Background: Percutaneous renal biopsy is performed for diagnosis and prediction of prognosis of renal diseases. Adequacy of tissue and clinically significant bleeding are the main issues of the procedure. We aimed to compare these issues in renal biopsy by blind and real time ultrasound guided technique.Methods: It was a cross sectional, randomized study conducted between June 2016 to December 2016. In blind technique, marking for biopsy was done by ultrasound. Two attempts were performed for all and more if tissue was inadequate. Patients kept in bed rest for 24 hours, observed for post procedure hematuria and ultrasound done at 6 hours and 24 hours to diagnose perinephric hematoma.Results: Total 75 biopsies (blind = 37 and Ultrasound -guided = 38) were evaluated. Blind and Ultrasound-guided technique had significant difference of number of attempt (mean±SD) 2.4±0.6 and 2.1±0.3 (p<0.01) respectively with no difference of number of glomeruli in light microscopy. Bleeding complications were macroscopic hematuria (11(30%)vs15(40%)) and perinephric hematoma ( 5(13.5%)vs3(7.9%)) in blind and Ultrasound-guided technique respectively with no significant difference. Those patients who developed perinephric hematoma was observed in all at 6 hours.Conclusions: Ultrasound-guided technique of percutaneous renal biopsy is superior with fewer attempts and equivalent in adequacy of tissue and bleeding complication than blind technique.

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Percutaneous Renal Biopsy: Comparison of Blind and Real-time Ultrasound Guided Technique.

/pdf/kidney-biopsy-guidebook-2020-in-japan-4z2gp0udsq.pdf

Kidney biopsy guidebook 2020 in Japan

A Systematic Review of Complications Associated With Percutaneous Native Kidney Biopsies in Adults in Low- and Middle-Income Countries

Background and Aims: Glomerular disease is the one of the major cause of end stage kidney disease in Nepal We have undertaken this study to know the spectrum of glomerular disease in native kidneys in patients attending department of nephrology of Nepal Medical College Teaching Hospital Methods: This is a retrospective analysis of patients who have undergone native kidney biopsy from July 2013 to June 2014 Seventy five cases were included We reviewed the biopsy requisition and where available admission forms for symptoms, indications and complications of the biopsy, urine analysis report and final biopsy report Kidney biopsy was done under USG guidance or assistance Automated biopsy gun of 16 or 18G was used Kidney tissues were sent for light microscopy and immune fluorescence examinations After 24 hrs of biopsy, USG-KUB and urine RME were repeated for complications Results: Majority of our study population (62%) was from age group of 13 to 30 years Sixty five percent of the patients (n= 49) were admitted with a diagnosis of nephrotic syndrome Most frequent histopathological finding was Minimal Change Disease (267%) followed by LN (213%), Membranous Nephropathy (186%), Focal Segmental Glomerulosclerosis (134%) and IgA nephropathy (93%) Patients with the histopathological diagnosis of LN and IgAN presented with hematuria in 812% and 714% respectively MCD patients presented with proteinuria only Total no of glomeruli in the sample was 2341±1155 Conclusion: Nephrotic syndrome was the most common indication for the renal biopsy MCD was the most common histological finding in our series and Lupus nephritis is not uncommon in our series Journal of Advances in Internal Medicine Vol5(2) 2016: 24-28

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Spectrum of glomerular diseases in native kidneys in patients attending Nepal Medical College Teaching Hospital

Background and Aims: Kidney biopsy is decisive while evaluating for the diagnosis of glomerular, vascular, tubulointerstitial and genetic diseases. There is paucity of data on prevalence and pattern of various types of kidney diseases in Nepalese population. We describe various types of kidney diseases in patient population undergoing kidney biopsy at our centre. 
Methods: This is a prospective analysis of all patients, who underwent percutaneous renal biopsy at Manipal teaching hospital, over a duration of 30 months, i.e. August 2017 to January 2019. All kinds of kidney disease patients were included for kidney biopsy, irrespective of their clinical syndromes and underlying diagnosis. 
Results: A total of 175 consecutive biopsies were analyzed. The mean age of the patient was 35 } 15 years. Majority of the biopsy performed were in females. The majority of biopsy cases were age between 21-30 years of age. The youngest case to undergo renal biopsy was a child with asymptomatic isolated hematuria. The most frequent histological pattern observed in our study was IgA nephropathy (34.6%), followed by Focal segmental glomerulosclerosis (15.45%) and Membranous nephropathy (14.85%). Regarding complication macroscopic hematuria was seen in 15 (8.5%) cases and 8 (4.5%) cases had perinephric hematoma. There was no death related to renal biopsy. 
Conclusion: IgA nephropathy was the commonest histological pattern. Subnephrotic proteinuria was the commonest indication for biopsy. Complication of kidney biopsy is rare and considered safe procedure in clinical practice to determine diagnosis, prognosis and treatment.  

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Pattern of glomerular diseases in biopsy proven native kidney in Western Nepal

A prospective study was carried out from 2009 to 2013 in the Department of Radiology and Imaging of Nepal Medical College and Teaching Hospital, Attarkhel, Jorpati, Kathmandu, Nepal, in which a total of 75 patients underwent percutaneous renal biopsy with a 16 or 18 gauge needles. This was done blindly by marking a site on the skin, or, whenever there was difficulty with the blind procedure, by direct real time USG guidance. In all cases, the marking in the skin was done by the radiologist and the biopsy was performed by the Nephrologist, with the aid of the radiologist in cases of real-time USG guided renal biopsy. This study was carried out to assess the safety and efficacy of the USG aided, and USG guided renal biopsy, to see for the types and severity of complications arising from renal biopsies to determine the optimal period of observation required after the procedure. All renal biopsies were performed after the patients were admitted to the hospital at least 1 day prior to the procedure. Coagulation profile was done in all patients prior to the procedure. All patients were kept under strict complete bed rest for 24 hours post procedure. The ages of the patients ranged between 14 years to 71 years, with 42 female and 33 male patients. A mean of 21.8 glomeruli was obtained in each specimen, with absent glomerular yield seen in only 3 patients. Minimal change disease was seen in 19 patients, being the most common histopathological diagnosis followed by a spectrum of others. The overall complication rate was 4% and all of these were self-limiting needing no other intervention, or management except for observation and bed rest. Late complications were not seen. Percutaneous renal biopsy with the help of USG is a safe and efficacious procedure with less chance of minor complications.

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A Rijal

Papers

USG assisted and USG guided percutaneous renal biopsy at Nepal Medical College Teaching Hospital: a three and half years study.