Bir çocuk nefroloğunun eş-zamanlı ultrasonografi eşliğinde böbrek biyopsisi deneyimi

Amaç: Böbrek biyopsisinin böbrek hastalıklarının yönetiminde oldukça önemli bir yeri vardır. Özellikle çocuklarda yapılan biyopsiler ek zorluklar gösterir. Bu çalışmanın amacı, çocuklarda uygulamış olduğumuz beş yıllık ultrasonografi eşliğinde perkutan böbrek biyopsisi (PRB) deneyimimizi değerlendirmektir. Yöntemler: Ocak 2015- Mart 2020 arasında bir üçüncü basamak hastanesinde PRB uygulanan çocukların hastane kayıtları geriye dönük olarak irdelenmiştir. Tüm biyopsiler, eş zamanlı USG altında tek bir çocuk nefroloğu tarafından otomatik biyopsi tabancası kullanılarak uygulanmıştır. Bulgular: Medyan yaşı 14,5 yaş olmak üzere; 17 erkek (%53,1) ve 15 kız çocuğuna (%46,9) 32 böbrek biyopsisi uygulandı. En sık biyopsi endikasyonu, çocukların 13/32’sinde (%40,6) nefrotik sendrom idi. Biyopsi örneklerinden alınan medyan glomerül sayısı 18 (min-max=7-54 glomerül) idi. Histopatolog tarafından tüm olgularda (%100) tanı konulabildi. Gözlenen tek komplikasyon, 16 yaşındaki bir erkek çocuğunda subkapsüler hematomla birlikte kendiliğinden düzelen gross hematüri süreci idi (%3,1). Sonuç: Çocuklarda; PRB Bir çocuk nefroloğu tarafından otomatik biyopsi tabancası kullanılarak, eş-zamanlı USG altında yapıldığında, yeterince fazla örneğin alınmasını sağlayan, etkili ve güvenli bir tekniktir. Böbrek biyopsisi, bir nefroloğun çalışma sorumluluğunda yapması gereken önemli bir uygulamadır.

Anahtar Kelimeler:

Böbrek biyopsisi, Çocuklar, Eş-zamanlı ultrasonografi, Biyopsi tabancası

A pediatric nephrologist’s experience on real-time ultrasound-guided kidney biopsy

Aim: Kidney biopsy is crucial in management of renal diseases. Biopsies in children have added difficulties. The aim of this study is to investigate our 5-year experience of real-time ultrasound (USG)-guided percutaneous renal biopsy (PRB). Methods: Institutional database of children who underwent PRB in a tertiary hospital between January 2015 and March 2020 were evaluated retrospectively. A single pediatric nephrologist performed all the biopsies using an automated spring-loaded biopsy gun under real-time USG guidance. Results: Thirty-two biopsies were performed in 17 males (53.1%) and 15 females (46.9%), and the median age of the children was 14.5 years. The most common indication for biopsy was nephrotic syndrome in 13 /32 children (40.6%). Median number of glomeruli obtained from biopsy specimens was 18 (min-max=7-54 glomeruli). A diagnosis was achieved in all cases (100%) by a histopathologist. The only complication observed in a 16-year-old boy was a self-limited gross hematuria (3.1%) episode with subcapsular hematoma. Conclusion: Real-time USG-guided PRB with an automated biopsy gun is an effective and safe technique, providing superior yield when performed by a pediatric nephrologist. Performing kidney biopsy is an essential tool in a nephrologist’s workshop.

Keywords:

kidney biopsy real-time USG guidance, biopsy gun, children, paediatric nephrologist,

