Menoufia Medical Journal

ORIGINAL ARTICLE
Year
: 2014  |  Volume : 27  |  Issue : 2  |  Page : 423--425

Ultrasound-guided renal biopsy in various renal disorders


Abbas Elanani, Tarek A Ella, Basma Dessouky, Mohamed El-Zawawi 
 Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menufia, Egypt

Correspondence Address:
Abbas Elanani
MB, BCh, Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menufia
Egypt

Abstract

Objectives This study aims to illustrate indications, contraindications, techniques, and complications of ultrasound-guided renal biopsy and its role in the diagnosis of various renal disorders. Background Percutaneous ultrasound-guided renal biopsy is the gold standard in the evaluation of renal diseases. Recent advances in technique have improved the safety of the procedure. Material and methods This prospective study was conducted between October 2010 and October 2012 on 30 consecutive patients with various indications for ultrasound-guided renal biopsy. Results There were 24 patients with diffuse renal pathology and six patients with focal renal pathology; 15 patients used free-handed biopsy and 15 patients used automated gun biopsy, and complications of the renal biopsy was observed in 10 patients with hematuria (33.3%), whereas 20 patients showed no complications (66.7%). Conclusion Our results support that the use of automated gun loaded with Tru-cut needles under ultrasound guidance is a safe and an efficient method for performing renal biopsies in patients. The use of smaller (18 G) needles would reduce the complication rate while allowing the retrieval of sufficient tissue for histological diagnosis.



How to cite this article:
Elanani A, Ella TA, Dessouky B, El-Zawawi M. Ultrasound-guided renal biopsy in various renal disorders.Menoufia Med J 2014;27:423-425


How to cite this URL:
Elanani A, Ella TA, Dessouky B, El-Zawawi M. Ultrasound-guided renal biopsy in various renal disorders. Menoufia Med J [serial online] 2014 [cited 2020 Apr 7 ];27:423-425
Available from: http://www.mmj.eg.net/text.asp?2014/27/2/423/141720


Full Text

 Introduction



Renal biopsies play a pivotal role in determining the diagnosis in patients with impaired renal function and other renal diseases. The outcome of histological diagnosis after percutaneous renal biopsy can be utilized not only in making a diagnosis, but also in planning treatment of the specific illness [1].

Despite the fact that percutaneous biopsy can be now considered as a procedure with almost no catastrophic complications if it is performed with standard techniques, it is always associated with minor complications that the attending physician must be aware of. There is obviously a transient damage to the collecting system and to the structures surrounding the kidney. This generates bleeding, creating symptoms such as hematuria and a decrease in hemoglobin level [2].

In this study, we evaluated the real-time sonographic guidance in conjunction with an automated 16-18-Ggauge core biopsy system as a safe and accurate method to perform percutaneous renal biopsy and whether it can be safely performed as an outpatient procedure.

 Materials and methods



This prospective study was conducted between October 2010 and October 2012 on 30 consecutive patients; their ages ranged from 3 to 63 years. They were referred from the Internal Medicine, Pediatric Departments to the Radiodiagnosis Department, Menoufia University hospital, with various indications for renal ultrasound and ultrasound-guided renal biopsy. We used 14-, 16-, and 18-G biopsy needles; 15 patients used free-handed biopsy and 15 patients used automated gun biopsy. The free-handed biopsy needle was inserted under ultrasound guidance into the abdominal wall but not pierced into the renal capsule. Thereafter, the patient was asked to hold breath after deep inspiration. The needle was then advanced until the tip was seen within the outer cortex. The automated biopsy gun loaded with the biopsy needle was introduced using an adaptor attached to the ultrasound probe and advanced under real-time ultrasonographic vision to the lower pole, where the preloaded automated biopsy gun was discharged for the true cut.

Macrohematuria and blood pressure were measured intensively for the first 2 h, and follow-up hemoglobin was measured both 10 and 24 h postbiopsy. The postprocedure ultrasound was performed, immediately after the procedure, after 6 h of biopsy before discharge, after 24 h, and after 2 weeks. Each of the assessed ultrasonographic gray-scale and color Doppler features of the kidney and ultrasound-guided renal biopsy were analyzed with the final diagnoses obtained from renal biopsy results, and the sensitivities of the different results were calculated.

