Cranial versus Caudal Direction Technique of Native Percutaneous Kidney Biopsy: A Randomized Controlled Trial

Abstract

Background

Percutaneous kidney biopsy (PKB) is the gold standard for diagnosing various kidney diseases, but it can result in potential complications. This study aimed to compare kidney tissue adequacy and safety between the two biopsy techniques, including cranial direction (CN) and caudal direction (CD), of needle biopsy under real-time ultrasonogram guidance.

Methods

This single-center, prospective, single-blinded, randomized trial included patients undergoing native PKB from July 5, 2017, to June 30, 2019. Patients were randomized to the CN and CD groups. Adequacy and complications between the two groups were analyzed. All PKBs were performed under real-time ultrasonogram guidance with a 16-gauge kidney biopsy needle.

Results

A total of 107 participants were enrolled (53 in the CD group and 54 in the CN group). The CD group has more glomeruli than the CN group but with no statistical significance (16 versus 11, p = 0.0865). The CD group obtained more adequate kidney tissue samples than the CN group (69.8% versus 59.3%, p = 0.348). The number of inadequate glomeruli tissue sampling is similar in both groups (14 versus 15, respectively). Furthermore, the CN group had more adverse events, including Hb decline ≥10% after kidney biopsy, perinephric hematoma size ≥1 cm, hematuria, and the need for blood transfusion, than the CD group.

Conclusion

The CD technique of the percutaneous kidney biopsy in the native kidney has fewer complications and was possibly more effective than the CN technique.

Keywords:

• kidney biopsy
• needle trajectory
• post-biopsy complication

Data Availibiity

Data are available on request to the corresponding author due to privacy/ethical restrictions.

Ethical Consideration

This study was approved by the institutional review board of Navamindradhiraj University (COA 70/2560) and was registered with the Thailand Clinical Trial Registry (TCTR20170706001: https://www.thaiclinicaltrials.org/show/TCTR20170706001). This study compiles with the Declaration of Helsinki.

Acknowledgment

The authors thank all nurses, nephrologist and pathologist staff in the Department of Medicine and Department of pathology, Faculty of Medicine, Navamindradhiraj University and Vajira Hospital.

Disclosure

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Navamindradhiraj University Research Fund.