NON BREATH HOLD ULTRASOUND GUIDED RENAL BIOPSY : REVIEW OF TECHNIQUE, CLINICAL AND HISTOPATHOLOGICAL OUTCOME
Dr Ferdinand Chu1, Dr Gary Chan2, Dr Kelvin Choi2, Associate Professor Desmond Yap3, Assistant Professor Alexander Tang3
1St. Vincent’s Public Hospital, Darlinghurst, Australia, 2Queen Mary Hospital, Pokfulam, Hong Kong, 3University of Hong Kong, Pokfulam, Hong Kong
Purpose: We reviewed all ultrasound (US) guided renal biopsies performed in Queen Mary Hospital, Hong Kong over a 30 months’s period for complication and specimen adequacy rate.
Method: We retrospectively review ALL biopsies of native (N = 231) and graft kidneys (N = 70) for medical indications in between 1st Jan 2020 and 30th Jun 2022. The renal biopsies were performed under local anaesthetics by a small team of interventional radiologists using ultrasound guided non breathhold technique. We recorded the patients’ age, gender, haemoglobin, platelet, Creatinine levels, International Normalized Ratio (INR), before renal biopsy, and presence of major/minor bleeding complication, adequacy of tissue for histopathological diagnosis and outcome.
Results: In our cohort of Native kidney biopsy 2.2% and 1.2% developed a small haematoma and large haematoma respectively. The latter is of Common Terminology Criteria for Adverse Events (CTCAE v4) Grade 3, requiring angiographic embolization. All patients with a major bleed had increased creatinine, low haemoglobin and platelet levels compared to laboratory reference. Our specimen adequacy rate is 98.7%. Thrombotic Microangiopathy (TMA) has been identified as a major risk factor for major complication.
In our cohort of Graft kidney biopsy. None developed bleeding complication. Our specimen adequacy rate is 100%.
Conclusion: Our technique has been shown to be safe with good diagnostic yield, despite the presence of known risk factors (low haemoglobin, low platelet and high creatinine) in some of the patients. Patients who had all 3 risk factors have an increased risk of major bleeding complications. We have shown a strong association between major bleeding complication and the diagnosis of thrombotic microangiopathy (TMA).
Biography:
Ferdinand Chu was awarded MBBS(Sydney) in 1986, FRCR in 1994 and completion of Specialist training in UK in 1995. He spent most of his career in Queen Mary Hospital, Hong Kong. He was the head of Interventional Radiology Team from 2009 to 2022 when he retired in Hong Kong. He is now a part time Senior Staff Specialist in St. Vincent’s Hospital, Darlinghurst, NSW.
His main interest in interventional radiology includes haemodialysis access intervention, liver tumour ablation and Uterine fibroid embolization. He has multiple first author articles and chapters in two renal text books.