Ananin Petr, Milovanova Anastasiia, Kulikov Kirill, Stolyarevich Ekaterina, Tsygin Alexey
National Medical Research Centre for Children's Health, Lomonosovskiy pr., 2 str 1, 119991, Moscow, Russian Federation.
Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
Pediatr Nephrol. 2025 Sep 22. doi: 10.1007/s00467-025-06973-1.
The native kidney biopsy is an important diagnostic procedure in pediatric nephrology. Recent meta-analyses did not find the size of the needle as a risk factor for bleeding complications, but they were predominantly based on adult studies. There are few papers comparing the safety and core adequacy in pediatric native kidney biopsy.
We present a large single-center retrospective study performed in a tertiary pediatric nephrology center. Data of children who received a real-time ultrasound-guided native kidney biopsy with a 16- or an 18-gauge needle from 2018 to 2024 were analyzed.
Overall, 1040 children (644 boys) were included, with a median age of 10.25 (6.6; 14.23) years. One hundred three (9.9%) patients experienced bleeding complications. Perinephric hematoma was reported in 86 (8.3%) cases, gross hematuria in 18 (1.7%), and 3 (0.3%) children required transfusion. Multivariate regression analysis revealed the needle size (OR for 16-gauge 2.06, 95% CI 1.22-3.47, p = 0.007) as a risk factor for complications in the overall cohort and in children under 12 years old. The needle size did not affect complication rates in children aged 12-18 years. Inadequate kidney cores were reported in 37 (4.5%) cases; OR for 18-gauge needles (OR 5.08, 95% CI 1.07-24.21, p = 0.041) was found.
Use of a 16-gauge needle reduces the risk of obtaining an inadequate core in comparison with an 18-gauge. An 18G needle has a safety advantage over a 16G needle in children younger than 12 years. A 16G needle is as safe as an 18G needle and should be used for native kidney biopsy in children older than 12 years.
原发性肾活检是儿科肾脏病学中一项重要的诊断程序。最近的荟萃分析未发现穿刺针的尺寸是出血并发症的危险因素，但这些分析主要基于成人研究。比较儿科原发性肾活检安全性和取材充足性的论文较少。
我们在一家三级儿科肾脏病中心进行了一项大型单中心回顾性研究。分析了2018年至2024年期间接受16或18号穿刺针实时超声引导下原发性肾活检的儿童数据。
总体而言，纳入了1040名儿童（644名男孩），中位年龄为10.25（6.6；14.23）岁。103名（9.9%）患者出现出血并发症。86例（8.3%）报告有肾周血肿，18例（1.7%）有肉眼血尿，3例（0.3%）儿童需要输血。多因素回归分析显示，穿刺针尺寸（16号穿刺针的OR为2.06，95%CI为1.22 - 3.47，p = 0.007）是整个队列以及12岁以下儿童并发症的危险因素。穿刺针尺寸对12至18岁儿童的并发症发生率无影响。37例（4.5%）报告取材的肾组织不足；发现18号穿刺针的OR（OR为5.08，95%CI为1.07 - 24.21，p = 0.041）。
与18号穿刺针相比，使用16号穿刺针可降低取材不足的风险。在12岁以下儿童中，18G穿刺针比16G穿刺针具有安全性优势。16G穿刺针与18G穿刺针一样安全，应用于12岁以上儿童的原发性肾活检。
