A KHAN1, B NANKIVELL1, A KHAN2, J CHAPMAN1
1Renal Medicine Department Westmead Hospital , Westmead , Australia, 2Storr Liver Center, Westmead Institute of Medical Research, University of Sydney, Westmead , Australia
Background/Aims: Real time ultrasound guided percutaneous kidney biopsy (PCKB) is considered a standard procedure worldwide, for the pathological diagnosis of native and transplant kidneys. Monitoring the adequacy of sample and post biopsy complications is important as quality indicators. We thus monitor safety and adequacy of the real time ultrasound guided biopsy technique to correlate with the level of experience of the operator.
Method: A total of 449 (398 transplant and 51 native) elective day case biopsies performed at Westmead Hospital Sydney over one year were retrospectively reviewed to determine the overall complication and adequacy rates.
Results: A total of 355 biopsies (group 1) were performed by a consultant by either ultrasound guidance or assistance and 94 biopsies (group 2) were performed by supervised trainees using ultrasound guidance. The overall tissue specimen adequacy was 97.1 %, however, it differed significantly, between group 1 (97.7% adequacy) and 2 (94.7% adequacy, p< 0.03). The overall biopsy complications rate was 3.3%, with a statistically significant difference between group 1 (1.1%) and group 2 (11.7%, p<0.001). Overall, post biopsy transient haematuria was detected in 3.1% patients (p<0.001), 1.6% cases had a diagnosed haematoma, 1.6% cases had gross haematuria and 0.4% patient developed an AV fistula. A total of 97.6% patients were discharged after 4 hours observation and 2.4% required admission.
Conclusion: Complication rates following PCKB are low and are reduced when performed by experienced nephrologists. It remains important to provide rigorious education and supervision programs to train nephrologists to perform safe and effective native and transplant renal biopsies.
Dr Asrar Khan is a consultant Nephrologist specialised in all aspects of nephrology including haemodialysis, peritoneal dialysis and renal transplantation.
Dr Khan has worked as Fellow in Renal and Transplant Medicine at Westmead Public Hospital and as a Staff Consultant Nephrologist at Mildura Base Hospital. He is a Consultant Nephrologist at Mildura, Wollongong and Nowra Private Hospital. Dr Khan has been actively involved in teaching of both under and post graduate medical students throughout his career. He worked as a Senior Lecturer at Monash University and now as a Senior Clinical Lecturer at School of Medicine University of Wollongong.