 Results



Of the 30 patients included in the current study, there were 18 male patients (60%) and 12 female patients (40%); their age ranged from 3 to 63 years. These data are demonstrated in [Table 1].{Table 1}

Regarding the biopsy results, six (20%) patients had focal renal pathologies and 24 (80%) had diffuse renal pathologies. The focal renal pathologies were renal cell carcinoma in three (10%) patients, lymphoma in three (10%), and metanephric adenoma in one (3.3%). The diffuse pathologies were membranoproliferative GN in six (20%) patients, focal segmental GN in four (13.3%), mesangial proliferative GN in two (6.7%), lupus GN in four (13.3%), glomerulosclerosis in four (13.3%), multiple myeloma in two (6.7%), and renal amyloidosis in two (6.7%). These data are demonstrated in [Table 2].{Table 2}

Diffuse renal pathology was represented by normal ultrasound features in 10 patients. Regarding the focal renal pathology, it was represented in six patients (unilateral renal mass was seen in five patients, 83.3%). On applying color Doppler mapping on the examined six focal renal pathologies, two cases showed peripheral vascularity representing 33.3% of the examined focal renal masses, whereas no intralesional flow was detected. Combined peripheral and intralesional flow was present in one case representing 16.7% of the examined cases.

The complications of the renal biopsy were 10 patients with hematuria (33.3%), and 20 patients showed no complications (66.7%). With respect to the types of biopsy technique and its relationship with the rate of complications, we used free-handed biopsy in 15 cases with six complicated cases (40%), and we used automated gun biopsy in 15 cases with four complicated cases (26.7%).

Regarding the size of the needle used, we used 14-, 16-, and 18-G needles. The rate of complications related to the size of the needle were: using 18 G in 14 cases with two complicated cases (14.3%), using 16 G in eight cases with three complicated cases (37.5%), and using 14 G in eight cases with five complicated cases (62.5%).

 Discussion



Percutaneous renal biopsy plays a fundamental role in clinical practice, providing important information for diagnosis and prognosis of renal diseases. Similar to every invasive procedure, renal biopsy is liable to potential complications; with the introduction of automated biopsy guns and real-time ultrasound guidance, the risk for complications has been markedly reduced [3].

In this study, we found that the biopsy results in diffuse renal pathology were: four cases of focal segmental GN (13.3%), six cases of membranoproliferative GN (16.7%), four cases of lupus GN (13.3%), two cases of mesangial proliferative GN (6.7%), four cases of chronic sclerosing glomerulosclerosis (3.3%), two cases of multiple myeloma (6.7%), and two cases of renal amyloidosis (6.7%). This agreed with the results of Balakrishnan et al. [4], who stated that higher results were 10% membranoproliferative GN and 16.5% focal segmental GN followed by 6.9% lupus GN and 1% renal amyloidosis [4].

In focal renal pathology, there were three cases of renal cell carcinoma (50%), two cases of lymphoma (33.3%), and one case of metanephric adenoma (16.7%); this agreed with the study by Johnson et al. [5] who stated that renal cell carcinoma was present in 18 of 44 cases (40.9%) followed by lymphoma in four of 44 cases (9.9%).

Of six cases with focal renal pathology, five cases were malignant (83.3%) and one case was benign (16.7%); this agreed with the study by Park et al. [6] who stated that 77% (37/48) were malignant and 23% (11/48) were benign and with the study by Maturen et al. [7] who stated that, of 152 biopsies, 60% showed malignant neoplasm and 61% (40%) yielded benign findings.

In this study, we found six cases of focal renal pathology; on gray-scale ultrasound, five cases were solid (83.3%) and one case was mixed (16.7%). The five solid cases were malignant and one mixed case was benign, which agreed with the study by Johnson et al. [5], who stated that 100% of cases were solid.

In this study, the use of the gun with an ultrasound machine was associated with a higher success rate. We used automated gun in 15 cases with four (26.7%) complicated cases and free-handed biopsy in 15 cases with six complicated cases (40%), and this agreed with the study by Chan et al. [8], who stated that the rate of complication is high with free-handed biopsy and low with automated gun, and disagreed with the study by Chishti et al. [9], who stated that there is no difference in the complication rate between a manual needle and an automatic needle of the same gauge.

In this study, we found that the overall complications rate is 33.3% of 30 cases, with 100% minor complication, which disagreed with the study by Preda et al. [10], who found an overall complication rate of 12.2% in 515 ultrasound-guided renal biopsies, and with the study by Burstein et al. [11], who reported overall complications in 14.3% of patients who underwent ultrasound-guided renal biopsies. Of these, 6.6% were minor complications and 7.7% were major complications for which patients required blood transfusion[10],[11].

In this study, in all patients (100%), sufficient material was obtained for histopathology, which agreed with the study by Chishti et al. [9] who stated that, in all patients (100%), sufficient material was obtained for histopathology.

 Conclusion



Real-time sonographic guidance in conjunction with an automated 16-G core biopsy system is a safe and an accurate method in hands of trained and experienced personnel to perform percutaneous renal biopsy and can be safely performed as an outpatient procedure.

 Acknowledgements



Conflicts of interest

There are no conflicts of interest.

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