Percutaneous Renal Biopsy Using an 18-Gauge Automated Needle Is Not Optimal

Background: As percutaneous renal biopsies (PRBs) are increasingly performed by radiologists, an increase in the use of 18-gauge automated needle stands to compromie adequacy. We compare the adequacy and safety of PRB with 14-, 16-, and 18-gauge automated needles. Methods: PRB of native (N-592) and transplant (T-1,023) kidneys was performed from January 2002 to December 2019 using real-time ultrasound. Baseline clinical and laboratory data, biopsy data (number of cores, total glomeruli, and total glomeruli per core), and outcome (hematoma on renal US at 1-h, complications, and transfusion) were collected prospectively. PRB with N14g (337) versus N16g (255) and T16g (892) versus T18g (131) needles were compared. A p value of Results: PRB with an 18-g needle yielded the lowest number of total glomeruli per biopsy (N14g vs. N16g: 33 +/- 13 vs. 29 +/- 12, p < 0.01 and T16g vs. T18g: 34 +/- 16 vs. 21 +/- 11, p < 0.0001), significantly fewer total glomeruli per core (T16g vs. T18g: 12.7 +/- 6.4 vs. 9.6 +/- 5.0, p < 0.001 and N16g vs. T18g: 14.2 +/- 6.3 vs. 9.6 +/- 5.0, p < 0.001). A hematoma by renal US 1-h post-PRB was similar for native (14g-35% vs. 16g-29%, p = 0.2), and transplant biopsies (16g-10% vs. 18g-9%, p = 0.9) and the complication rate for native (14g-8.9% vs. 16g-7.1%, p = 0.5), transplant biopsies (16g-4.6% vs. 18g-1.5%, p = 0.2) and transfusion rate for native (14g-7.7% vs. 16g-5.8%, p = 0.4), and transplant biopsies (16g-3.8% vs. 18g-0.8%, p = 0.1) were similar irrespective of needle size. Conclusions: PRB of native and transplant kidneys with the use of a 16-gauge needle provides an optimal sample. However, our experience in transplant biopsies suggests the use of an 18-gauge needle stands to jeopardize the diagnostic accura (c) 2021 S. Karger AG, Baselcy of the PRB while not improving safety.

Automated summary

The study compared the adequacy and safety of percutaneous renal biopsies using 14-, 16-, and 18-gauge needles, finding that using a 16-gauge needle provides the optimal sample while the use of an 18-gauge needle may compromise diagnostic accuracy and does not improve safety.