New concept of renal biopsy procedure: ultrasound GuIded renal biopsy at Flexible and Unconventional approach (GIFU)

 

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New concept of renal biopsy procedure: ultrasound GuIded renal biopsy at Flexible and Unconventional approach (GIFU)

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Yoshinari
Yasuda
Yoshinari Yasuda yasuda.yoshinari.c3@f.gifu-u.ac.jp Gifu University Graduate School of Medicine Nephrology Gifu Japan *
Gakuro Yoshida gakuro_yoshida@yahoo.co.jp Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Nanami Toyoda nanami160068@gmail.com Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Tomoki Watanabe watanabe.tomoki.h3@f.gifu-u.ac.jp Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Momoka Kawai k.peach0000@gmail.com Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Shingo Hashimoto parakeet1128@yahoo.co.jp Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Sou Nishiyama s.nishiyama12@gmail.com Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Sae Tateyama saekoda8181@gmail.com Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Junko Naito jnaito0627@gmail.com Gifu University Graduate School of Medicine Nephrology Gifu Japan -
Hiroyuki Okura hokura@fides.dti.ne.jp Gifu University Graduate School of Medicine Cardiology Gifu Japan -
 
 
 
 
 

Renal biopsy is a fundamental examination in the field of nephrology, for diagnosis, choice of treatment and prognosis prediction. Since renal biopsy is invasive procedure, safety precaution is essential. Generally, the kidney is explored along its longitudinal axis under ultrasound guidance, and the lower pole of the kidney is punctured by using automated biopsy needle (conventional method). In Gifu University, renal biopsy has been conducted at flexible upper surface approach with short axis ultrasound guidance (GIFU method). Safety and effectiveness of our new concept of renal biopsy was analyzed with the previous conventional renal biopsies.

Study subjects were consecutive 125 patients, who were examined renal biopsy at Gifu University from January 2011 to December 2012. Eighteen patients were excluded from the study due to either too small sample size or unavailable ultrasound images. Proportion of renal cortex out of whole renal biopsy specimen and numbers of obtained glomeruli were analyzed between 48 patients with conventional method and 59 patients with GIFU method. Complications after renal biopsy were compared in both methods. In addition, theoretical merits and demerits were compared between GIFU method and conventional method. 

Proportion of renal cortex out of whole renal biopsy specimen were significantly greater in GIFU method group compared to conventional method group, 90 [IQR: 70-100] vs 80 [68-90] (%), p=0.008. Numbers of glomeruli were also significantly more in GIFU method group compared to conventional method group, 22 [IQR: 17-27.5] vs 17 [IQR: 11.5-23.5], p=0.002. Although 2 cases of large hematoma were complicated in GIFU method group, no serious complication was observed in both groups. Merits and demerits in both methods were summarized in Table. In GIFU method, insertion of puncture needle is hard due to muscle resistance, however by using sharp Japanese automated biopsy needle, ACECUT, could solve this problem.


Points of comparisonGIFU methodConventional method
Distance to the puncture siteshortlong
Angle for safe puncturewidenarrow
Hemostasis by pressureeasydifficult
Frequency of needle reboundraresometimes
Visualization of the puncture needle tipeasydifficult
Puncture approach directionflexiblerestricted
Insertion of the puncture needlehardsmooth

Clinical utility and safety of our new concept of renal biopsy, GIFU method, were shown. Further validation studies with larger sample size and in multiple hospitals were needed.

Kewords