Ultrasound-guided renal biopsy
Biopsia renal ecodirigida
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"apellidos" => "Peláez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699510050758" "doi" => "10.3265/Nefrologia.pre2010.Jul.10507" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699510050758?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410050755?idApp=UINPBA000064" "url" => "/20132514/0000003000000005/v0_201502091651/X2013251410050755/v0_201502091651/en/main.assets" ] "en" => array:10 [ "idiomaDefecto" => true "titulo" => "Ultrasound-guided renal biopsy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "492" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M. Rivera Gorrin" "autores" => array:1 [ 0 => array:4 [ "Iniciales" => "M." "apellidos" => "Rivera Gorrin" "email" => array:1 [ 0 => "mriverag.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Biopsia renal ecodirigida" ] ] "textoCompleto" => "<p class="elsevierStylePara"> </p><p class="elsevierStylePara">Renal biopsy is an invasive diagnostic technique essential for the treatment of nephrology patients. Through the histological analysis of the renal tissue an etiological diagnosis can be performed, a prognosis can be issued and the therapy of the majority of parenchymal nephropathies can be oriented, both for native kidneys as well as kidney transplants. This latter group also in­cludes protocol biopsies, above all in clinical trials, which merit a separate discussion.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">BACKGROUND </span></p><p class="elsevierStylePara">This technique was introduced in 1951 by the Danes Iversen and Brun<span class="elsevierStyleSup">1 </span>through a modification of hepatic puncture-aspiration, technique described by these authors. Guided by pyelography, they performed biopsies on patients in a seated position, obtaining appropriate material in 40% of the cases. Kark et al., introduced changes in 1954. For one, they used a modified Vim-Silverman needle and they also placed the patient in prone position with a pillow under the abdomen. With this, the renal biopsy yield rose to 96%.<span class="elsevierStyleSup">2 </span>From that time on, although its indications are practically the same, renal biopsy has changed considerably in its technical aspects.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">PRACTICAL CONSIDERATIONS </span></p><p class="elsevierStylePara">Three types of biopsy can be discerned: percutaneous renal biopsy, open biopsy and transvascular biopsy.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Percutaneous renal biopsy </span></p><p class="elsevierStylePara">This is currently the technique of choice. After local anaesthesia, the needle is introduced through the lumbar muscles. As a first option, the left kidney is biopsied (more comfortable for the right-handed operator and far from vital organs) in its lower pole (more accessible). This is the most widespread technique, and requires less personnel, above all in real-time ultrasound-guided modality (only a physician and a nurse).</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Open renal biopsy </span></p><p class="elsevierStylePara">This procedure involves surgery under general anaesthesia. It consists of the extraction of a wedge of renal tissue. Indicated for uncooperative patients (e.g. small children) and patients with greater risk of haemorrhage (direct haemostasis can be performed). It requires more personnel (surgeon, anesthesiologist, nurse, etc.) and availability of an operating theatre. It is almost obsolete, as it does not really reduce the complications. On the other hand, ultrasound-guided percutaneous biopsy under sedation has become the general practice for children.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Transvascular biopsy </span></p><p class="elsevierStylePara">By cannulating a central vein, the renal vein is reached and a small sample of kidney tissue is extracted. This requires certain infrastructure (x-ray room and fluoroscope). It has the disadvantage of venous cannulation and the use of contrast medium. It is indicated in severe coagulation alterations, as it does not perforate the renal capsule, reducing the risk of haemorrhage. Few centres use this technique.<span class="elsevierStyleSup">3 </span></p><p class="elsevierStylePara">Other methods such as the transurethral biopsy or laparoscopy are even more unusual.<span class="elsevierStyleSup">4,5 </span></p><p class="elsevierStylePara">The most commonly used puncture devices are needles based on the classic Tru-Cut, automatic or semi-automatic, with a 14 G or 18 G calibre. The advantages of automatic biopsy needles over manual ones: the needle remains less time in the kidney, it is autonomous given that just one person is needed to perform the whole biopsy and there is less risk of tearing the kidney tissue. According to our experience and to other authors, the diagnostic yield of both devices is similar, although the risk of complications is less with the automatic needle.