Mendelssohn D C, Cole E H
Department of Medicine, Toronto Hospital, University of Toronto, Ontario.
Am J Kidney Dis. 1995 Oct;26(4):580-5. doi: 10.1016/0272-6386(95)90592-8.
A solitary native kidney is generally considered to be an absolute contraindication to percutaneous biopsy. However, technical advances, such as real-time ultrasound guidance and automated core biopsy systems, provide an excellent safety profile with an extremely low risk of catastrophic complications and have caused some investigators to call for a reassessment of this contraindication. The overall results at our institution are reported. Of 544 consecutive native and allograft kidney biopsies conducted over 2.5 years, 482 were performed with an automated core biopsy system and 281 also used real-time ultrasound guidance. The overall complication rate was 5.3%. Transient gross hematuria was seen in 4.4% and hematoma was seen in 1.5%; no patient experienced loss of kidney function and there were no deaths. We recently have begun to perform percutaneous biopsy of solitary native kidneys in carefully selected patients. To date, nine such procedures have been attempted, with success in eight cases. One patient had transient gross hematuria; no other complications were noted. This encouraging preliminary experience suggests that otherwise uncomplicated adult patients with a solitary kidney might be considered for percutaneous biopsy. It now seems appropriate to prospectively evaluate percutaneous biopsy of solitary kidneys in a larger cohort of unselected patients.
孤立性单肾通常被认为是经皮肾活检的绝对禁忌证。然而，诸如实时超声引导和自动活检枪系统等技术进步，提供了良好的安全性，灾难性并发症风险极低，这使得一些研究者呼吁重新评估这一禁忌证。本文报告了我们机构的总体结果。在2.5年期间连续进行的544例单肾及移植肾活检中，482例采用自动活检枪系统进行，其中281例还使用了实时超声引导。总体并发症发生率为5.3%。4.4%的患者出现短暂肉眼血尿，1.5%的患者出现血肿；无患者出现肾功能丧失，也无死亡病例。我们最近开始在经过精心挑选的患者中对孤立性单肾进行经皮肾活检。迄今为止，已尝试进行了9例此类手术，8例成功。1例患者出现短暂肉眼血尿；未发现其他并发症。这一令人鼓舞的初步经验表明，对于无其他复杂情况的孤立肾成年患者，可考虑进行经皮肾活检。现在似乎有必要在更大规模的未选择患者队列中对孤立肾经皮肾活检进行前瞻性评估。
