A tandem guide for renal biopsy

Percutaneous renal biopsy with direct ultrasound guidance can minimize complications of the biopsy procedure. Presently, many laboratories use ultrasound to localize the kidney, and to calculate the appropriate depth and angle for biopsy needle placement. The actual biopsy, however, is performed blindly. A modification of this technique is presented wherein a 22-gauge guide needle is directed into the kidney using direct ultrasound visualization. This needle serves as a tandem guide for the biopsy needle. The technique reduces the number of unsuccessful needle passes, and minimizes the time required for the procedure, patient discomfort, and potential morbidity.     

同轴活检针在超声导向肾脏穿刺活组织检查中的应用

目的探讨非穿刺探头引导下同轴活检针配合导向经皮肾脏穿刺活组织检查的应用价值。方法采用彩色多普勒超声诊断仪和普通探头,对45例肾脏疾病患者进行肾脏活组织检查,将同轴活检针预置于。肾包膜处,在超声实时监控下,取出针芯,插入巴德穿刺枪进行穿刺活检。结果每次进针所获得的肾组织的长度2～15mm,平均（8．39±3．41）mm。光镜下每例所得的肾小球的数目为5～47个,平均（20．02±12．46）个,超声定位下均成功取出肾组织。2例术中出现穿刺点肾包膜下小血肿,其余均无并发症发生。结论非超声穿刺探头引导下同轴活检针穿刺肾脏,是一种简单、安全、准确的诊断方法,取材成功率高,并发症少,有利于在基层医院广泛开展。     

肾活检所致出血的相关因素分析

[目的]探讨超声引导下肾活检所致出血并发症的相关因素,对出血原因进行分析,以减少并发症的发生.[方法]在超声引导下以美国Bard 16G自动活检装置对520例肾脏病患者行肾穿刺活检,从肾实质厚度、肾穿刺次数、肾穿时血压水平、肾脏病理改变几方面进行分析.[结果]在520例肾穿活检中,肾实质厚度在0.80~1.5 cm、肾...     

257例弥漫性肾病超声引导下快速自动活检情况分析

目的　分析超声引导下快速自动肾活检的临床应用价值。方法　超声引导下经皮快速自动肾穿刺活检弥漫性肾病患者 2 5 7例 ,所取组织送病理学检查。以检出肾小球作为取材成功 ,明确病理诊断为取材满意。结果　左右肾下极共进针 62 2次 ,获 3 95 2个肾小球 ,平均每例进针 2 .42次 ,取材成功率 97.2 8% ,左肾下极取材成功率略高于右肾下极 ;不同进针次数取材成功率不同 ,且随着进针次数增加 ,取材成功率亦增大 (P <0 .0 5 )。病理类型中以原发性肾小球疾病为多见。结论　超声引导下快速自动肾活检技术是一种安全、高效的微创检查方法 ,值得临床推广应用     

The diagnosis of cyclosporin nephrotoxicity in patients after kidney transplantation

The authors review possibilities of thin needle aspiration biopsy of renal allotransplants in the diagnosis of cyclosporin nephrotoxicity. 151 thin needle aspiration biopsy specimens were explored in 55 patients following kidney transplantation. According to the authors, this method when applied in the early postoperative period may turn an informative one. However, if the time elapsed after operation exceeds 3 months, they recommend performing puncture biopsy of renal transplants.     

Usefulness of cutting needle biopsy in recurrent and advanced staged head and neck malignancies in a palliative setting

Goal of work Advanced staged and recurrent head and neck malignancies require histological confirmation before planning further treatment. The purpose of this article is to focus on the clinical usefulness of cutting needle biopsies in the head and neck as a minimal invasive procedure to establish a tissue diagnosis in a palliative setting. Materials and methods A retrospective analysis on 74 core needle biopsies in 32 patients with recurrent and advanced staged head and neck malignancies was performed to determine the advantages of ultrasound-guided cutting needle biopsies compared to open biopsy and fine-needle aspiration cytology in palliative cancer treatment. Main results We experienced 100% success in obtaining high-quality histopathologic specimens. In 93.8% of the patients, a tissue core of the target organ was successfully obtained. All of the patients tolerated the procedure well without any minor or major complications. Conclusions Cutting needle biopsy in the head and neck is a safe and minimal-invasive procedure that can be performed in local anaesthesia on an outpatient basis. In a palliative setting, it can be recommended as an attractive alternative to both fine needle aspiration and open biopsy. It represents a simple and fast device for obtaining a tissue diagnosis with high diagnostic yield and accuracy and low morbidity.     

