Back
Renal biopsy is an invasive procedure that is necessary for the diagnosis of intrinsic renal diseases, providing crucial information about the prognosis and activity of the renal disease. Formerly, this procedure was exclusive to nephrologists, but currently it is also performed by interventional radiologists, which has somewhat shifted the role of the nephrologist. Obtaining an adequate sample is crucial in determining the diagnosis and possible treatment that the patient will receive, as well as anticipating potential associated complications, including pain, hematuria, hematoma, among others. According to current studies, the safety of the procedure has been demonstrated when following a strict protocol.
All renal biopsies performed from January to September 2023 were analyzed corresponding to two level III hospitals in Lima, Peru. In the first hospital, renal biopsies were performed exclusively by interventional radiologists without the involvement of nephrologists, while in the second hospital, they were performed by nephrologists (real-time ultrasound guidance or marking point). Pre-biopsy laboratory variables, post-biopsy hemoglobin control, quality of the sample based on the number of glomeruli reported in the anatomopathological analysis, and post-renal biopsy events and/or complications were compared as safety variables of the procedure.
A total of 58 renal biopsies were reported during this period (21 renal biopsies performed by interventional radiologists and 37 by nephrologists). The efficacy of the procedure was evaluated by the quality of the sample. The mean number of glomeruli in the first group was 22.57, and in the second group, it was 17.95, with no significant difference found between the two groups (p = 0.343). No relationship was found between the number of reported glomeruli and any variables such as age, urea, creatinine, pre-procedure hemoglobin, longitudinal diameter, and kidney parenchyma, except for the anteroposterior diameter of the kidney (p = 0.03). In terms of safety, a significant difference was found for the presence of post-procedure pain (p < 0.01) and renal hematoma (p = 0.048) in the group of renal biopsies performed by interventional radiologists. There was also no significant difference in the variation of pre- and post-procedure hemoglobin levels in both groups.
The importance of a diagnostic and prognostic procedure for renal pathology, such as renal biopsy, demands parameters of efficacy and safety. Therefore, this study demonstrated the comparative efficacy of renal biopsies performed by nephrologists compared to other specialists, with a lower average of mild and moderate complications that affect patient safety. Considering that the nephrologist is the one who has the initial contact with the patient and provides follow-up for the underlying condition throughout the treatment, which often spans many years, it is important not to lose procedural skills for the benefit of our patients. Nephrologist-performed biopsies are equally effective and often safer than those performed by other specialists.