Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees.

BACKGROUND: Recently there has been a progressive loss of specialty related skills for nephrologists. Among the skills we find the kidney biopsy that has a central role in diagnosis of renal parenchymal disease. One of the causes might be the belief that the kidney biopsy should be performed only in larger Centers which can rely on the presence of a renal pathologist and on nephrologists with a large experience. This trend may increase in the short term procedural safety but may limit the chance of in training nephrologists to become confident with the technique. METHODS: We evaluated renal biopsies performed from May 2002 to October 2016 in our Hospital, a mid-sized facility to determine whether the occurrence of complications would be comparable to those reported in literature and whether the increase in the number of biopsy performing physicians including nephrology fellows which took place since January 2012, after our Nephrology Unit became academic, would be associated to an increase of complications or a reduction of diagnostic power of renal biopsies. Three hundred thirty seven biopsies were evaluated. Patients underwent ultrasound guided percutaneous renal biopsy using a 14 G core needle loaded on a biopsy gun. Observation lasted for 24 h, we evaluated hemoglobin levels 6 and 24 h and kidney ultrasound 24 h after the biopsy. RESULTS: Complications occurred in 18.7% of patients, of these only 1,2% were major complications. Complications were more common in female (28%) compared to male patients (14,8%) (p = 0.004). We found no correlation between diagnosis, kidney function and complication rates; hypertension was not associated to a higher risk in complications. The increase of biopsy performing personnel was not associated to an increase in complication rates (18,7% both pre and post 2012) or with an increase of major complications (1.2% vs 1,2%). CONCLUSIONS: Kidney biopsy can be safely performed in mid-sized hospitals. Safety and adequacy are guaranteed even if the procedure is performed by a larger number of less experienced nephrologists as long as under tutor supervision, thus kidney biopsy should become an integral part of a nephrology fellow training allowing more widespread diffusion of this technique.

Inadequate Macronutrient and Micronutrient Intakes in Hemodialysis and Peritoneal Dialysis Patients: Data from a Seven-Day Weighed Dietary Record.

BACKGROUND/AIMS: It is very important to assess the nutritional intake in patients on dialysis given the high prevalence of poor nutritional status of those in this population. The aim of this study was to assess nutrient intakes in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: A clinical cross-sectional study was conducted over 7 days on 14 dialysis patients (98 days) who were trained to keep a weighed food record and a 7-day food diary. Nutrient intake adequacy was compared with specific guidelines for Italians and dialysis patients. RESULTS: The mean daily protein intake (0.92 ± 0.36 g/kg) and energy intake (EI; 25.3 ± 7.4 kcal/kg) were inadequate according to the European best practice guidelines (EBPG). The ratio of EI to resting energy expenditure was 1.22. Inadequate intakes, compared to the EBPG, were found for calcium (525 ± 162 mg/day) and iron (8.7 ± 2.1 mg/day). Dietary fiber (14.7 ± 8.7 g/day), niacin (14.4 ± 5.2 mg/day), thiamine (0.8 ± 0.3 mg/day) and riboflavin (1.1 ± 0.4 mg/day) were also inadequate according to the Italian recommended dietary allowances (LARN). HD patients did not display different nutrient intakes between the dialysis days and the interdialytic period. Overall, the percentage of days during which nutrient recommendations were not satisfied ranged from 16 to 100% depending on the nutrient. CONCLUSION: Macronutrient and micronutrient intakes in HD and PD patients are largely inadequate compared to the EBPG. The weighed dietary record appears to be a useful and accurate tool for individual assessment of food intake in motivated patients. No nutrient intake differences were found between dialytic and interdialytic days in patients on HD.