PDF

___

1. Tondel C, Vikse BE, Bostad L, Svarstad E. Safety and complications of percutaneous kidney biopsies in 715 children and 8573 adults in Norway 1988-2010. Clin J Am Soc Nephrol. 2012;7:1591-7.
2. Korbet SM. Nephrology and the Percutaneous Renal Biopsy: A Procedure in Jeopardy of Being Lost Along the Way. Clin J Am Soc Nephrol. 2012;7:1545–7.
3. Poster RB, Jones DB, Spirt BA. Percutaneous Pediatric Renal Biopsy: Use of the Biopsy Gun. Radiology. 1990;176:725-7.
4. Hogan JJ, Mocanu M, Berns JS. The native kidney biopsy: Update and evidence of best practice Clin J Am Soc Nephrol. 2016;11:354-62.
5. Golay V, Roychowdhury A. The percutaneous native kidney biopsy: a nephrologist’s perspective. OA Nephrology. 2013;May 27;1:8.
6. Franke M, Kramarczyk A, Taylan C, Maintz D, Hoppe B, Koerber F. Ultrasound-Guided Percutaneous Renal Biopsy in 295 Children and Adolescents: Role of Ultrasound and Analysis of Complications. PLoS ONE. 2014;9(12): e114737. doi:10.1371/journal.pone.0114737.
7. Hussain F, Mallik M, Marks SD, Watson AR, British Association of Paediatric Nephrology. On behalf of the British Association of Paediatric Nephrology. Renal biopsies in children: current practice and audit of outcomes. Nephrol Dial Transplant. 2010;25:485–9.
8. Hussain F, Watson A, Hayes J, Evans J. Standards for renal biopsies; comparison of inpatient and day care procedures. Pediatr Nephrol. 2003;18:53-6.
9. Gupta S, Wallace MJ, Cardella JF, Kundu S, Miller DL, Rose SC. Quality improvement guidelines for percutaneous needle biopsy. J Vasc Interv Radiol. 2003; 14(Suppl):S227-S30.
10. Hama T, Nakanishi K , Shima Y, Mukaiyama H, Togawa H, Tanaka R, et al. Renal biopsy criterion in children with asymptomatic constant isolated proteinuria . Nephrol Dial Transplant. 2012;27:3186–90.
11. Gattineni J. Highlights for the Management of a Child with Proteinuria and Hematuria. International Journal of Pediatrics. 2012;768142:1-7.
12. Schwartz GJ and Work DF. Measurement and estimation of GFR in children and adolescents. J Am Soc Nephrol. 2009;4:1832-43.
13. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017;140(3):e20171904.
14. Racusen LC, Solez K, Colvin RB, Bonsib SM, Castro MC, Cavallo T, et al. The Banff 97 working classification of renal allograft pathology. Kidney International.1999;55:713-23.
15. Fogo AB. Approach to renal biopsy. AJKD. 2003;Vol 42: No4 (October).
16. Esposito V, Mazzon G, Baiardi P, Toreggiani M, Semeraro L, Catucci D et al. Safety and adequacy of percutaneous kidney biopsy performed by nephrology trainees. BMC Nephrology. 2018;19:14.
17. Lee SA, Kim MS, Kim SC, Lee DY. Clinical and Pathological Findings of Renal Biopsy in Children: Outcomes from a Single Center Over 27 Years Child Kidney Dis. 2017;21:8-14.
18. Printza N, Bosdou J, Pantzaki A, Badouraki M, Kollios K, Ghogha Ch, et al. Percutaneous ultrasound-guided renal biopsy in children: a single centre experience. HIPPOKRATIA. 2011;15;258-61.
19. Whittier WL, Gashti C, Saltzberg S, Korbet S. Comparison of native and transplant kidney biopsies: diagnostic yield and complications. Clin Kidney J. 2018;11: 616–22.
20. Pongsittisak W, Wutilertcharoenwong N, Ngamvichchukorn T, Kurathong S, Chavanisakun C, Teepprasan T, et al. The efficacy of blind versus real-time ultrasound-guided percutaneous renal biopsy in developing country. SAGE Open Medicine. 2019;7:1-7.
21. Turner MW, Hutchinson TA, Barre PE, Jothy S. A prospective study on the impact of renal biopsy in clinical management. Clin Nephrol. 1986;26:217-21.
22. Korbet SM, Gashti CN, Evans JK, Whittier WL. Risk of percutaneous renal biopsy of native kidneys in the evaluation of acute kidney injury. Clinical Kidney Journal. 2018;11;610–5.
23. Sethi I, Brier M, Dwyer A. Predicting post renal biopsy complications Semin Dial. 2013;26:633-5.
24. Korbet SM. Percutaneous renal biopsy. Semin Nephrol. 2002;22:254-67.
25. Lees JS, McQuarrie EP, Mackinnon B. Renal biopsy: it is time for pragmatism and consensus. Clinical kidney Journal. 2018;11:605-9.
26. Nicholson ML, Wheatley TJ, Doughman TM, White SA, Morgan JD, Veitch PS, et al. A prospective randomized trial of three different needle for renal transplant biopsy. Kidney Int. 2000;58:390-5.
27. Gupta A, Smith JC, Hayes W, Deal JE, Gilbert RD, Inward C, et al. Positive trends in paediatric renal biopsy service provision in the UK: a national survey and re-audit of paediatric renal biopsy practice. Pediatr Nephrol. 2016;31:613-21.