Performing an Ultrasound-Guided Percutaneous Needle Kidney Biopsy: An Up-To-Date Procedural Review
Antonio Granata,
Giulio Distefano,
Francesco Pesce,
Yuri Battaglia,
Paola Suavo Bulzis,
Massimo Venturini,
Stefano Palmucci,
Vito Cantisani,
Antonio Basile,
Loreto Gesualdo
Affiliations
Antonio Granata
Nephrology and Dialysis Unit, “Cannizzaro” Hospital, 95126 Catania, Italy
Giulio Distefano
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy
Francesco Pesce
Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy
Yuri Battaglia
Division of Nephrology and Dialysis, St. Anna University Hospital, 44121 Ferrara, Italy
Paola Suavo Bulzis
Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy
Massimo Venturini
Department of Diagnostic and Interventional Radiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy
Stefano Palmucci
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy
Vito Cantisani
Department of Radiology, Policlinico Umberto I, Sapienza Rome University, 00161 Rome, Italy
Antonio Basile
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”, University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy
Loreto Gesualdo
Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70121 Bari, Italy
Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.
