Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan.
Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Hospital, Sendai, Japan.
Clin Exp Nephrol. 2020 May;24(5):389-401. doi: 10.1007/s10157-020-01869-w. Epub 2020 Mar 18.
Practice patterns and bleeding complications of percutaneous native kidney biopsy (PNKB) have not recently been investigated and the Japanese Society of Nephrology performed a nationwide questionnaire survey in 2018.
The survey consisted of nine sections about PNKB: (1) general indications; (2) indications for high-risk patients; (3) informed consent; (4) pre-biopsy evaluation; (5) procedures; (6) sedation; (7) post-biopsy hemostasis, bed rest, and examinations; (8) bleeding complications; and (9) specimen processing. A supplementary survey examined bleeding requiring transcatheter arterial embolization (TAE).
Overall, 220 directors of facilities (nephrology facility [NF], 168; pediatric nephrology facility [PF], 52) completed the survey. Indications, procedures, and monitoring protocols varied across facilities. Median lengths of hospital stay were 5 days in NFs and 6 days in PFs. Gauge 14, 16, 18 needles were used in 5%, 56%, 33% in NFs and 0%, 63%, 64% in PFs. Mean limits of needle passes were 5 in NFs and 4 in PFs. The bed rest period was 16-24 h in 60% of NFs and 65% of PFs. Based on 17,342 PNKBs, incidence rates of macroscopic hematuria, erythrocyte transfusion, and TAE were 3.1% (NF, 2.8%; PF, 6.2%), 0.7% (NF, 0.8%; PF, 0%), and 0.2% (NF, 0.2%; PF, 0.06%), respectively. Forty-six percent of facilities processed specimens all for light microscopy, immunofluorescence, and electron microscopy, and 21% processed for light microscopy only. Timing of bleeding requiring TAE varied among PNKB cases.
Wide variations in practice patterns of PNKB existed among facilities, while PNKBs were performed as safely as previously reported.
经皮肾穿刺活检术（PNKB）的实践模式和出血并发症最近尚未得到调查，日本肾脏病学会于 2018 年进行了一项全国范围的问卷调查。
该调查由九个关于 PNKB 的部分组成：（1）一般适应证；（2）高危患者的适应证；（3）知情同意；（4）活检前评估；（5）操作程序；（6）镇静；（7）活检后止血、卧床休息和检查；（8）出血并发症；（9）标本处理。补充调查研究了需要经导管动脉栓塞术（TAE）治疗的出血情况。
共有 220 家医疗机构的负责人（肾病科[NF]168 家，儿科肾病科[PF]52 家）完成了调查。各机构的适应证、操作程序和监测方案存在差异。NF 平均住院时间为 5 天，PF 为 6 天。NF 中使用 14 号、16 号、18 号针的比例分别为 5%、56%、33%，PF 中分别为 0%、63%、64%。NF 平均进针次数为 5 次，PF 为 4 次。NF 中 60%的卧床休息时间为 16-24 小时，PF 为 65%。基于 17342 例 PNKB，肉眼血尿、红细胞输注和 TAE 的发生率分别为 3.1%（NF：2.8%；PF：6.2%）、0.7%（NF：0.8%；PF：0%）和 0.2%（NF：0.2%；PF：0.06%）。46%的机构对所有标本均进行了光镜、免疫荧光和电子显微镜检查，21%的机构仅进行了光镜检查。需要 TAE 的出血时间在不同的 PNKB 病例中存在差异。
PNKB 的实践模式在各医疗机构之间存在广泛差异，而 PNKB 的安全性与以往报道相当。
