E BROWNE1,2, C FLETCHER1,2, L VIJEYARATNAM1,2, J SAUNDERS1,2, T YING1,2
1Royal Prince Alfred Hospital, Camperdown, Australia, 2Charles Perkins Centre, Central Clinical School, The University of Sydney, Australia
Aim: To determine the safety and diagnostic yield of ultrasound-guided percutaneous kidney biopsy in a quaternary-care hospital.
Background: Contemporary data on the safety and diagnostic yield of kidney biopsies are lacking. Inadequate sampling may cause significant patient stress and delay appropriate management.
Method: We evaluated consecutive native and transplant kidney biopsies over a 5-year period. We recorded major complications within one-week post-biopsy. We determined adequacy of sampling in a subset of native biopsies by determining whether a histopathological diagnosis was reached.
Results: Between January 2016 to April 2020, 1636 native and kidney transplant biopsies were performed by nephrology trainees. Twenty-one patients (1.3%) required a blood transfusion within 7-days. Of 1274 transplant biopsies, major complications occurred in 13 (1%) including 4 clot retentions, 2 embolisations and 7 hematomas requiring surgical intervention. Of 362 native kidney biopsies, major complications occurred in 4 (1.1%) including 1 clot retention and 3 clinically significant haematomas managed conservatively. Five biopsies were abandoned due to patient distress, gun malfunction or technical difficulties. Of 356 native biopsies with available histopathology; average number of glomeruli was 22 (SD 16). 41 (12%) of samples had <10 glomeruli, and 4 (1%) had no glomeruli. Approximately 15% of native biopsies did not reach a conclusive diagnosis due to inadequate sampling or processing issues.
Conclusion: Major complications in a high-volume centre was low, however, insufficient sampling was not infrequent. Ongoing training and auditing are required to improve patient safety and inform management.
Dr Evan Browne is a Basic Physician Prep Trainee based in Royal Prince Alfred Hospital in Sydney with an experience in renal clinical research on the judicious use of cardiovascular investigations and adverse events on antiretroviral therapy. He hopes audits like this one can value-add real meaning when discussing complex concepts with patients and might provide more insight to improve our system of care.