Percutaneous ultrasound-guided renal biopsy a Libyan experience

Objective: To assess the safety and efficacy of ultrasound-guided percutaneous renal biopsy (PRB), to ascertain the risk factors for complications and determine the optimal period of observation. Patients Materials and Methods: Eighty six PRBs were performed by the radiologist at The National Organ Transplant Centre, Central Hospital, Tripoli, Libya between 1st February 2006 and 31st January 2008 using an automated biopsy gun with 16 gauge needle (C Rose Bard Inc.,Murray Hill, NJ). A coagulation profile was performed on all the patients. All patients were kept on strict bed rest for 6-hours post-procedure. Results: Eighty-six renal biopsies were performed on 78 (90.7%) patients referred from the rheumatology department and 8 (9.3%) post-kidney transplant recipients. 23 (26.7%) were males with age range of 15 to 56 years and 63 (73.3%) females with an age range of 16 to 66 years. A mean of 17.5 glomeruli were present in each specimen. A glomerular yield of less than five glomeruli was seen in 4 (4.7%) biopsies. Class I lupus nephritis was seen in 1 (1.3%) patient, class II lupus nephritis in 7 (9 %) patients, class III lupus nephritis in 13 (16.7%) patients and class IV lupus nephritis in 29 (37.2%) patients. All the 8 (9.3%) renal allografts were diagnosed as either acute tubular necrosis or acute interstitial rejection. The risk of post-biopsy bleeding was higher in women, older patients and a higher APTT. The overall complication rate was 5.8%. Three complications were observed within 6 hours of biopsy. No late complication was seen. Conclusion: PRB under real-time ultrasound-guidance is a safe and efficacious procedure and can be done as outpatient procedure. An observation time of 6 hours post-biopsy is optimal. Risk of complication is higher in women, older patients and those with a higher (APTT).