Percutaneous renal biopsy: comparison of manual and automated puncture techniques with native and transplanted kidneys

The diagnostic usefulness of the biopsy cylinder and biopsy-inducedcomplications were investigated for 458 percutaneous renal biopsies(315 native, 143 transplant kidneys) on 339 patients (averageage, 44.6±18.5 years) under two different biopsy regimes(regime I, manual biopsy technique with Tru-Cut needle, 14 gauge;regime II, automated biopsy technique using a Biopty instrumentand adapted biopsy needle, 18 gauge). In 435 (95%) of the biopsies, kidney tissue with 9.09 ±5.28 glomeruli was obtained (regime I, 93.5%, 9.5±4.9glomeruli; regime II, 96.5%, 8.7 + 5.6 glomeruli; p>0.05).Neither with native nor with transplant kidneys was there anyevident advantage for a particular regime in terms of the diagnosticusefulness of the cylinder. Bleeding complications (perirenalhaemat-omas, bleeding into the renal pelvis, blood clots inthe urinary bladder) were observed in 69 (15.1%) patients (regimeI, 15.6%; regime II, 14.6% P>0.05). Clinically relevant bleedingcomplications were significantly rarer under regime II (9.1%versus 3.5%; P<0.05). Complications were less frequent withtransplant than with native kidneys (12.6% versus 16.2%). Dopplersonography of the biopsied transplant kidneys revealed arteriovenousfistulae in nine cases (6.3%; regime I, 8.0%; regime II, 5.4%). In general, use of an automated biopsy instrument and a thinnerbiopsy needle reduced the number of significant complicationsfollowing percutaneous renal biopsy, while achieving comparablydiagnostic efficacy.