Rao Namrata S, Chandra Abhilash
Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
Kidney Res Clin Pract. 2018 Mar;37(1):41-48. doi: 10.23876/j.krcp.2018.37.1.41. Epub 2018 Mar 31.
Needle guides have recently come into use for ultrasound-guided percutaneous renal biopsies; however, it is not yet clear if the use of needle guides leads to decreased post-biopsy complication rates and improved tissue yields. Thus, we conducted a retrospective single center study comparing biopsy yield, adequacy, and rates of complications before and after utilization of a needle guide device.
A retrospective analysis was performed on all native kidney biopsies performed before and after June 2015 corresponding to the start of needle guide use. All biopsies in the latter period of the study were performed by a single operator. We compared clinical characteristics, indications, type of investigation, tissue yield, adequacy of procedure, and rates of major and minor complications.
A total of 343 biopsies were analyzed, 140 in the pre-needle guide use period (Period I) and 203 in the needle guide use period (Period II). Biopsy yields were similar, irrespective of the use of needle guides. Tissue adequacy was better in Period II (93.7% vs. 84%, < 0.001, with respect to pathologist-reported inconclusive biopsies. There were no differences in terms of major complications (1.7%) for the two periods; however, the rate of minor complications (8.4%) was significantly reduced in Period II ( = 0.006). According to multiple logistic regression analysis, not using a needle guide (odds ratio, 3.70; < 0.001) along with low hemoglobin level, higher pre-dialysis serum creatinine level, and high urinary red blood cell count were significant predictors of biopsy complications.
Use of a needle guide improves biopsy adequacy and is associated with reduced rates of minor complications in native renal biopsies. Therefore, needle guides may be recommended in percutaneous renal biopsies, especially when transitioning to single-operator performed procedures.
针引导器最近开始用于超声引导下经皮肾活检；然而，使用针引导器是否能降低活检后并发症发生率并提高组织获取量尚不清楚。因此，我们进行了一项回顾性单中心研究，比较使用针引导器装置前后的活检获取量、充分性和并发症发生率。
对2015年6月（对应针引导器开始使用）前后进行的所有原发性肾活检进行回顾性分析。研究后期的所有活检均由一名操作者进行。我们比较了临床特征、适应证、检查类型、组织获取量、操作充分性以及主要和次要并发症的发生率。
共分析了343例活检，针引导器使用前时期（时期I）140例，针引导器使用时期（时期II）203例。无论是否使用针引导器，活检获取量相似。时期II的组织充分性更好（病理学家报告的不确定活检方面，93.7%对84%，<0.001）。两个时期的主要并发症发生率（1.7%）无差异；然而，时期II的次要并发症发生率（8.4%）显著降低（=0.006）。根据多因素逻辑回归分析，不使用针引导器（比值比，3.70；<0.001）以及低血红蛋白水平、透析前血清肌酐水平较高和尿红细胞计数较高是活检并发症的重要预测因素。
使用针引导器可提高活检充分性，并与原发性肾活检中次要并发症发生率降低相关。因此，在经皮肾活检中，尤其是在过渡到由单一操作者进行的操作时，可能推荐使用针引导器。