Percutaneous puncture guided by ultrasonic multitransducer scanning.

A technique for percutaneous puncture guided by real-time scanning is described. By means of a special puncture adaptor fastened to one end of a multitransducer, a needle can be guided in the plane of scanning in an adjustable angle to the transducer front. By this technique, the puncture target as well as the needle can be monitored on the real-time image during the entire puncture procedure. The technique has been used for amniocentesis, fine needle biopsy of a renal mass, renal cyst puncture, and pericardiocentesis.     

肾活检在糖尿病肾脏疾病诊断中的价值

糖尿病合并肾脏疾病的肾脏病理表现复杂,非糖尿病肾病并不少见,其与糖尿病肾脏疾病（diabetic kidney disease,DKD）的治疗与预后有较大差异,早期明确诊断意义重大。单纯依靠临床表现及生化指标来诊断肾脏病变及判断预后存在较大的局限性,而近年来研究较多的用于早期诊断的新型生物标志物应用价值尚有待研究。肾活检作为一种相对安全的操作,被推荐应用于DKD的诊断、鉴别诊断、制定治疗方案和预后评估。     

A microassay for mammalian renal 25-hydroxyvitamin D3-1-hydroxylase applicable to man

A micro determination of the renal 25-hydroxyvitamin D3-1-hydroxylase activity was developed that uses as little as 1 mg of rat kidney tissue. The method was applied to the remaining portions of needle kidney biopsy specimens taken for diagnostic purposes from children who had asymptomatic proteinuria and/or hematuria (more than 1-year duration) but were otherwise normal in calcium metabolism and renal function. The 25-hydroxyvitamin D3-1-hydroxylase levels of these children were found to be 66 1,25-dihydroxyvitamin D3 per milligram of tissue per 20 min for an 11-year-old male, 117 pg for a 9-year-old male, and 89 pg for a 10-year-old female.     

超声引导经皮肾穿刺活检方法的改进

目的 改进肾穿刺方法，以减少肾穿刺的并发症，提高标本质量。方法 将１００例有肾穿刺适应症的患者随机分成３组，均在Ｂ超经导下用穿刺枪取材。Ａ组：定位于右肾下极外侧，略偏近髓质，垂直进针；Ｂ组：定位于右肾上极外侧皮 主的部位，垂直进针；Ｃ组：定位于右肾上下极外侧，靠近肾外缘处，穿刺时针略向内倾斜，针尖对准肾皮质较厚的部位。结果 每厘米肾组织中肾小球个数Ｃ组最多，Ｂ 组次之，Ａ组最少。穿刺的成功率三组相     

TEMNO针自动活检术在小儿肾穿刺中的应用

为提高小儿肾活检的水平，本文报告了我科２４９例小儿肾穿刺活检的方法及效果的研究情况。方法２４９例中，１４８例应用了ＴＥＭＮＯ针实时超声引导下自动活检术，１０１例应用Ｔｒｕ－Ｃｕｔ针超声引导下手动活检术进行了两种方法对比分析。结果ＴＥＭＮＯ针法明显优于Ｔｒｕ－Ｃｕｔ针法。ＴＥＭＮＯ针细，穿刺较浅，实际得到的肾小球多，虽然每条组织平均为１４±７．９个肾小球，与Ｔｒｕ－Ｃｕｔ针法相比无显著性差异（Ｐ＞０．０５），但成功率高（９８．３％），满意度高（９５％），分别较Ｔｒｃ－Ｃｕｔ针法的９２％及８７％都有显著性差异（Ｐ＜０．０５），有利于做出免疫学及细胞学诊断。两组肾穿后合并症比较有极显著性差异（Ｐ＜０．００１）。结论：作者认为ＴＥＭＮＯ针自动检检术具有显著的优越性：操作简便，安全可靠，合并症少，使难度很高的小儿肾穿刺变得轻松快捷，安全准确，使初学者容易掌握，有利于推广小儿肾穿刺工作的开展，以便进一步提高小儿肾脏疾病的诊断水平。     

