Factors associated with complications and adequacy of percutaneous kidney biopsy.

ABSTRACT

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.