PERCUTANEOUS RENAL BIOPSY - COMPARISON OF MANUAL AND AUTOMATED PUNCTURE TECHNIQUES WITH NATIVE AND TRANSPLANTED KIDNEYS

The diagnostic usefulness of the biopsy cylinder and biopsy-induced co mplications were investigated for 458 percutaneous renal biopsies (315 native, 143 transplant kidneys) on 339 patients (average age, 44.6 +/ - 18.5 years) under two different biopsy regimes (regime I, manual bio psy technique with Tru-Cut needle, 14 gauge; regime II, automated biop sy technique using a Biopty instrument and adapted biopsy needle, 18 g auge). In 435 (95%) of the biopsies, kidney tissue with 9.09 +/- 5.28 glomeruli was obtained (regime I, 93.5%, 9.5 +/- 4.9 glomeruli; regime II, 96.5%, 8.7 +/- 5.6 glomeruli; P > 0.05). Neither with native nor with transplant kidneys was there any evident advantage for a particul ar regime in terms of the diagnostic usefulness of the cylinder. Bleed ing complications (perirenal haematomas, bleeding into the renal pelvi s, blood clots in the urinary bladder) were observed in 69 (15.1%) pat ients (regime I, 15.6%; regime II, 14.6%; P > 0.05). Clinically releva nt bleeding complications were significantly rarer under regime II (9. 1% versus 3.5%; P < 0.05). Complications were less frequent with trans plant than with native kidneys (12.6% versus 16.2%). Doppler sonograph y of the biopsied transplant kidneys revealed arteriovenous fistulae i n nine cases (6.3%; regime I, 8.0%; regime II, 5.4%). In general, use of an automated biopsy instrument and a thinner biopsy needle reduced the number of significant complications following percutaneous renal b iopsy, while achieving comparably diagnostic efficacy.