五种经皮肾穿刺活检术对原发性肾脏的安全性和有效性比较：一项多中心研究。

Comparative safety and efficiency of five percutaneous kidney biopsy approaches of native kidneys: a multicenter study.

机构信息

Centre de néphrologie et transplantation, AP-HM, Hôpital de la Conception, Marseille, France.

出版信息

Am J Nephrol. 2012;35(5):387-93. doi: 10.1159/000337932. Epub 2012 Apr 13.

DOI:10.1159/000337932

PMID:22508466

Abstract

BACKGROUND

Renal biopsy (RB) is necessary for the diagnosis, prognosis, and therapy guidance of native kidney diseases. Few studies have compared outcomes of RB procedures. We retrospectively compared the safety and efficiency of five biopsy procedures.

METHODS

The number of glomeruli on light microscopy (LM) and on immunofluorescence (IF) and serious adverse events following RB performed in five nephrology units (C1-C5) were collected. C1 performed ultrasound (US) assessment before RB and used a 14-gauge core-cutting needle biopsy gun, C2 US guidance and a 14-gauge needle, C3 tomodensitometry guidance and a 14-gauge needle, C4 US guidance and a 16-gauge needle, and C5 tomodensitometry guidance and a 16-gauge needle.

RESULTS

RB was performed in 943 adults between January 2006 and July 2010. Serious adverse events occurred in 1.5% of biopsies. The complication rate was not different between nephrology units. The mean number of glomeruli on biopsy was 14.2 ± 8.6 with LM and 4.4 ± 3.3 on IF. It was different according to the nephrology unit for LM (p = 0.01) and for IF (p < 0.001). The number of failed biopsies was influenced by the nephrology unit and radiological guidance technique, favoring real-time US guidance. Failed biopsies using US or tomodensitometry assessment before RB was certainly due to kidney imprecise localization since it was often non-renal tissue sampling. At least 10 glomeruli were found in 69% of biopsies on LM. This rate varied according to the nephrology unit (p = 0.004) and was higher when 14-gauge needles were used in comparison with 16-gauge needles.

CONCLUSION

RB is safe regardless of the technical procedure, but radiological guidance and needle size influence the efficiency of biopsies.

摘要

背景

肾活检（RB）对于原发性肾脏疾病的诊断、预后和治疗指导是必要的。很少有研究比较 RB 程序的结果。我们回顾性比较了五种活检程序的安全性和效率。

方法

收集了在五个肾病科（C1-C5）进行的 RB 后光镜（LM）和免疫荧光（IF）肾小球数量以及严重不良事件的数据。C1 在 RB 前进行了超声（US）评估，并使用了 14 号活检枪，C2 使用 US 引导和 14 号针，C3 使用断层扫描引导和 14 号针，C4 使用 US 引导和 16 号针，C5 使用断层扫描引导和 16 号针。

结果

2006 年 1 月至 2010 年 7 月期间，943 名成年人接受了 RB。1.5%的活检出现严重不良事件。肾病科之间的并发症发生率没有差异。LM 活检的平均肾小球数为 14.2±8.6，IF 为 4.4±3.3。这与肾病科有关（p=0.01）和 IF（p<0.001）。失败的活检数量受到肾病科和放射学引导技术的影响，实时 US 引导更有利。在 RB 前使用 US 或断层扫描评估时，失败的活检肯定是由于肾脏定位不准确，因为通常是肾外组织取样。LM 活检中至少有 10 个肾小球的比例为 69%。这一比例因肾病科而异（p=0.004），并且在使用 14 号针时比使用 16 号针时更高。