Jaturapisanukul Solos, Chavanisakun Chutima, Benjakul Nontawat, Ngamvichchukorn Tanun, Laungchuaychok Punnawit, Kurathong Sathit, Pongsittisak Wanjak
Division of Nephrology and Renal Replacement Therapy, Department of Internal Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Vajira Renal-Rheumatology-Autoimmune Disease Research Group, Bangkok, Thailand.
Int J Nephrol Renovasc Dis. 2023 Mar 28;16:93-101. doi: 10.2147/IJNRD.S400639. eCollection 2023.
Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance.
This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle.
A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group.
The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.
经皮肾活检（PKB）是诊断各种肾脏疾病的金标准，但可能会导致潜在并发症。本研究旨在比较实时超声引导下针吸活检的两种活检技术（包括头向（CN）和尾向（CD））之间的肾组织充足率和安全性。
这项单中心、前瞻性、单盲、随机试验纳入了2017年7月5日至2019年6月30日期间接受原位PKB的患者。患者被随机分为CN组和CD组。分析两组之间的充足率和并发症。所有PKB均在实时超声引导下使用16G肾活检针进行。
共纳入107名参与者（CD组53名，CN组54名）。CD组的肾小球数量比CN组多，但无统计学意义（16个对11个，P = 0.0865）。CD组获得的肾组织样本比CN组更充足（69.8%对59.3%，P = 0.348）。两组肾小球组织取样不足的数量相似（分别为14个和15个）。此外，CN组的不良事件比CD组更多，包括肾活检后血红蛋白下降≥10%、肾周血肿大小≥1 cm、血尿以及输血需求。
原位肾经皮肾活检的CD技术并发症较少，可能比CN技术更有效。
