Nishino Tomohiko, Hirano Sakurako, Takemura Shin, Tomori Shinya, Ono Sayaka, Takahashi Kazuhiro, Mimaki Masakazu
Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan.
Am J Nephrol. 2023;54(11-12):528-535. doi: 10.1159/000533593. Epub 2023 Aug 14.
Real-time ultrasound-guided percutaneous kidney biopsy is essential for diagnosis and treatment planning; nonetheless, the optimal puncture approach has yet to be established. In vivo, performing different approaches on the same patient at once is not possible. This study aimed to determine the impact of different approaches on the number of obtained glomeruli and their potential to cause arterial injury using pig kidneys, which are similar to humans.
A total of 120 pig kidneys (60 right-sided kidneys and 60 left-sided kidneys) for research were obtained from a slaughterhouse. The specimens were collected from the lower pole on the sagittal plane of the kidney using three different approaches on the same kidney: caudocranial approach, caudal to cranial; craniocaudal approach, cranial to caudal; and vertical approach, through the surface cortex. Five blinded pediatric nephrologists assessed the number of glomeruli and arterial injuries.
Overall, 360 specimens were collected from the kidneys through biopsy using a 16-gauge needle (mean vertical kidney length, 11.2 ± 0.7 cm; mean depth, 3.47 ± 0.23 cm). No significant difference in the incidence of arterial injury was observed between the three approaches (caudocranial vs. craniocaudal vs. vertical approaches: 78% vs. 87% vs. 87%, p = 0.14). In contrast, the vertical approach retrieved significantly more glomeruli than the caudocranial and craniocaudal approaches (caudocranial approach: 7.5 ± 2.8, craniocaudal approach: 7.8 ± 2.7, and vertical approach: 8.9 ± 3.3, p < 0.001).
Considering its efficacy and safety profile, the vertical approach may be preferred, as more glomeruli can be obtained without increasing the incidence of arterial injury. Although the results cannot be directly extrapolated to humans due to the differences between species, they still offer important insights into the characteristics of each approach.
实时超声引导下经皮肾活检对于诊断和治疗规划至关重要；然而，最佳穿刺方法尚未确定。在活体中，不可能同时对同一患者采用不同的方法。本研究旨在利用与人类相似的猪肾，确定不同方法对获取肾小球数量及其导致动脉损伤可能性的影响。
从一家屠宰场获取了总共120个用于研究的猪肾（60个右侧肾和60个左侧肾）。在同一肾脏上使用三种不同方法从肾矢状面的下极采集标本：尾头方向进针，从尾向头；头尾方向进针，从头向尾；以及垂直进针，穿过表面皮质。五名不知情的儿科肾病学家评估肾小球数量和动脉损伤情况。
总体而言，使用16号针通过活检从肾脏采集了360个标本（平均肾脏垂直长度为11.2±0.7厘米；平均深度为3.47±0.23厘米）。三种方法之间动脉损伤发生率未观察到显著差异（尾头方向进针与头尾方向进针与垂直进针：78%对87%对87%，p = 0.14）。相比之下，垂直进针获取的肾小球明显多于尾头方向进针和头尾方向进针（尾头方向进针：7.5±2.8，头尾方向进针：7.8±2.7，垂直进针：8.9±3.3，p < 0.001）。
考虑到其有效性和安全性，垂直进针方法可能更受青睐，因为在不增加动脉损伤发生率的情况下可以获取更多肾小球。尽管由于物种差异结果不能直接外推至人类，但它们仍为每种方法的特点提供了重要见解。
