Angiographic visualization for percutaneous renal biopsy

Fifteen patients underwent visualization of the kidney for percutaneous biopsy by selective renal angiography. Biopsies were performed in 11 patients, and adequate renal tissue was obtained in all instances. Postbiopsy angiogram revealed pinpoint bleeding in ten patients and significant extravasation in one case, which was controlled with a selective epinephrine infusion. In four cases, biopsy was not performed when the cortex was found to be less than 5 mm thick.     

Percutaneous renal biopsy

Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is essential in the diagnosis of glomerular, vascular, and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. The use of real-time ultrasound and automated biopsy needles has simplified and improved the success and safety of this procedure. In the recent past, we have seen a shift of the PRB from nephrologists to radiologists and this has raised appropriate concern that loss of this procedure may undermine the nephrologist's status as a subspecialist. We must continue to properly train young nephrologists in the proper technique and value of performing renal biopsy procedures or we stand to lose control of a procedure that was an integral part of the development of our subspecialty.     

Day care renal biopsy

Over the 6 years 1989–1994, 384 percutaneous renal biopsies were performed, 329 on native and 55 on transplanted kidneys. Biopsy was undertaken on a day care basis in 304 instances (79.2%). Failure to obtain 5 or more glomeruli was experienced in 23 (6.0%) of the 304 day care biopsies. There were no significant differences in technical failure rates between day care patients and inpatients, local analgesia and general anaesthetic, or native and transplanted kidneys, but a higher rate was observed in biopsies performed unaided by trainees than by experienced operators (P = 0.002). Six patients were detained overnight for minor complications and a seventh for unrelated reasons. Two patients discharged on the day of biopsy despite gross haematuria were readmitted 8–10 days later with secondary haemorrhage. The complication rate of 2.6% compares favourably with published data. Few paediatric renal units currently perform day care renal biopsy, and we recommend its wider acceptance. Received August 4, 1995; received in revised form November 6, 1995; accepted November 17, 1995     

Laparoscopic retroperitoneal renal biopsy

Histologic information can be pivotal in making treatment decisions. Ultrasound-guided percutaneous biopsy is the current standard, but if this procedure fails or is considered to be high risk, laparoscopic biopsy may be appropriate. A CT or ultrasound scan is obtained to determine whether there is any condition that would mandate biopsy of a particular kidney. The retroperitoneal space is entered with a visual obturator, and, after CO2 insufflation to 15 to 20 mm Hg, the space is enlarged initially by blunt dissection with the laparoscope. Two-tooth biopsy forceps are used to obtain tissue, and hemostasis is achieved with the argon beam coagulator with care to vent the increased pressure created by the flow of gas. Postoperatively, specific attention is given to blood pressure control. Hemorrhage is the most common serious complication, so any anticoagulation regimen must be reinstituted cautiously.     

Percutaneous renal biopsy using Biopty biopsy instrument and Biopty biopsy needle

We assessed the clinical usefulness of Biopty biopsy instrument & Biopty biopsy needle in percutaneous renal biopsy (PRB) compared with Tru-cut disposable needle and Vim-Silvermann needle. Sixty cases, each consisting 20 cases, were performed PRB by 3 different needles. There was no significant differences between Biopt y-cut needle and Tru-cut needle in the length of renal biopsy tissue and number of glomeruli obtained. The frequency of clinical complications such as fever, flank pain and decrease in Ht greater than 2% was lower in Biopty needle group after PRB. The frequency of middle and large size of hematoma was also lower in Biopty needle group after PRB. We could also obtain specimen from transplanted kidney without complications except small hematoma. From three results, Biopty biopsy needle is a useful tool in performing PRB.     

Renal mass biopsy for the small renal mass

Opponents of premanagement biopsy of small renal masses are not difficult to find. Many urologists contend that the benefits of biopsy do not outweigh the risks, arguing that the results do not influence management substantially and that the most useful information from renal mass biopsy can be attained with advanced imaging. In this article, we develop the counter arguments and demonstrate that renal mass biopsy should be implemented into the small renal mass management algorithm.     

Efficacy of epidural anesthesia for retroperitoneoscopic renal biopsy

Laparoscopic procedures are performed using general anesthesia due to the perceived limitations of regional anesthesia in the upper abdomen and retroperitoneum. We present our initial experience with epidural anesthesia for retroperitoneal laparoscopic renal biopsy.     

肾活检新技术装置

目的探讨一种操作简便、成功率高、并发症少的肾活检技术。方法应用自动同步负压肾穿装置及专用穿刺针进行肾活检。结果肾活检２００例，成功率９９５％，２例出现肉眼血尿。结论自动同步负压肾穿装置具有简便易行、成功率高、并发症少等优点。