Yaqub Sonia, Ahmed Nayla, Fatima Urooj, Maqbool Ayesha, Ashif Waqar, Hussain Syed A
Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Aga Khan University Medical College, Karachi, Pakistan.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):891-897.
The use of an automated biopsy device, and real-time ultrasound for percutaneous kidney biopsies (PKBs) has improved the likelihood of obtaining adequate tissue for diagnosis and also has reduced the complications associated with the procedure. We aimed to determine the frequency and type of complications associated with PKB and to determine the diagnostic yield. It was a retrospective file-based review of cases who underwent PKB of native kidney between January 2003 and December 2013 at the Aga Khan University Hospital in Karachi, Pakistan. PKBs were performed by trained nephrologists or radiologists using an automated device with a 16/18-gauge needle under real-time ultrasound. The data obtained included age, gender, clinical and histopathological diagnosis, and complications associated with the procedure (minor: hematuria, local infections, and hematoma; major: transfusions, severe infections, surgery, nephrectomy, arteriography, embolism, and death. Yield of the procedure was based on the number of glomeruli obtained. Patients having major complications were compared with the patients who had minor or no complications. A total of 433 native kidney biopsies were performed. The mean age of the patients was 41 ± 15.9 years, and 58% of the patients were male. The main histological findings were membranoproliferative glomerulonephritis (17.6%) followed by focal and segmental glomerulosclerosis (16.4%) and interstitial nephritis (13.9%). Majority of the procedures were performed by nephrologists (67.4%). The overall complication rate was 14.2%. Among those, 21 patients (4.8%) had a major complication while the others had minor complications. Of those who had a major complication, 17 patients required blood transfusion(s) and had hematuria or a major hematoma, three had prolonged hospitalization >24 hours, and one patient required surgical intervention. Only 10 procedures (2.3%) had inadequate tissue to establish the histopathologic diagnosis. PKB under real-time ultrasound guidance is a safe and efficacious procedure to establish the histological diagnosis of the renal disease.
使用自动活检装置和实时超声进行经皮肾活检（PKB）提高了获取足够组织用于诊断的可能性，也减少了与该操作相关的并发症。我们旨在确定与PKB相关的并发症的频率和类型，并确定诊断成功率。这是一项基于病历的回顾性研究，研究对象为2003年1月至2013年12月在巴基斯坦卡拉奇阿迦汗大学医院接受原发性肾PKB的患者。PKB由训练有素的肾病学家或放射科医生在实时超声引导下使用16/18号自动活检针进行。获得的数据包括年龄、性别、临床和组织病理学诊断以及与该操作相关的并发症（轻微：血尿、局部感染和血肿；严重：输血、严重感染、手术、肾切除术、动脉造影、栓塞和死亡）。该操作的成功率基于获得的肾小球数量。将发生严重并发症的患者与发生轻微并发症或无并发症的患者进行比较。共进行了433例原发性肾活检。患者的平均年龄为41±15.9岁，58%的患者为男性。主要组织学发现为膜增生性肾小球肾炎（17.6%），其次是局灶节段性肾小球硬化（16.4%）和间质性肾炎（13.9%）。大多数操作由肾病学家进行（67.4%）。总体并发症发生率为14.2%。其中，21例患者（4.8%）发生严重并发症，其他患者发生轻微并发症。在发生严重并发症的患者中，17例患者需要输血，伴有血尿或巨大血肿，3例患者住院时间延长>24小时，1例患者需要手术干预。只有10例操作（2.3%）获得的组织不足以确立组织病理学诊断。实时超声引导下的PKB是一种安全有效的用于确立肾脏疾病组织学诊断的方法。
