Percutaneous Kidney Biopsy of Native Kidneys in Adults: A Single-Center, 40-Year Experience

Background: Percutaneous renal biopsy (PRB) of native kidneys is an essential tool in the diagnosis and management of renal disease. We report one of the largest single center experiences on the success and safety of the procedure. Methods: From 6/1983 to 12/2022, 1384 adults underwent PRB using real-time ultrasound guidance using predominantly automated 14- (n 839) or 16- (n 312) gauge needles. An attending nephrologist or a fellow (85% of biopsies) under the supervision of an attending nephrologist performed all biopsies. Following the procedure, patients were observed for 24 hours. A complication was defined by the need for an intervention, such as a transfusion of blood products or invasive radiologic or surgical procedure, or those resulting in the need for readmission or death. Data was collected prospectively in 1153 (83%) biopsies. Statistical analysis was performed using the Mann-Whitney test and Wilcoxon matched pairs test for continuous data or the Fisher’s exact test for categorical data. Data are reported as mean ± standard deviation (SD) and a p-value of < 0.05 was considered significant. Results: Pts were 46±17 yo, 38% were male, 38% white and 43% AA. The serum creatinine (SCr) was 2.3±2.4 with 47% >1.5 mg/dl. The pre-PRB hemoglobin (Hgb) was 11.7±2.2 and the post-PRB Hgb was 10.7±2.1 g/dl (delta 0.97 g/dl, P <0.0001). Adequate tissue for diagnosis was obtained in 99% of biopsies. The total glomeruli (light + immunofluorescence microscopy) per biopsy was 30±14 with 77% having >20 glomeruli. Significantly more glomeruli were obtained using the 14 vs 16-gauge automated needle (32±14 vs 27±11, P <0.0001) with 81 vs 74% having >20 glomeruli (P 0.01). Complications occurred in 7.0% of biopsies with transfusions required in 5.6% of biopsies. There was 1 (0.09%) death from post-PRB bleeding. There was no difference in complication rate (7.0 vs 8.0%, P 0.6) or transfusion requirement (5.6 vs 5.8%, P 0.9) for PRB with a 14- vs 16- gauge needle. Complications post-PRB were identified in <8 hrs in 73%, <12 hrs in 84% and <24 hrs in 90% of pts with 10% of complications occurring >24 hrs post-PRB. Conclusion: PRB of native kidneys using real-time ultrasound with an automated needle remains a successful and safe procedure. We find that the use of a 14-gauge automated needle not only provides a larger biopsy sample but is as safe as a 16-gauge automated needle.