The role of ultrasonography in the study of medical nephropathy

Diagnostic techniques in nephrology include clinical history, physical examination, laboratory tests, scintigraphy, diagnostic imaging techniques as well as renal biopsy. In kidney diseases, ultrasonography is used as a first-line imaging technique, and its role in medical nephropathy is to exclude urological pathologies, to differentiate between acute and chronic renal failure, to follow-up on the course of a disease, to guide needle biopsy, etc. Ultrasound images are useful at characterizing the pelvis, assessing renal dimensions and parenchymal echogenicity, sampling color–power Doppler signals and evaluating their characteristics and distribution as well as measuring parenchymal resistive index. Taken together, these data can provide useful clues to the diagnosis and help to reduce the number of possible differential diagnoses.     

肾脏病理结合肾功能显像评价慢性肾病残余肾功能的临床意义

目的探讨肾脏病理结合肾功能显像综合评价慢性肾病(CKD)残余肾功能的临床意义。方法 105例临床初步诊断为慢性肾炎伴慢性肾功能不全患者,同时进行经皮肾穿刺活组织检查及99 Tcm-DTPA肾动态显像(ECT)检查,对CKD残余肾功能进行综合评价,并确定治疗方案,动态观察CKD进展情况,回顾性验证两种检查方法对CKD残余肾功能判断的可靠性。结果 105例CKD患者中,肾脏病理显示肾小球硬化及肾小管间质慢性化程度,多数情况下(92%)与ECT对于CKD残余肾功能的判断是相符的,但8%的患者二者并不相符。根据形态学及功能学检查结果,所有2～5期的CKD患者共105例进行相应的治疗,随访2～3年,共35例进入透析。结论 对于各种CKD的诊断除病因诊断外,肾组织病理形态学诊断及肾脏功能诊断两者间既不能相互替代,又密不可分。仅根据CKD肾脏组织病理形态学判断CKD残余肾功能具有局限性。结合肾功能显像进行综合评价,正确评估保护CKD残余肾功能的治疗价值,对CKD治疗方案的确定具有重要临床指导意义。     

系统性红斑狼疮合并肾炎患者肾穿刺活检术的围术期护理

目的探讨系统性红斑狼疮合并肾炎患者肾穿刺活检术的护理方法。方法回顾性分析并总结2010年9月至2011年5月,哈尔滨医科大学附属第一医院风湿免疫科收治的43例系统红斑狼疮合并肾炎患者的临床资料。结果有效的术前、术后护理可以明显缓解患者的焦虑情绪,使患者心理状态平稳,使其能够正确地配合医生的手术操作,减少术后并发症,减轻患者的不适感;43例患者手术后都恢复到术前的状态,能够进一步接受系统性红斑狼疮的专科治疗。结论加强系统性红斑狼疮合并肾炎患者肾穿刺活检术的护理,可以明显减少并发症的出现,为今后临床工作中提高肾穿刺活检术的成功率及患者的生活质量提供依据。     

Approach to the patient with renal disease

There are various ways by which a patient with renal disease can present as either an initial outpatient or an inpatient consultation. Some patients can present with incidental hematuria and/or proteinuria. Symptoms generally vary but are more commonly noted with advanced stages of chronic kidney disease. A systematic, well organized approach is of utmost necessity in arriving at the correct diagnosis. A multitude of laboratory and ancillary studies, including a percutaneous renal biopsy (performed when necessary), are available to arrive at the right diagnosis. An algorithmic approach to hematuria and proteinuria is also presented.     

