Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA,
Am J Nephrol. 2020;51(12):982-987. doi: 10.1159/000512902. Epub 2021 Jan 15.
As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromise adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles.
PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound. Baseline clinical and laboratory data, biopsy data (number of cores, total glomeruli, and total glomeruli per core), and outcome (hematoma on renal US at 1-h, complications, and transfusion) were collected prospectively. PRB with N14g (337) versus N16g (255) and T16g (892) versus T18g (131) needles were compared. A p value of <0.05 was significant.
PRB with an 18-g needle yielded the lowest number of total glomeruli per biopsy (N14g vs. N16g: 33 ± 13 vs. 29 ± 12, p < 0.01 and T16g vs. T18g: 34 ± 16 vs. 21 ± 11, p < 0.0001), significantly fewer total glomeruli per core (T16g vs. T18g: 12.7 ± 6.4 vs. 9.6 ± 5.0, p < 0.001 and N16g vs. T18g: 14.2 ± 6.3 vs. 9.6 ± 5.0, p < 0.001). A hematoma by renal US 1-h post-PRB was similar for native (14g-35% vs. 16g-29%, p = 0.2), and transplant biopsies (16g-10% vs. 18g-9%, p = 0.9) and the complication rate for native (14g-8.9% vs. 16g-7.1%, p = 0.5), transplant biopsies (16g-4.6% vs. 18g-1.5%, p = 0.2) and transfusion rate for native (14g-7.7% vs. 16g-5.8%, p = 0.4), and transplant biopsies (16g-3.8% vs. 18g-0.8%, p = 0.1) were similar irrespective of needle size.
PRB of native and transplant kidneys with the use of a 16-gauge needle provides an optimal sample. However, our experience in transplant biopsies suggests the use of an 18-gauge needle stands to jeopardize the diagnostic accuracy of the PRB while not improving safety.
随着经皮肾活检（PRB）越来越多地由放射科医生进行，使用 18 号自动针的数量增加可能会影响充分性。我们比较了使用 14 号、16 号和 18 号自动针进行 PRB 的充分性和安全性。
从 2002 年 1 月至 2019 年 12 月，使用实时超声对原发性（N-592）和移植（T-1,023）肾脏进行 PRB。前瞻性收集基线临床和实验室数据、活检数据（活检芯数、肾小球总数和每个活检芯的肾小球总数）以及结果（PRB 后 1 小时肾脏 US 上的血肿、并发症和输血）。比较了使用 N14g（337）与 N16g（255）和 T16g（892）与 T18g（131）针进行 PRB。p 值<0.05 为有统计学意义。
使用 18 号针进行 PRB 得到的每个活检芯的肾小球总数最低（N14g 与 N16g：33 ± 13 与 29 ± 12，p<0.01；T16g 与 T18g：34 ± 16 与 21 ± 11，p<0.0001），每个活检芯的肾小球总数明显减少（T16g 与 T18g：12.7 ± 6.4 与 9.6 ± 5.0，p<0.001；N16g 与 T18g：14.2 ± 6.3 与 9.6 ± 5.0，p<0.001）。PRB 后 1 小时肾脏 US 上的血肿在原发性肾脏（14g-35%与 16g-29%，p=0.2）和移植肾脏活检中相似（16g-10%与 18g-9%，p=0.9），原发性肾脏（14g-8.9%与 16g-7.1%，p=0.5）和移植肾脏活检中并发症发生率（16g-4.6%与 18g-1.5%，p=0.2）和输血率（14g-7.7%与 16g-5.8%，p=0.4）以及移植肾脏活检中相似（16g-3.8%与 18g-0.8%，p=0.1），与针的大小无关。
使用 16 号针进行原发性和移植性肾脏的 PRB 可提供最佳样本。然而，我们在移植性肾脏活检中的经验表明，使用 18 号针可能会影响 PRB 的诊断准确性，而不会提高安全性。
