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Needle Guide Efficacy and Safety in Pediatric Renal Biopsies

Taylor, Veronica
http://orcid.org/0000-0001-7418-2984
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563527742490046

Abstract Details

2019, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Percutaneous renal biopsy is an essential tool in the diagnosis and management of renal disease, however, there are variations in the techniques employed. A needle guide is a device which aids in needle tracking during ultrasound-guided biopsies. It is unclear what impact the needle guide has on procedure duration, complication rate, and tissue sample adequacy in a pediatric population. Methods: We conducted a retrospective review of all renal biopsy procedures performed at our institution from January 2016-November 2018. All biopsies were performed by a trainee and a nephrology attending trained in the specified technique. Biopsies occurring concurrently with other invasive procedures were excluded. Procedure duration, tissue sample adequacy, and complication rate were compared between biopsies performed with and without the use of a needle guide. Major complications were defined as those which resulted in the need for a blood transfusion or an invasive procedure, the development of serious infection, prolonged hospitalization, readmission, or patient death. Minor complications were defined as perinephric hematoma, parenchymal bleeding, site infection, or macroscopic hematuria or pain requiring additional imaging. Results: Of 160 renal biopsy procedures, 54 were performed with and 106 without the use of a needle guide. Minor complications were observed in 85 (53.1 %) biopsies. On post-biopsy Doppler ultrasound, 81 (50.6%) patients had perinephric hematoma (64% of which were <1cm), 25 (15.6%) had parenchymal bleeding that resolved, and 3 (1.9%) had an arteriovenous fistula that did not require intervention. 15 (9.4%) patients had gross hematuria or pain requiring surveillance ultrasound. Biopsies performed with a needle guide had a lower rate of minor complications (39% vs 60%, p=0.01). Two biopsies performed without a guide had complications resulting in a hospital stay >24h, one of which required an invasive procedure. Relative risk of developing a complication without a needle guide was 1.55 (p =0.02, CI 1.07-2.24). The mean number of passes to acquire adequate tissue was significantly less with the needle guide than without (2.2 vs. 2.6, p=0.01), although there was no difference in adequacy between the two groups. On multivariate logistic regression, kidney transplant biopsy (vs. native) and those performed with a needle guide were significantly associated with fewer complications. On multivariate linear regression, transplant kidney biopsy, needle guide, and age were associated with reduced procedure time. The mean procedure duration was 11.2 mins shorter when performed with a guide when controlling for covariates (p<0.01). Conclusion: Renal biopsy needle guide use is safe, decreases procedure time, and provides adequate sampling with fewer passes in pediatric patients. It is an attractive tool particularly in centers with trainees who wish to improve efficacy and decrease complications.
Patrick Ryan, Ph.D. (Committee Chair)
Marepalli Rao, Ph.D. (Committee Member)
21 p.
Surgery
pediatric; kidney biopsy; complication; outcomes

Recommended Citations

Citations

  • Taylor, V. (2019). Needle Guide Efficacy and Safety in Pediatric Renal Biopsies [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563527742490046

    APA Style (7th edition)

  • Taylor, Veronica. Needle Guide Efficacy and Safety in Pediatric Renal Biopsies. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563527742490046.

    MLA Style (8th edition)

  • Taylor, Veronica. "Needle Guide Efficacy and Safety in Pediatric Renal Biopsies." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1563527742490046

    Chicago Manual of Style (17th edition)

ucin1563527742490046
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This open access ETD is published by University of Cincinnati and OhioLINK.