<span class="elsevierStyleSup">6-8 </span>As far as calibre is concerned, we prefer 14 G as it achieves sufficient amount of renal tissue in more than 90% of the biopsies, with just one puncture needed in 80% of them.<span class="elsevierStyleSup">9 </span></p><p class="elsevierStylePara">A diagnostic biopsy is considered to be one with sufficient biopsy sample. The number of glomeruli needed varies from one for diffuse nephropathies to 25 for some focal nephropathies. On average, a sufficient biopsy is one that has between 8 and 10 glomeruli; some of them should come from the juxtamedullary region.<span class="elsevierStyleSup">10 </span></p><p class="elsevierStylePara">With regard to patient preparation, it is essential to discard the presence of a solitary kidney, polycystic kidney disease, hydronephrosis and small or malformed kidneys. A pre-biopsy renal ultrasound should be performed for this reason. We should check that the blood pressure is controlled and that the coagulation parameters are normal. Although this is debated in medical bibliography,<span class="elsevierStyleSup">11 </span>we also request the bleeding time test to detect the surreptitious intake of anti-platelet agents (quite common in herbs stores, for example). In the event of it being high, arginine-vasopressin is prescribed to correct this before the biopsy. Likewise, it is essential that the informed consent is signed.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">ULTRASOUND-GUIDED RENAL BIOPSY </span></p><p class="elsevierStylePara">Until a few years ago, renal puncture was performed blindly, with the subsequent high rate of blank samples and complications.<span class="elsevierStyleSup">12 </span>With the appearance of imaging techniques (ultrasound and computerised tomography), the drawbacks of blind renal biopsy have been mostly eliminated. Real-time ultrasound-guided renal biopsy is currently a consolidated technique. It has obvious advantages with regards to tomography. Besides not posing a risk of radiation for the patient, it offers better availability, making it possible to perform «bedside” biopsy. It is far more economical and does not need the use of contrast media. As it allows for continuous visualisation of the needle’s position in the renal parenchyma, as well as its placement in the required renal area, the professional who handles it is not taking any risk. The biopsy time is also shortened, from approximately 30 minutes in the case of tomography to 10-15 with the ultrasound.</p><p class="elsevierStylePara">Real-time ultrasound-guided biopsy requires experience in handling US, since the selection, locating the puncture point and viewing the needle tip can sometimes be quite difficult (obese, senile or uncooperative patients, small or cystic kidney). At present, with the incorporation of ultrasounds to renal biopsy, obtaining sufficient diagnostic material is over 90% in most series.<span class="elsevierStyleSup">13-15 </span>Diagnostic yield depends on the professional’s skill in handling the needle and placing it as superficially as possible to take a sample exactly from the cortex.<span class="elsevierStyleSup">14-18 </span>The incidence of biopsy complications has been reduced from approximately 10% with a blind technique to 2-6% with an ultrasound-guided<span class="elsevierStyleSup">.19-21</span></p><p class="elsevierStylePara">The usual post procedure hospital monitoring period is 24 hours. With the new technology (automatic needles and ultrasound monitoring), renal biopsy has become a low risk procedure, so some authors recommend it as an outpatient procedure with only 6-8 hours of hospital bed rest after the biospsy.<span class="elsevierStyleSup">22,23 </span>A recent study shows that this practice is not recommendable, given that 33% of prematurely discharged biopsy patients suffer complications.<span class="elsevierStyleSup">20 </span></p><p class="elsevierStylePara">An article by Dr. Toledo et al.<span class="elsevierStyleSup">24 </span>reviews their experience with 867 native kidney renal biopsies over 18 years. They performed a retrospective study of 797 biopsies with a 0.75% rate of major complications and a prospective analysis over one year of 70 renal biopsies where they recorded major complications (1.4%) as well as minor complications (2%). Since post biopsy ultrasounds were performed only on patients with clinical results, some minor complications such as asymptomatic haematoma (< 2cm in diameter) or obstruction of the transitory route with clots were not included in this series.<span class="elsevierStyleSup">9,20 </span>All the major complications appeared in patients with substrate favourable to bleeding. The procedure’s yield was good. This paper is of great interest as it deals with a broad series of ultrasound-guided biopsies performed by nephrologists and due to the low rate of complications that compares favourably with publications in major international journals, above all if the fact that half the patients had kidney failure, a known risk factor for bleeding, is taken into account.