databases, and by telephone interview. Our pathology database was examined for sample adequacy and diagnosis.
There were no delayed complications in the study group with 187 patients (97.4%) being discharged home on the same day. Major complications occurred in five patients (2.6%), all related to bleeding. Of these, two needed radiological intervention to achieve haemostasis. Sufficient tissue for diagnosis was achieved in 97% of cases, with a mean of 47 ± 23 glomeruli obtained per patient. Most biopsies were obtained with ≤ 2 passes (84%).
Our findings show that in selected adult patients, renal biopsy can be performed as a day-case procedure. Given the benefits of day-case strategies in terms of patient and healthcare costs, we advocate increased utilization of this technique.
尽管在过去 20 年中，经皮肾活检的安全性有所提高，但仍与出血并发症有关。由于担心延迟性出血，大多数肾脏病专家会主张进行过夜观察。最近在成人和儿科人群中的证据表明，在某些人群中，这是不必要的。自 1991 年以来，我们已经提供了一项日间肾脏活检服务，每年进行 70 例此类手术。在这项研究中，我们对这种做法进行了回顾性分析。
连续 3 年共分析了 192 例患者。根据标准化标准选择患者，并且使用现代技术（超声引导下的自动活检针）进行活检。通过检查病历和当地医院入院数据库以及电话访谈来确定并发症。我们检查了病理学数据库以评估样本充足性和诊断。
研究组中没有延迟性并发症，187 例患者（97.4％）当天出院回家。五例患者（2.6％）发生了主要并发症，均与出血有关。其中，有两名患者需要放射介入治疗以达到止血。在 97％的病例中获得了足够的诊断组织，每位患者平均获得 47 ± 23 个肾小球。大多数活检均通过≤2 次穿刺获得（84％）。
我们的研究结果表明，在选择的成年患者中，肾脏活检可以作为日间手术进行。鉴于日间手术策略在患者和医疗保健成本方面的优势，我们提倡更多地使用这种技术。
