Whittier William L, Gashti Casey, Saltzberg Samuel, Korbet Stephen
Division of Nephrology, Rush University Medical Center, Chicago, IL, USA.
Clin Kidney J. 2018 Oct;11(5):616-622. doi: 10.1093/ckj/sfy051. Epub 2018 Jul 6.
The safety and adequacy are established for the native percutaneous renal biopsy (PRB) but no prospective studies exist that directly compare these with transplant PRB.
From 1995 to 2015, 1705 adults underwent percutaneous native [native renal biopsy (NRB)] or transplant renal biopsy (TRB) by the Nephrology service. Real-time ultrasound and automated biopsy needles (NRB, 14 or 16 gauge; TRB, 16 gauge) were used. Patients were observed for 24 h (NRB) or 8 h (TRB) post-procedure. Adequacy was defined as tissue required for diagnosis plus glomerular yield. Complications were defined as those resulting in the need for an intervention, such as surgery, interventional radiologic procedure, readmission, blood transfusion and death. Data were collected prospectively in all biopsies.
At the time of biopsy, NRB patients were younger (mean ± SD, 47 ± 17 versus 50 ± 14 years, P < 0.0001) and more often female (62 versus 48%, P < 0.0001) compared with TRB. A fellow supervised by an attending performed the procedure in 91% of NRB compared with 63% of TRB (P < 0.0001). TRB patients were more hypertensive [systolic blood pressure (SBP) 140 ± 22 versus 133 ± 18 mmHg, P < 0.0001] and had a higher serum creatinine (3.1 ± 1.8 versus 2.3 ± 2.2 mg/dL, P < 0.0001), activated partial thromboplastin time (28 ± 4.3 versus 27 ± 5 s, P < 0.0001) as well as lower hemoglobin (Hgb) (11.2 ± 1.8 versus 11.7 ± 2.1 g/dL, P < 0.0001) compared with NRB. Adequate tissue for diagnosis was obtained in > 99% of NRB and TRB (P = 0.71). Compared with TRB, NRB had a greater drop in Hgb after the biopsy (0.97 ± 1.1 versus 0.73 ± 1.3 g/dL, P < 0.0001), a higher complication rate (6.5 versus 3.9%, P = 0.02) and higher transfusion rate (5.2 versus 3.3%, P = 0.045). There was one death in each group attributed to the biopsy.
Although death is equally rare, the complication rate is higher in NRB compared with TRB despite TRB having more of the traditional risk factors for bleeding. Differences in technique, operator (fellow or attending) or needle gauge may explain this variability.
经皮肾穿刺活检术（PRB）用于自体肾穿刺活检的安全性和有效性已得到证实，但尚无前瞻性研究将其与移植肾穿刺活检直接进行比较。
1995年至2015年期间，1705例成人接受了肾脏病科进行的经皮自体肾活检（NRB）或移植肾活检（TRB）。采用实时超声和自动活检针（NRB用14或16号针；TRB用16号针）。术后对患者观察24小时（NRB）或8小时（TRB）。有效性定义为诊断所需组织加上肾小球获取量。并发症定义为导致需要进行干预的情况，如手术、介入放射学操作、再次入院、输血及死亡。所有活检数据均进行前瞻性收集。
活检时，与TRB相比，NRB患者更年轻（平均±标准差，47±17岁对50±14岁，P<0.0001），女性比例更高（62%对48%，P<0.0001）。91%的NRB由住院医师指导下的住院医生操作，而TRB这一比例为63%（P<0.0001）。与NRB相比，TRB患者高血压更常见[收缩压（SBP）140±22mmHg对133±18mmHg，P<0.0001]，血清肌酐水平更高（3.1±1.8mg/dL对2.3±2.2mg/dL，P<0.0001），活化部分凝血活酶时间更长（28±4.3秒对27±5秒，P<0.0001），血红蛋白（Hgb）水平更低（11.2±1.8g/dL对11.7±2.1g/dL，P<0.0001）。>99%的NRB和TRB获得了足够的诊断组织（P=0.71）。与TRB相比，NRB活检后Hgb下降幅度更大（0.97±1.1g/dL对0.73±1.3g/dL，P<0.0001），并发症发生率更高（6.5%对3.9%，P=0.02），输血率更高（5.2%对3.3%，P=0.045）。每组各有1例死亡归因于活检。
尽管死亡同样罕见，但与TRB相比，NRB的并发症发生率更高，尽管TRB存在更多传统的出血危险因素。技术、操作人员（住院医生或主治医师）或活检针型号的差异可能解释了这种变异性。