<span class="elsevierStyleSup">25-27 </span></p><p class="elsevierStylePara">We are pleased that Spanish nephrologists are including ultrasounds in their daily tasks more and more, a practice that our department has advocated for a number of years.<span class="elsevierStyleSup">28, 29 </span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">KEY CONCEPTS</span><span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">1.    </span>Renal biopsy is an essential diagnostic technique in handling the nephrological patient. <span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">2.    </span>Real-time ultrasound-guided renal biopsy with automatic needle has decreased the complication rate. <span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">3.    </span>With the inclusion of ultrasound to nephrology, the nephrologist has recovered his main role in performing renal biopsy. <span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">4.    </span>After the biopsy, a systematic ultrasound should be performed to avoid infradiagnosis of complications. <span class="elsevierStyleBold"> </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">5.    </span>The bed rest period after biopsy should be 24 hours.</p><ul> </ul>" "pdfFichero" => "P1-E503-S2274-A10537-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Iversen P, Brun C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 9 | 27 |
| 2024 October | 156 | 36 | 192 |
| 2024 September | 174 | 43 | 217 |
| 2024 August | 128 | 64 | 192 |
| 2024 July | 181 | 32 | 213 |
| 2024 June | 148 | 40 | 188 |
| 2024 May | 186 | 60 | 246 |
| 2024 April | 137 | 38 | 175 |
| 2024 March | 115 | 27 | 142 |
| 2024 February | 101 | 38 | 139 |
| 2024 January | 124 | 31 | 155 |
| 2023 December | 100 | 39 | 139 |
| 2023 November | 155 | 40 | 195 |
| 2023 October | 165 | 49 | 214 |
| 2023 September | 191 | 47 | 238 |
| 2023 August | 185 | 39 | 224 |
| 2023 July | 204 | 32 | 236 |
| 2023 June | 212 | 47 | 259 |
| 2023 May | 177 | 53 | 230 |
| 2023 April | 148 | 22 | 170 |
| 2023 March | 172 | 25 | 197 |
| 2023 February | 221 | 26 | 247 |
| 2023 January | 209 | 46 | 255 |
| 2022 December | 171 | 39 | 210 |
| 2022 November | 182 | 38 | 220 |
| 2022 October | 267 | 53 | 320 |
| 2022 September | 247 | 38 | 285 |
| 2022 August | 250 | 53 | 303 |
| 2022 July | 239 | 68 | 307 |
| 2022 June | 270 | 46 | 316 |
| 2022 May | 248 | 34 | 282 |
| 2022 April | 241 | 51 | 292 |
| 2022 March | 243 | 70 | 313 |
| 2022 February | 228 | 56 | 284 |
| 2022 January | 234 | 41 | 275 |
| 2021 December | 250 | 54 | 304 |
| 2021 November | 230 | 38 | 268 |
| 2021 October | 333 | 57 | 390 |
| 2021 September | 205 | 50 | 255 |
| 2021 August | 228 | 59 | 287 |
| 2021 July | 220 | 30 | 250 |
| 2021 June | 176 | 30 | 206 |
| 2021 May | 179 | 54 | 233 |
| 2021 April | 494 | 121 | 615 |
| 2021 March | 365 | 83 | 448 |
| 2021 February | 292 | 34 | 326 |
| 2021 January | 204 | 30 | 234 |
| 2020 December | 187 | 27 | 214 |
| 2020 November | 149 | 24 | 173 |
| 2020 October | 132 | 21 | 153 |
| 2020 September | 138 | 12 | 150 |
| 2020 August | 147 | 41 | 188 |
| 2020 July | 170 | 27 | 197 |
| 2020 June | 146 | 27 | 173 |
| 2020 May | 163 | 35 | 198 |
| 2020 April | 143 | 23 | 166 |
| 2020 March | 196 | 29 | 225 |
| 2020 February | 197 | 43 | 240 |
| 2020 January | 228 | 27 | 255 |
| 2019 December | 203 | 46 | 249 |
| 2019 November | 248 | 33 | 281 |
| 2019 October | 232 | 27 | 259 |
| 2019 September | 226 | 42 | 268 |
| 2019 August | 192 | 30 | 222 |
| 2019 July | 208 | 32 | 240 |
| 2019 June | 159 | 35 | 194 |
| 2019 May | 186 | 38 | 224 |
| 2019 April | 241 | 46 | 287 |
| 2019 March | 196 | 33 | 229 |
| 2019 February | 115 | 21 | 136 |
| 2019 January | 118 | 25 | 143 |
| 2018 December | 168 | 34 | 202 |
| 2018 November | 202 | 15 | 217 |
| 2018 October | 175 | 18 | 193 |
| 2018 September | 143 | 10 | 153 |
| 2018 August | 142 | 15 | 157 |
| 2018 July | 82 | 11 | 93 |
| 2018 June | 84 | 12 | 96 |
| 2018 May | 105 | 13 | 118 |
| 2018 April | 105 | 11 | 116 |
| 2018 March | 102 | 8 | 110 |
| 2018 February | 65 | 5 | 70 |
| 2018 January | 81 | 10 | 91 |
| 2017 December | 76 | 8 | 84 |
| 2017 November | 56 | 8 | 64 |
| 2017 October | 75 | 7 | 82 |
| 2017 September | 57 | 11 | 68 |
| 2017 August | 83 | 12 | 95 |
| 2017 July | 87 | 8 | 95 |
| 2017 June | 54 | 3 | 57 |
| 2017 May | 75 | 7 | 82 |
| 2017 April | 59 | 8 | 67 |
| 2017 March | 70 | 3 | 73 |
| 2017 February | 56 | 25 | 81 |
| 2017 January | 31 | 23 | 54 |
| 2016 December | 89 | 8 | 97 |
| 2016 November | 103 | 13 | 116 |
| 2016 October | 117 | 24 | 141 |
| 2016 September | 164 | 12 | 176 |
| 2016 August | 256 | 10 | 266 |
| 2016 July | 213 | 15 | 228 |
| 2016 June | 157 | 0 | 157 |
| 2016 May | 150 | 0 | 150 |
| 2016 April | 113 | 0 | 113 |
| 2016 March | 99 | 0 | 99 |
| 2016 February | 113 | 0 | 113 |
| 2016 January | 133 | 0 | 133 |
| 2015 December | 144 | 0 | 144 |
| 2015 November | 106 | 0 | 106 |
| 2015 October | 90 | 0 | 90 |
| 2015 September | 86 | 0 | 86 |
| 2015 August | 93 | 0 | 93 |
| 2015 July | 84 | 0 | 84 |
| 2015 June | 40 | 0 | 40 |
| 2015 May | 60 | 0 | 60 |
| 2015 April | 13 | 0 | 13 |
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