Factors associated with complications and adequacy of percutaneous kidney biopsy.

Objective: Percutaneous kidney biopsy (PKB) is an essential procedure in practical nephrology. However, it may cause serious complications, especially in high-risk patients. To determine the factors associated with the complications and the adequacy of PKB under ultrasonic guidance. Methods: Patients were stratified according to serum creatinine (SCr) and randomized for needle types (spring-loaded automatic gun and Tru-cut needle), diameters (16G vs 18G) and the effect of compression at biopsy site. The patients were observed for major (bleeding requiring a blood transfusion or intervention) and minor (not requiring intervention) complications. Results:The patients with serum creatinine (SCr) < 4.0 mg/dl (n=133) had significantly lower complications than those with SCr  4.0 mg/dl (n=35), both major (2 [1.5%] vs. 5 [14.3%]) and minor (6 [4.5%] vs. 3 [8.5%]). All complications occurred within 48 hours (93.8% within 24 hours). In group A, no significant difference in complications was found in needle types, axes, diameters and compression at the biopsy site, including numbers of puncture (< 6 times), length of tissue, kidney size and echogenicity. All samples except two were adequate for diagnosis, with an average of 13 glomeruli. There was no significant difference in tissue adequacy ( 10 glomeruli) in needle types and diameters, but the failure rate and number of puncture were higher with the Tru-cut needle (p < 0.01). Conclusion: The needle type and size or compression at the puncture site do not affect the complication after PKB under ultrasonic guidance, whereas a SCr 4.0 mg/dl is an important factor of the complications but there is no effect on the adequacy of the renal tissues.

Active lupus and pregnancy: How to handle.

We report herein the case of a 20-year-old Thai woman who developed lupus flare in the second trimester of pregnancy, as manifested by autoimmune hemolytic anemia, thrombocytopenia and glomerulonephritis. The patient underwent treatment with intravenous dexamethasone and, subsequently, pulse methylprednisolone to control plausible lupus exacerbation in the central nervous system. The disease subsided after an inevitable development of spontaneous abortion. We reviewed the current status of knowledge on interactions between pregnancy and systemic lupus erythematosus, proper management, and safety immunosuppressive drugs to ensure a more favorable outcome. This will be helpful for physicians to provide sound advice regarding pregnancy for lupus patients in their reproductive years.