Yesudas S S, Georgy N K, Manickam S, Raheena A, Monai R C, Noble B A, Pillai A
Department of Nephrology, PVS Memorial Hospital, Kalloor, India.
Indian J Nephrol. 2010 Jul;20(3):137-41. doi: 10.4103/0971-4065.70844.
Renal biopsy is an integral part of the nephrologists' diagnostic armamentarium. Usually it is performed by radiologists or nephrologists with radiologist's assistance. Our aim was to assess the efficacy and safety of percutaneous ultrasound-guided renal biopsy performed solely by nephrologists. We performed real-time ultrasound-guided renal biopsy on 37 patients (N group). The results were then compared with those of a similar number of biopsies done with radiologist's support (NR group) immediately prior to these. In the N group, 36 biopsies (97.3%) were successful and were histopathologically adequate, whereas in the NR group, all biopsies were successful but only 28 were adequate (75.68%). Eighteen patients required only a single attempt in the N group, whereas majority (34 patients) in the NR group required two or more attempts. The average attempt per bit of renal tissue was 1.22 in both the groups. The average number of passes per patient was 1.77 in the N group and 2.32 in the NR group. The mean size of renal tissue obtained was 1.41 ± 0.47 cm in the N group and 1.19 ± 0.42 cm in the NR group. The average number of glomeruli was 15.62 ± 5.26 and 13.7 ± 7.38 in the N and NR groups, respectively (P<0.05). In the N group, there were no complications except two cases of post procedural hematuria that was managed conservatively. There was no need for blood transfusion and both of them were discharged after 48 hours. No patient had peri-renal collection or hematoma on repeat ultrasonography of the abdomen at 24 hours. However, in the NR group, five patients developed complications and one patient required laparotomy. Our study shows that percutaneous ultrasound-guided renal biopsy can be safely and successfully performed entirely by nephrologists without outside assistance. In our series, nephrologists who performed solely took fewer attempts, had better yield and fewer complications when compared to biopsies performed with radiologist's assistance. More and more nephrologists should take up this simple yet vital procedure.
肾活检是肾病学家诊断手段的重要组成部分。通常由放射科医生或在放射科医生协助下的肾病学家进行。我们的目的是评估仅由肾病学家进行的经皮超声引导肾活检的有效性和安全性。我们对37例患者（N组）进行了实时超声引导肾活检。然后将结果与紧接在此之前在放射科医生支持下进行的相同数量活检（NR组）的结果进行比较。在N组中，36例活检（97.3%）成功且组织病理学结果充分；而在NR组中所有活检均成功，但只有28例结果充分（75.68%）。N组中18例患者仅需一次穿刺，而NR组中的大多数患者（34例）需要两次或更多次穿刺。两组中每获取一份肾组织平均穿刺次数均为1.22次。N组中每位患者的平均穿刺道数为1.77次而NR组为2.32次。N组获取的肾组织平均大小为1.41±0.47cm，NR组为1.19±0.42cm。N组和NR组平均肾小球数量分别为15.62±5.2）和13.7±7.38（P<0.05）。在N组中，除两例术后血尿经保守治疗外无其他并发症。无需输血，两人均在48小时后出院。24小时腹部重复超声检查时，无患者出现肾周积液或血肿。然而，在NR组中，5例患者出现并发症，1例患者需要剖腹手术。我们的研究表明，经皮超声引导肾活检可在无外界协助的情况下由肾病学家安全、成功地完全完成。在我们的系列研究中，与在放射科医生协助下进行的活检相比，仅由肾病学家进行的活检穿刺次数更少、取材成功率更高且并发症更少。越来越多的肾病学家应开展这项简单却至关重要的操作。
