Clin Nephrol. 2024 Aug;102(2):73-78. doi: 10.5414/CN111132.
Controversy exists as to the optimal observational time (OT) after outpatient percutaneous kidney biopsy. Further, there is some uncertainty about the benefit of smaller (18-gauge) vs. larger (16-gauge) biopsy needles. At our institution, we have been lowering the OT after outpatient kidney biopsies. Initially in 2015, we were monitoring for 6 hours and gradually began to decrease the OT over time. From 2020, we have adopted an OT of less than 4 hours. During this time period (in 2018), we also began using a smaller gauge needle (18 gauge). We reviewed all outpatient kidney biopsies performed by the nephrology division at our institution since 2015. There were 137 biopsies reviewed. 63 had OT of 4 - 6 hours, and 74 had OT < 4 hours. There was a total of 4 significant complications (2.9%). Two complications, symptomatic retroperitoneal bleeds, were detected in less than 3 hours. The other 2 complications were seen at 9 hours (clot retention) and 72 hours (retroperitoneal bleed after anticoagulation restarted). 63% of the biopsies were done using 18-gauge needles with 1 complication in this group vs. 3 in the 16-gauge group. All cases had adequate tissue for interpretation based on the ability to make a kidney diagnosis. The number of glomeruli obtained in the 18-gauge group was 29 ± 13 glomeruli, and in the 16-gauge group was 25 ± 10, which did not differ between groups. In summary, in an outpatient population, all significant post-biopsy complications were evident either within the first 3 hours or after 9 hours, and this suggests the feasibility of using shorter than standard OT in outpatient kidney biopsies. Furthermore, an 18-gauge needle may lower the risk of complications and obtain adequate tissue.
关于门诊经皮肾活检后的最佳观察时间（OT）存在争议。此外，较小（18 号）与较大（16 号）活检针的益处尚不确定。在我们的机构中，我们一直在降低门诊肾活检后的 OT。最初在 2015 年，我们监测了 6 小时，并逐渐随着时间的推移减少 OT。从 2020 年开始，我们采用了少于 4 小时的 OT。在此期间（2018 年），我们还开始使用较小的规格针（18 号）。我们回顾了自 2015 年以来我们机构肾脏病科进行的所有门诊肾活检。共审查了 137 例活检。63 例 OT 为 4-6 小时，74 例 OT <4 小时。共有 4 例严重并发症（2.9%）。2 例并发症，症状性腹膜后出血，在 3 小时内发现。另外 2 例并发症分别发生在 9 小时（血块滞留）和 72 小时（抗凝后重新开始后腹膜出血）。63%的活检使用 18 号针进行，该组中有 1 例并发症，而 16 号针组有 3 例。所有病例均根据能够做出肾脏诊断的能力获得了足够的组织进行解释。18 号针组获得的肾小球数量为 29±13 个肾小球，16 号针组为 25±10 个肾小球，两组之间无差异。总之，在门诊人群中，所有显著的活检后并发症要么在最初的 3 小时内，要么在 9 小时后出现，这表明在门诊肾活检中使用短于标准 OT 是可行的。此外，18 号针可能会降低并发症的风险并获得足够的组织。