Retrograde percutaneous nephrostomy

The percutaneous approach has become an accepted procedure for the removal of kidney stones in the urinary tract. Developed initially from our method of transvenous punch biopsy and transvenous cholangiography, the "inside-out" retrograde nephrostomy technique involves either cystoscopic or fluoroscopic placement of a 9 or 10 French catheter into a selected minor calix, through which a fine 21-gauge needle passes and exists the skin. The tract is then dilated over the needle. Used in over 200 cases without any complications directly attributable to the nephrostomy, the retrograde approach is safer, more reliable, and less time consuming than the previous standard antegrade approach, particularly in the nondilated pelvicalyceal system. Also presented are several new modifications to the original procedure and further technical considerations for operators.     

CT-guided paravertebral block for microwave ablation of kidney tumors: a new technique

Purpose

In patients undergoing computed tomography (CT)-guided microwave ablation (MWA) for renal tumors, we developed a CT-guided anterior paravertebral block (PVB) associated with anesthesia of the kidney capsule and inhalation of an equimolar mixture of oxygen and nitrous oxide (EMONO). The primary objectives were to describe our technique and to study its efficacy in terms of procedural success. The secondary objective was to study the tolerance by evaluating patient pain scores and the number of complications.

Methods

Patients suffering from renal carcinoma classified T1a and considered to be poor candidates for surgery were included in this prospective, single-center pilot study. They underwent MWA under CT-guided loco-regional anesthesia: an anterior variant of the PVB at the level of T10, ipsilateral to the renal MWA associated with anesthesia of the kidney capsule and EMONO. Technical success was defined as total thermal ablation without additional sedation and no side effect during the procedure. Maximal pain score during the procedure was assessed using a visual analog score.

Results

Four patients were included. All procedures were technical success. No side effects were reported, either due to the procedure or anesthesia. The maximal pain score recorded immediately after procedure was 2 ± 2.4 on the visual analog score.

Conclusions

MWA of the kidney is feasible under CT-guided anterior paravertebral block. PVB is well tolerated and can be associated with anesthesia of the kidney capsule and EMONO. This new technique may be an alternative to general anesthetic or conscious sedation in clinical practice.

     

Successful ultrasound‐guided percutaneous embolization of renal pseudoaneurysm by autologous blood clot: Preliminary report of a new method

We report the case of a 25‐year‐old female with renal arteriovenous fistula and pseudoaneurysm (PA) formation following renal core‐needle biopsy, treated successfully by ultrasound‐guided percutaneous embolization with autologous blood clot injection. After inserting a 15‐gauge needle within the PA sac, 10 ml of blood was retrieved from the sac, and then reinjected into the PA as well as in the needle tract after the obtained blood completely clotted. The procedure was completed by manual compression of the flank. Follow‐up sonographic examinations revealed no complication, and the PA size reduced gradually over time due to fibrotic shrinkage. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45 :592–596, 2017     

Percutaneous aspiration of polycystic kidneys

Summary

Massive kidneys in autosomal dominant polycystic kidney disease may leave insufficient retroperitoneal space for kidney transplantation, and also cause chronic pain from abdominal distention, due to compression of the intra-abdominal viscera or stretch of the renal capsule. A technique of ultrasound-guided, percutaneous cyst aspiration of the previously embolized kidney has proved to be a safe and effective procedure for reducing kidney volume in 10 patients, and morbidity was markedly reduced compared to nephrectomy.     

Ultrasonic real-time guidance for percutaneous puncture.

Real-time scanning was applied to the sonically guided puncture technique. A special puncture attachment connected to the ultrasound sector scanner was developed for this purpose. A puncture needle is introduced into the scanning plane through the canal in the attachment. Excellent real-time images of both the target lesion and the needle can be clearly seen on the oscilloscope during the puncture procedure. Puncture not only for cystic structures but also for solid masses can be made easily and safely by this new technique. Successful applications of the technique have been carried out for renal cyst puncture, percutaneous antegrade pyelography, percutaneous nephrostomy, percutaneous renal biopsy, and perineal prostatic biopsy.