SAFETY OF ULTRASOUND-GUIDED PERCUTANEOUS RENAL BIOPSY - RETROSPECTIVEANALYSIS OF 1090 CONSECUTIVE CASES

Background. Ultrasound-guided renal biopsy with an automated spring-lo aded biopsy device has become the standard method for kidney biopsy. I nformation on the success rate and safety of the routine use of this p rocedure from large series is not available. Such information is of in terest for cost benefit considerations and for medicolegal purposes. W e performed an audit of this procedure. Subjects and methods. From Jan uary 1993 to June 1997, 1090 percutaneous renal biopsies were performe d in the renal units of Heidelberg (n = 557) and Karlsruhe (n = 533) u sing a spring-loaded biopsy device (Biopty(R); Radiplast AB, Uppsala, Sweden). After intensive local disinfection, biopsies were performed u nder local anaesthesia and direct visualization by ultrasound (Sonolay er SSH-140 A, Toshiba Inc., Japan). A puncturing adaptor was used (mod el UAGV 009 A, Toshiba, Japan). Of the 1090 biopsies 114 (10.4%) were performed on renal allografts and 976 (89.6%) on orthotopic kidneys. B iopsies were performed only if patients were strictly normotensive (<1 40/90 mmHg) and had normal coagulation parameters (PT, PTT, factor VII I, thrombocyte count, and bleeding time). All patients had been advise d not to take aspirin or non-steroidal antiinflammatory agents for at least 5 days prior biopsy. We analysed (1) yield of diagnostically use ful material, and (2) frequency of postbiopsy complications (e.g. macr ohaematuria, haematoma, infections, and AV fistula). Results. Except f or one case requiring interventional radiology because of persisting b lood loss and three cases requiring blood transfusions, no serious com plications were seen in the 1090 consecutive renal biopsies, e.g. deat h, loss of kidney, life-threatening haemorrhage, or persisting haemody nymically relevant AV fistulae. The frequency of minor haematoma with an extension >2x2 cm, but no significant decrease of haemoglobin, was 2.2% (25/1090). Self-limited mild macrohaematuria occurred in 0.8% (9/ 1090). The incidence of small, haemodynamically irrelevant AV fistulae detected by Doppler ultrasound was 9% (48/533). Sufficient tissue for reliable histopathological diagnosis was obtained in almost all cases (1077/1090 = 98.8%). The median number of glomeruli per biopsy sample was 9 (range 1-37). Conclusion. If contraindications, especially high blood pressure and abnormal haemostasis, are respected, ultrasound-gu ided percutaneous renal biopsy with an automated biopsy device is safe . Skilled operators obtain satisfactory amounts of kidney tissue in al most all cases.