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From the Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, the Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, the Department of Mathematics, Louisiana State University-Shreveport, the Edward Via College of Osteopathic Medicine, Columbia, South Carolina, and the W.J.B. Dorn VA Medical Center, University of South Carolina, Columbia. B.A., J.H.B., and D.E.P. are former fellows of the Department of Medicine (Division of Nephrology), University of Mississippi Medical Center, Jackson. B.A. is currently affiliated with Midwest Nephrology Associates, Midwest City, Oklahoma; J.H.B. is currently affiliated with Ferguson Medical Group, Sikeston, Missouri; and D.E.P. is currently affiliated with Renal Associates of Northeast Louisiana, Monroe.
Published: August 2014
AI Article Synopsis
Article Abstract
Objectives: The safety and efficacy of percutaneous renal biopsy (PKB) are relatively little studied in a training setting. We sought to review our recent experience with bedside PKB in our training program.
Methods: We performed a retrospective cohort review of our consecutive 2.5-year renal biopsy experience (May 2007-November 2009) at the University of Mississippi Nephrology Fellowship. All of the biopsies were performed exclusively by renal fellows using real-time ultrasound (US) visualization within the framework of a structured US-PKB training course.
Results: A total of 64 patients underwent PKB during the index period; 50 (78.1%) of these procedures were performed on native kidneys. Participant age was 39.8 ± 13.7 years, blood pressures measured 140.1/85.3 ± 21.5/14.9 mm Hg, serum creatinine was 3.05 ± 3.15 mg/dL, and median random urine protein:creatinine ratio was 2.38 (25%-75% interquartile range 0.49-7.32). The biopsied kidneys measured 11.8 (±1.6) cm. We recovered 18.8 ± 11.5 glomeruli per procedure; two biopsies were unsuccessful. Focal glomerular sclerosis and lupus nephritis (22% and 25%, respectively) predominated among the specimens. Only three specimens returned with no diagnostic changes. There was a close correlation between preceding history and recovered diagnoses of diabetic changes and lupus nephritis (r 0.605 and 0.842; P < 0.0001 for both). Initial hemoglobin of 10.8 ± 1.8 g/dL dropped to 10.2 (1.9) g/dL after the procedure (P < 0.0001). Five (7.8%) patients needed transfusion; one patient experienced persistent urine leakage; however, none of the patients needed surgical or radiological intervention or died.
Conclusions: In the setting of a well-structured training environment, US-guided PKB is a reasonably safe and valuable component of renal fellowship training.
