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Percutaneous renal biopsy (PRB) was first introduced in 1951 and has been an irreplaceable tool in nephrology practice ever since. Currently, ultrasound-guided PRB has revolutionized the clinical practice of nephrology since it is an essential tool for the diagnosis, treatment and prognosis of several diseases, which is why it is essential that Nephrology centers teach this skill to their residents in training. The objective is to present the experience of one year of performing PRB in the Nephrology department of the 21st Century National Medical Center
Cross-sectional study that describes the demographic variables of the patients who underwent PRB in the period from September 16, 2022 to September 18, 2023. The quantitative variables are described according to their distribution and the qualitative variables as frequencies.
In the service, a total of 94 PRB were performed, two of them were performed in the right kidney. All patients with creatinine greater than 1.5 mg/dl received desmopressin at a dose of 0.3 g/kg (40%). 54% of the patients were women, with a median age of 39 (27-57) years and index body mass of 26.7±4.6 kg2/m2. The average renal dimensions of the punctured kidneys were 10.3±1.1 x 4.5±1.3 x 4.3±1.2 cms. The indications for PRB were nephrotic syndrome (40%), lupus nephropathy (27%), nonspecific urinary disorders (20%), vasculitis (7%), acute kidney injury of undetermined cause (5%), and rapidly progressive glomerulonephritis. (1%). Median creatinine was 1.6 mg/dl (IQR 0.6-8.2), median estimated glomerular filtration rate was 68.8±43.3 ml/min/m2SC, urea 57.9 mg/dl (IQR 19-215), hemoglobin 12.3 ±2.5 g/dl, platelets 263,000 (IQR 137,000-274,000), albumin 2.7±0.8 g/dl. Of the 42 patients with creatinine greater than 1.5 mg/dl, 37% required 4 punctures to guarantee sufficient sample, likewise requiring 3 or more punctures was correlated when the resident began the training (r=0.7). The average number of glomeruli obtained was 18±2 for electron microscopy and 5±2 for immunofluorescence. 86% did not present complications, 12% presented a hematoma of less than 5 ml (average of 0.25±0.8 ml), one patient developed a low-grade fistula and another active bleeding that required management in the hemodynamics unit.
PRB is a safe procedure with a low complication rate (even when performed by residents in training) and should be a routine part of nephrology clinical practice. The main indication for biopsy, as in most centers, is nephrotic syndrome, the main indication for BRP.